Figure Legends
Figure 1
Angiographic evidence of a significant stenosis in the mid-RCA.
Figure 2
(a) A balloon-induced dissection in the distal part of the lesion with some luminal thrombus and an eccentric calcific plaque is evident in the cross-section. (b) In the mid-segment of the RCA the cross-section shows a calcific plaque extended to more than 2 quadrants (arrows heads). (c) Healthy coronary segment in the proximal landing zone.
Figure 3
Predilation with a 3.0 mm non-compliant balloon checked in two orthogonal angiographic views showing good expansion of the ballon.
Figure 4
3.0 x 25 mm sirolimus-eluting BRS deployment (a) optimized with a 3.5 x12 mm non-compliant balloon expanded at 18 atm (b) with a good angiographic result (c).
Figure 5
The OCT pullback after BRS implantation shows a large dissection at the distal edge (a) and well expanded BRS with fully apposed struts in the mid-segment (b).
Figure 6
Angiography shows the second BRS lost in the proximal segment (red circle indicating one of the markers of the dislodged BRS). Red arrows show the markers of the deployed BRS.
Figure 7
Angiographic still frames show the 3.5 x 26 mm DES implanted within the dislodged BRS in the proximal segment (a) and the 3.0 x 18 mm DES deployed distally to the previous BRS (b) with good final angiographic result (c).
Figure 8
Final OCT pullback. (a) The cross-section shows good apposition of the DES struts in the distal part covering the dissected segment. (b) Good expansion and apposition of the BRS struts. (c) Short BRS-DES overlap. (d) DES struts well apposed to the vessel wall proximally to the overlap zone with the BRS. (e) DES expanded inside the “lost” BRS with a good expansion of both devices. (f) Non significant malapposition of the DES struts at the proximal edge level.
Figure 9
Angiographic view of the RCA at 9-months follow-up.
Figure 10
Complete endothelialization of the distal DES struts. (b) Good MLA with evidence of an advanced reabsorption process of the BRS with black boxes still visible (white arrows) in the context of the neo-intima and well separated by the media (arrow heads). (c) The stent struts rendering function of the co-registration identifies the DES metallic struts only. (d) The cross-section highlights the BRS black boxes (arrow head) “covered” by the DES metallic struts (white arrow). (e) Acquired malapposition of the proximal DES at the proximal edge level. (f) OCT long view showing good lumen profile and MSA.