Author + information
- Received October 19, 2015
- Revision received October 26, 2015
- Accepted November 5, 2015
- Published online February 22, 2016.
- Piera Capranzano, MD∗ (, )
- Bruno Francaviglia, MD,
- Davide Capodanno, MD, PhD,
- Maria Elena Di Salvo, MD,
- Claudia Ina Tamburino, MD,
- Fabio Maria Santagati, MD and
- Corrado Tamburino, MD, PhD
- ↵∗Reprint requests and correspondence:
Dr. Piera Capranzano, University of Catania, Cardiovascular Department, Ferrarotto Hospital, Citelli 1, Catania 95124, Italy.
A 58-year-old diabetic man underwent implantation of 3 overlapping Absorb bioresorbable vascular scaffolds (BVS) (2.5/28, 2.5/28, and 3.0/28 mm) (Abbott Vascular, Santa Clara, California) in a heavily calcified left anterior descending artery stenosis. Optical coherence tomography (OCT) revealed multiple fractures of the 3.0/28 BVS, leading to in-scaffold implantation of a zotarolimus-eluting stent (ZES) (Figures 1A and 1B). The 4-month angiography showed a severe edge in ZES restenosis treated with another stent. The OCT revealed an unexpected disappearance of BVS struts (Figure 1C) in the ZES segment and a nonocclusive cluster of polymeric struts stuck in the vessel wall 8.5-mm far from the distal scaffold, with various coverage patterns (Figures 1D to 1H). Three-dimensional OCT suggested a single fragment of polymeric crown (Figures 1I and 1J). The patient has not experienced adverse events over 8-month follow-up and never stopped dual antiplatelet therapy (DAPT).
This case provided a demonstration of strut embolization, which was an incidental OCT finding, showing that incorporation into the vessel wall rather than abrupt obstruction is a possible fate of embolized struts. This phenomenon may underlie late ischemic events, especially after DAPT discontinuation. It is conceivable that the metal-in-polymer technique might cause an additive stress on the BVS, likely inducing a scaffold fragments separation. Where the metal-in-polymer technique is used, an OCT may be appropriate to exclude scaffold embolization and guide DAPT duration.
Dr. Tamburino has received honoraria/lecture fees from Medtronic, Abbott Vascular, and Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 19, 2015.
- Revision received October 26, 2015.
- Accepted November 5, 2015.
- 2016 American College of Cardiology Foundation