In-scaffold neovascularization of a bioresorbable vascular scaffold after 6 years of implantation

摘要

A 47-year-old non-diabetic, non-smoker, normotensive male presentedwith chronic stable angina and positive treadmill test in June2013. His clinical examination was unremarkable. Two-dimensionalechocardiography revealed no regional wall motion abnormality andleft ventricular ejection fraction of 60%. His coronary angiographyrevealed mid-left anterior descending artery (LAD) 90% tubular stenosis,which was successfully stented with a 3.5 28 mm bioresorbablevascular scaffold (BVS) (Absorb stent, Abbott Vascular, SantaClara, CA, USA) (Video 1). He remained asymptomatic on aspirin150 mg, clopidogrel 75 mg, and atorvastatin 20 mg daily doses of medicines,for the next 6 years. Recently, he presented with Class II anginawith an inconclusive treadmill test. A check angiogram revealed a patentLAD lumen with no in-stent restenosis. An optical coherencetomography (OCT) imaging (Illumien Optis, Abbott/St Jude Medical,Westford, MA, USA) across the LAD revealed no significant luminalstenosis and completely resorbed struts (Video 2). A signal rich fibroticneoplaque (intima) with areas of neoatherosclerosis (Figure 1) andmultiple neovascular channels (Figure 2) could be seen. The distal andproximal platinum markers of BVS (Supplementary material online,Figure S1) could be seen as high intensity thin linear signal with backscattering,separated by a distance of 28 mm.