Optical coherence tomography guided additional Noevas bioresorbable vascular scaffold in the treatment of iatrogenic coronary artery dissection: a case report.

BACKGROUND

Iatrogenic coronary artery dissection is a potential complication during percutaneous coronary bioresorbable vascular scaffolds placement. We report that significant dissection occurred during post-expansion of the left circumflex branch bioresorbable vascular scaffolds to attach it to the wall. Additional resorbable stents successfully covered the dissection without blood flow restriction.

CASEREPORT: The patient was a 49-year-old male with refusing intracoronary metal stents and was diagnosed with stable angina pectoris and type 2 diabetes. Coronary angiography showed serious lesions in three vessels. A Noevas stent was had placed in the proximal segment of the anterior descending branch. Unfortunately a type-D dissection occurred during post-dilatation after the second scaffold was placed in the proximal of the circumflex branch. A third scaffold was inserted to cover the dissection and optical coherence tomography reexamination showed good apposition. After 6 months of coronary angiography, optical coherence tomography examination showed no deterioration of the circumflex branch dissection, and the proximal intimal hyperplasia in the proximal scaffold was 95%. Scoring balloon and drug balloon dilatation were successfully performed, and right coronary artery dilatation with drug coated balloon was performed. The patient had no symptoms of chest pain after 2 years of follow-up.

CONCLUSION

Additional bioresorbable vascular scaffold coverage of coronary type-D dissection with the help of imaging tools may be a practical strategy when patients selcet for coronary metal-less implantation. Furthermore, imaging review is recommended especially for diabetics.