Absorb in ISR


The following 2 cases were presented in Asia PCR(SingLive) on 23rd January 2015 by Dr. Tan Chong Hiok

Bio-Absorbable stent

  • Stents have been used to keep narrowed or blocked arteries opened for the last 20 years
  • They have always been made of metals which means that they will always remain in the artery implanted forever
  • Recently new materials have been used for these scaffolds which will ‘dissolve’ over a 2 year period
  • That means that at the end of 2 years, no traces of the scaffold remains
  • Time has been ‘turned back’ and the artery is back to its original un-diseased state

Abbott and Elixir

  • Presently there are 2 bio-absorbable available in Singapore
  • The ‘Absorb’ by Abbortt and ‘DESolve’ by Elixir
  • Both are made of Poly-Lactic acid
  • They have generally been used in simple cases
  • The following 2 cases are complex intervention utilising the Absorb stent


  • 68 Yr gentleman
  • 2008 Bare metal stent used to treat the original RCA CTO
  • In 2010 there was in-stent-restenosis which was treated with drug eluting balloon
  • In 2014 he presented again with chronic total occlusion of the repeated in-stent-restenosis
  • He was suffering from angina

Crossing the CTO

  • Using a 2.5 x 15mm OTW balloon as anchor/support
  • Fielder XT-A crossed the CTO segment

Sequential balloon dilatation

  • Dilatation of the occluded vessel was performed with sequentially larger balloons
  • Starting with Sprinter Legend 1.25 x 12 at 14 atm
  • Then Sprinter Legend 2.0 x 12 at 14 atm
  • Finally Kaneka Fortis 3.25 x 18 up to 22 atm
  • However, the mid RCA could not be adequately dilated

Let’s try cutting balloon

  • Using Flextome 3.5 x 10 inflated up to 14 atm
  • Full expansion still could not be achieved


Still looking hazy

  • After repeated cutting balloon dilatations
  • There is still a little haziness at the mid RCA

Let’s try Absorb

  • Placement of Absorb 3.5 x 28mm BVS

After the Absorb the mid RCA looked better. However, the ostium is not well expanded


Final angiogram

  • After placing another Absorb 3.5 x 18 in the ostium RCA
  • Post dilated with 4.0 x 15 mm NC balloon up to 17 atm
  • RPL stented with Xience 2.5 x 38
  • The artery looked fully revascularised


  • 2nd case is again in RCA
  • In 2012 the RCA was treated with DES from pRCA to RPDA
  • Drug-eluting balloon was used to treat the RPL

CTO was Crossed with Gaia 2nd on Corsair

  • After 3.5 NC along RCA
  • Kissing balloon 2.5 into the PRL and PDA
  • The RPL after the PDA still looking very stenosed


Anchoring balloon placed in PDA

  • Squeezed an Absorb 2.5 x 18 into RPL
  • Re-crossed into PDA finished with kissing balloon

  • The RPL now looks more respectable
  • But the prox-mid RCA still not ideal

Another Absorb in proximal RCA

  • Absorb 3.5 x 28 placed in pRCA up to 14atm

LAO final angiogarm

AP cranial

Options for treatment in these cases

  • Leave them as they are after NC and cutting balloon
  • Treat with Drug eluting balloon – But the post dilatation result was not idea
  • DES – 2-3 layers of permanent metal
  • BVS – Hopefully it dissolves leaving single layer of Metal and a big lumen
  • Acute result looks acceptable
  • Long term result presently unknown