Overhanging Bioresorbable Vascular Scaffold Observed on Angioscopy 1 Year After Implantation

A 76-year-old man with effort angina underwent percutaneous coronary intervention (PCI) to the right coronary artery using a 3.0×18 mm bioresorbable vascular scaffold (BVS; Absorb GT1, Abbott Vascular, Santa Clara, CA, USA) (Figure A,B-1). During PCI, optical coherence tomography (OCT; Dragonfly OPTIS, Abbott Vascular) confirmed the BVS to be completely embedded in the vascular endothelium (Figure B-2,B-3) and 12 months later, coronary angiography confirmed no restenosis (Figure C-1). However, OCT revealed discontinuity of the BVS and some struts apart from the vessel (Figure C-2,C-4, Supplementary Movie 1). Subsequently, we observed the BVS with angioscopy (Forwardlooking, Project OVALIS, Osaka, Japan), which revealed torn struts overhanging into the vascular lumen, remaining stationary on the endothelium and resistant to coronary blood flow (Figure C-3, Supplementary Movie 2). During the follow-up catheterization procedure, there was no resistance to inserting imaging devices. According to OCT, the vessel wall of the proximal site of the overhanging BVS showed positive remodeling and there were no attached struts (Supplementary Movie 1). We speculate that prompt positive remodeling caused early dislodgement and scheduled degeneration of the dislodged struts causing them to roll up and fall onto the distal side. The patient’s preference was to be followed conservatively. He has been administered dual antiplatelet therapy without any relevant adverse events for 2 years after PCI.

Figure.

(A) Initial coronary angiography, (B-1,B-2,B-3) Coronary angiography and short-axis and longitudinal OCT images just after PCI. Arrowhead indicates BVS implantation site. (C-1) Coronary angiography at 1 year after intervention. Arrowhead indicates BVS implantation site. (C-2,C-4) Short-axis and longitudinal OCT images at 1 year after PCI. The overhanging strut is indicated by arrowheads. (C-3) Angioscopy showing transparent BVS strut (indicated by arrowheads) overhanging into the vascular lumen. BVS, bioresorbable vascular scaffold; OCT, optical coherence tomography; PCI, percutaneous coronary intervention.

Compared with a previous report of overhanging BVS 3 years after implantation by angioscopy,¹ in this case the overhanging BVS occurred in the early degeneration phase.

Disclosures

None.

Supplementary Files

Supplementary Movie 1. Pull-back movie of OCT at 1 year after PCI.

Supplementary Movie 2. Pull-back movie of angioscopy at 1 year after PCI.

Please find supplementary file(s);

http://dx.doi.org/10.1253/circj.CJ-20-0315

Reference

• 1.   Fujimura T, Kawasaki T, Kimura T. Very late strut overhang on coronary angioscopy after bioresorbable vascular scaffold implantation in a clinically stable patient. Circ J 2018; 82: 923–924.