Disruption of bioresorbable vascular scaffold struts due to loss of radial integrity: insights from optical coherence tomography

Strut disruption of bioresorbable vascular scaffold is a known potential concern, although uncommon when adequate lesion preparation is achieved and nominal size of the scaffold is respected. It is usually difficult to detect with angiography and/or intravascular ultrasound. Three-dimensional reconstructions of optical coherence tomography facilitates understanding of complex luminal anatomy and configuration of stent struts, providing evaluation of stent integrity immediately after deployment and therefore optimization of the complex revascularization procedure. The present article reports a case where this image modality enabled successful use of a drug-eluting stent inside a bioresorbable vascular scaffold to restore the luminal integrity, jeopardized by struts disruption. This case highlights the need to better characterize coronary atherosclerotic disease complexity before considering bioresorbable vascular scaffold implantation. Optical coherence tomography imaging could be a useful tool for accurate selection of the most suitable lesions for bioresorbable stents and to guide the revascularization process, so that in the event of stent fracture it may be detected and managed in a timely fashion.