Coronary Artery Aneurysm After Bioresorbable Scaffold Implantation in a Woman With an Acute Coronary Syndrome

J INVASIVE CARDIOL 2017;29(7):E77-E78.

Key words: bioresorbable scaffold, STEMI, aneurysm, ACS

A healthy 49-year-old woman was referred to our cath lab for an ST-segment elevation myocardial infarction. Her past medical history was significant for a mid-left anterior descending (LAD) lesion (fractional flow reserve-Atp, 0.69) treated 15 months before with a 3.0 x 28 mm bioresorbable scaffold (Figures 1A and 1B). An emergency angiography showed evidence of a thrombotic occlusion of the mid-LAD at the level of the bioresorbable scaffold (Figure 1C). After visible manual thrombus aspiration and glycoprotein IIb/IIIa therapy, an epicardial TIMI flow grade 3 was restored highlighting a contrast staining beside the stent (Figures 1C and 1D). Optical coherence tomography revealed complete coverage and apposition of the struts in the distal part of the bioresorbable scaffold (Figure 1F) and an aneurysmatic dilation of the proximal-mid vessel with stent thrombosis (Figure 1E). Bioresorbable scaffold in the presence of an acquired aneurysm behaved in two different ways: while covered struts stayed well apposed to the aneurysm wall or resulted in an evident malapposition without stent collapse or thrombosis, uncovered struts on the contrary resulted in bioresorbable scaffold collapse and thrombosis (Figure 1E). The simultaneous presence of bioresorbable scaffold thrombosis and coronary aneurysm was treated with direct drug-eluting stent implantation (3.5 x 32 mm) over the bioresorbable scaffold and the aneurysm. The bioresorbable scaffold was crushed between the aneurysm and the new drug-eluting stent; a few bioresorbable scaffold struts protruded outside the drug-eluting stent (Figures 1H and 1I). Optical coherence tomography highlighted “frame by frame” the mechanism of a late bioresorbable scaffold stent thrombosis due to a coronary aneurysm and provided further knowledge on the behavior of bioresorbable scaffolds in an unusual complex lesion that was percutaneously treated (Figure 1G).

From the ¹Cardiovascular Department, Interventional Cardiology, ASST Niguarda Ca’ Granda Hospital, Milan, Italy; ²Medicine and Surgery, University of Milano – Bicocca, Milan, Italy; and ³Cardiovascular Department, ASST Fatebenefratelli Sacco Hospital, Milan, Italy.

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.

Manuscript accepted April 24, 2017.

Address for correspondence: Alberto Cereda, MD, Cardiovascular Department, Interventional Cardiology, Niguarda Ca’ Granda Hospital, Milan, Italy. Email: alberto.cereda@email.it