Percutaneous Coronary Intervention With Bioresorbable Scaffolds in a Young Child
Tamim M Nazif1, Sanjog Kalra2, Ziad A Ali1
1Division of Cardiology, Columbia University Medical Center, New York, New York2Cardiovascular Research Foundation, New York, New York.
Insights
This case report details the first use of a bioresorbable scaffold (BRS) in a child with severe coronary artery disease. The procedure was successful, showing potential for BRS in pediatric cardiovascular interventions.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Biomaterials Science
Background:
- Coronary artery disease (CAD) requiring revascularization is rare in children but can occur due to conditions like homozygous familial hypercholesterolemia.
- Conventional metallic stents have limitations in pediatric patients, necessitating exploration of alternative treatments.
- Bioresorbable scaffolds (BRS) offer potential advantages over metallic stents in pediatric coronary interventions.
Observation:
- A 3-year-old boy with homozygous familial hypercholesterolemia presented with unstable, multivessel coronary artery disease.
- Intravascular imaging-guided PCI was performed using BRS in the right coronary artery, left main, and left circumflex arteries.
Findings:
- The PCI procedure using BRS achieved acute procedural success.
- Postmortem histological assessment revealed patent BRS with nonobstructive neointimal hyperplasia, indicating successful scaffold integration and function.
Implications:
- This case represents the first documented use of BRS in a pediatric patient for coronary artery disease.
- Bioresorbable scaffolds show promise for the future treatment of pediatric coronary artery disease, warranting further investigation.
Importance:
Although much less frequent than in adults, coronary artery disease requiring revascularization may develop in children because of homozygous familial hypercholesterolemia or other underlying conditions. Percutaneous coronary intervention (PCI) with a bioresorbable scaffold (BRS) may have advantages over metallic coronary stents in this population.
Objective:
To present a case of the successful treatment of unstable, multivessel coronary artery disease in a child with PCI with BRS implantation. This case highlights the limitations of conventional metal stents and the potential benefits of using BRSs in children.
Design, Setting, And Participants:
This is a case report from an academic tertiary care institution of a 3-year-old boy with homozygous familial hypercholesterolemia and unstable coronary artery disease requiring revascularization. We also briefly review the related literature.
Interventions/Exposures:
Intravascular imaging-guided PCI of the proximal right coronary artery and the left main and proximal left circumflex arteries was performed with BRSs.
Main Outcomes And Measures:
The primary outcomes were acute procedural success and survival to liver transplant (3 months after PCI).
Results:
Following BRS implantation, the patient recovered and remained free of cardiovascular symptoms 3 months after PCI. He subsequently underwent an orthotopic liver transplant for definitive treatment of homozygous familial hypercholesterolemia but died of noncardiac complications. A postmortem examination, including a histological assessment, revealed both BRSs to be patent with nonobstructive neointimal hyperplasia.
Conclusions And Relevance:
To our knowledge, this is the first report of PCI with BRSs in a child. This represents an application of a BRS with potentially important implications for the future treatment of coronary artery disease in children and warrants further study.
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