Author + information
- Received March 25, 2015
- Accepted March 26, 2015
- Published online August 17, 2015.
- Bu-Chun Zhang, MD, PhD∗,†,
- Antonios Karanasos, MD, PhD∗,
- Kees-Jan Royaards, MD‡,
- Jurgen Ligthart, BSc∗ and
- Evelyn Regar, MD, PhD∗∗ ()
- ∗Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
- †Department of Cardiology, The Affiliated Hospital of Xuzhou Medical College, Jiangsu, China
- ‡Department of Cardiology, Maasstad Ziekenhuis, Rotterdam, the Netherlands
- ↵∗Reprint requests and correspondence:
Dr. Evelyn Regar, Department of Cardiology, Thoraxcenter, BA-585, Erasmus University Medical Center, ‘s Gravendijkwal 230, 3015 CE Rotterdam, the Netherlands.
- bioresorbable scaffold
- incomplete lesion coverage
- intracoronary hematoma
- optical coherence tomography
- percutaneous coronary intervention
A 68-year-old man was treated in our catheterization laboratory for ST-segment elevation myocardial infarction. He had undergone 3.5 × 18-mm bioresorbable vascular scaffold (BVS) implantation in the proximal left anterior descending coronary artery for stable angina in another institution 2 days before.
At presentation, angiography showed a filling defect located >5 mm distally to the scaffolded segment (Figure 1A). An attempt at thrombus aspiration was performed, without retrieving any aspiration material, and the angiographic image remained unchanged (Figure 1B). Optical coherence tomography (OCT) was performed and revealed the absence of intraluminal thrombus, but the presence of an occlusive intramural hematoma, extending from the edge of the implanted BVS until distal to the second diagonal branch (Figure 2). The patient was treated with 2 additional BVS (3.5 × 23 mm and 2.5 × 12 mm) that covered the region of the intramural hematoma (Figure 1C). An extension of the dissection in the second diagonal branch was noted, which was treated conservatively in view of the Thrombolysis In Myocardial Infarction flow grade 3 and its small size.
Post-hoc revision of the baseline implantation (Figures 1D to 1F) revealed incomplete coverage of the segment subjected to pre-dilation. At that time, no distal edge dissection was visible at the final angiogram, only a mild stenosis of the distal edge.
BVS are a new treatment for obstructive coronary artery disease that could alleviate long-term metal stent complications (1). However, because of intrinsic differences in design, more aggressive lesion preparation is required, which could lead to a higher incidence of incomplete lesion coverage (2). In our case, OCT clearly identified an occlusive intramural hematoma as a pathomechanism for a recurrent event after BVS implantation. The use of intravascular imaging at baseline implantation could have led to early recognition and prevention of this complication.
Dr. Karanasos has received research support from St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 25, 2015.
- Accepted March 26, 2015.
- 2015 American College of Cardiology Foundation