The fate of bioresorbable struts located at a side branch ostium: serial three-dimensional optical coherence tomography assessment

A 64-year-old woman with stable angina pectoris underwent percutaneous coronary intervention of the left anterior descending coronary artery whereby a 3.0/12 mm bioresorbable everolimus-eluting stent (BVS, Abbot Vascular, Santa Clara, CA, USA) was deployed over the ostium of a diagonal branch. After stent post-dilatation, angiography showed no residual stenosis and TIMI III antegrade side branch flow (Panel A). The patient experienced no procedure-related complication and was discharged within 24 h after the procedure on dual antiplatelet therapy. Serial intravascular ultrasound and optical coherence tomography (OCT, LightLab Imaging, Westford, MA, USA) were performed after BVS deployment, and at 6-month and 2-year follow-up. At baseline, the BVS was well expanded and the diagonal branch was jailed by polymeric BVS struts (Panels B and C). At 6 months, OCT demonstrated a good lumen with corrugated appearance and marked structural changes of the individual struts (Panels E–G). At 2 years, the stent struts were not discernible any more, and the vessel wall showed a rather homogenous appearance while the lumen was widely patient and showed smooth borders (Panels I–K). At the ostium of the diagonal branch, the BVS stent strut was replaced by a neointimal membranous neocarina. We demonstrate the three-dimensional reconstruction of OCT to visualize the complex spatial relationship between the BVS struts and side branch orifice in such a way that it is easily and fast comprehensible at a glance (Panels D, H, and L). Such approach might be useful for clinicians in the future to evaluate the fate of stent struts and jailed side branches. Panels A–L. Asterisk indicates side branch jailed by the BVS struts. P, proximal; D, distal; GW, guide wire artefact; bar = 1 mm.