Acute Treatment and 5-Year Follow-up of Longitudinal Deformation of a Bioresorbable Scaffold

J INVASIVE CARDIOL 2021;33(4):E318-E319. 

Key words: coronary artery disease, optical coherence tomography, stents

A 46-year-old man with type 1 diabetes underwent percutaneous coronary intervention (PCI) for a long segment of physiologically significant left anterior descending (LAD) coronary artery disease (Figure 1A). The vessel was assessed with intravascular ultrasound and 3 abutting Absorb bioresorbable vascular scaffold (BVS) devices (Abbott Vascular) were implanted (3.0 x 28 mm, 3.0 x 28 mm, 3.5 x 18 mm) and optimized with non-compliant balloons with a good acute result (Figures 1B and 1C). The procedure was complicated by entrapment of a knotted Sion Blue guidewire (Asahi Intecc) in a branch of the apical LAD. This was deliberately broken by retraction against the tip of a Corsair microcatheter (Asahi Intecc), leaving behind a tiny fragment of guidewire. Despite disengaging the guide catheter during this maneuver (Figure 1D), the catheter was pulled deeply into the LAD, causing longitudinal deformation of the proximal BVS. This was not visible angiographically; however, optical coherence tomography (OCT) interrogation confirmed substantial scaffold disruption (Figures 1E and 1F). The proximal segment was further treated with a single 4.0 x 24 mm Promus Premier drug-eluting stent (Boston Scientific) and postdilated to 5 mm, trapping the distorted BVS behind the metallic stent. Figures 1G, 1H, and 1I show the final angiographic and OCT results.

The patient had another coronary angiogram 5 years later. OCT at this time showed complete resorption of the BVS (Figure 1J). The angiographic result was also good (Figure 1K). The metallic stent was well healed except for a short segment of late-acquired malapposition in 1 quadrant (Figure 1L).  

The images demonstrate that, as with any stent platform, longitudinal deformation is possible when implanting a BVS. Deformation may not be apparent on angiographic imaging. Therefore, if suspected, OCT imaging is mandatory to assess any scaffold deformation. However, after being recognized and treated appropriately, there was a good acute and long-term outcome for this patient.

From the Cardiology Department, Belfast Health & Social Care Trust, Royal Victoria Hospital, Belfast, Northern Ireland.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted April 21, 2020.

Address for correspondence: Calum S. Creaney, MD, Cardiology Department, Belfast Health & Social Care Trust, Royal Victoria Hospital, 274 Grosvenor Road, Belfast, Northern Ireland, BT12 6BA. Email: calum.creaney@nhs.scot