Author + information
- Received May 15, 2015
- Revision received June 16, 2015
- Accepted June 19, 2015
- Published online November 1, 2015.
- Felix Meincke, MD∗∗ (, )
- Tobias Spangenberg, MD∗,
- Christian-H. Heeger, MD∗,
- Martin W. Bergmann, MD†,
- Karl-Heinz Kuck, MD∗ and
- Alexander Ghanem, MD∗
- ∗Asklepios Klinik St. Georg, Department of Cardiology, Hamburg, Germany
- †Cardiologicum, Hamburg, Germany
- ↵∗Reprint requests and correspondence:
Dr. Felix Meincke, Department of Cardiology, Asklepios Klinik St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany.
A 46-year-old patient underwent implantation of a bioresorbable vascular scaffold (BVS) (Absorb 3.5 × 28 mm, Abbott Vascular, Abbott Park, Illinois) in April 2013 for a de-novo stenosis of the right coronary artery (Figures 1A to 1B). A total of 6 months after implantation, a follow-up angiography including optical coherence tomography (OCT) was performed, showing a partial malapposition of the scaffold (Figure 1C, Online Video 1). As the patient had no angina and the angiographic picture was unremarkable, the decision was made not to treat the malapposition, for example, by implantation of a metallic stent. In October 2014, the patient was readmitted with ST-segment elevation myocardial infarction due to acute BVS thrombosis. OCT revealed insufficient wall apposition in the distal part of the scaffold with subsequent incomplete coverage with neointimal tissue and resorption as compared with proximal wall-apposed parts as potential cause for the thrombosis (Figures 1D to 1F, Online Video 2). After balloon dilation, 3 zotarolimus-eluting stents were implanted covering the whole scaffold length.
These findings underline the importance of proper wall apposition of BVS, which is best verified by OCT imaging at the time of implantation. Insufficient wall contact might lead not only to delayed coverage but also to delayed resorption with subsequent elevated risk for scaffold thrombosis.
For supplemental videos and their legends, please see the online version of this article.
Dr. Kuck has relationships with St. Jude, Medtronic, and Biosense Webster. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 15, 2015.
- Revision received June 16, 2015.
- Accepted June 19, 2015.
- American College of Cardiology Foundation