Published online Aug 26, 2017. doi: 10.4330/wjc.v9.i8.710
Peer-review started: February 7, 2017
First decision: May 11, 2017
Revised: May 22, 2017
Accepted: June 19, 2017
Article in press: July 17, 2017
Published online: August 26, 2017
Processing time: 209 Days and 6.9 Hours
We describe the case of a patient presenting with ST-segment elevation myocardial infarction due to very late scaffold thrombosis. The patient was already admitted for an elective percutaneous recanalization of a chronically occluded left anterior descending artery (LAD). The procedure was performed according the sub-intimal tracking and re-entry (STAR) technique with 4 bioresorbable vascular scaffolds implantation. However, even though the coronary flow was preserved at the end of the procedure, the dissected segment was only partially sealed at the distal segment of the LAD. After 18 mo of regular assumption, dual antiplatelet therapy was discontinued for 10 mo before his presentation at the emergency room. This is the first reported case of a very late scaffold thrombosis after coronary chronic total occlusion (CTO) recanalization performed according to the STAR technique. This case raises concerns about the risk of very late scaffold thrombosis after complex CTO revascularization.
Core tip: We describe a case of a 53-year-old male patient who was admitted with anterior ST-elevation myocardial infarction 28 mo after elective percutaneous revascularization of a chronically occluded left anterior descending (LAD) threated with 4 bioresorbable vascular scaffolds (BVS) in order to seal a long flow limiting dissection after sub-intimal tracking and re-entry technique. Coronary angiography showed a large thrombus at the proximal segment of the proximal BVS and a long dissection was evident from mid to distal LAD. In this case, the progressive reduction of both scaffolds radial strength and structure dismantling might have been responsible for both intraluminal thrombosis and reoccurrence of vessel dissection.