Two-vessel peri-scaffold staining and malapposition 12 months after bioresorbable scaffold implantation

A 43-year-old woman presenting with ST-elevation myocardial infarction underwent primary percutaneous coronary intervention (PCI) of an occluded left anterior descending (LAD) coronary. After predilation, a 3.0 × 28 mm Absorb bioresorbable scaffold (BVS, Abbott vascular) and a 3.5 × 8 mm drug-eluting stent (xience prime, Abbott Vascular) were implanted in a diffusely diseased, partially aneurysmatic vessel with good final result (Panels A and B). One month later, a staged PCI of the proximal and distal right coronary was performed with two Absorb 3.0 × 18 mm scaffolds (Panels C and D). At this time, the result in the LAD was optimal (see Supplementary material online, Video 1, Panel E). Twelve months later, at planned control angiography, there was evidence of peri-scaffold staining around the BVS implanted in the LAD (see Supplementary material online, Video 2, Panel F) and the proximal RCA (Panel G). The aneurysmatic dilation of both vessels, along with strut malapposition and multiple interstrut hollows (Panel L, arrows), was confirmed at optical coherence tomography (LAD: Panels H and I; RCA proximal: Panel L). No peri-stent staining was evident around the drug-eluting stent in the LAD and around the BVS in the distal RCA (Panel M). All malapposed struts were covered by neointima. Late acquired malapposition has been reported for first- and second-generation drug-eluting stents, and is usually treated with life-long double-antiplatelet therapy. Since scaffold struts are resorbed 3 years after implantation, this might not be necessary in the case of BVS.