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IMAGES IN INTERVENTION

Persistent Bioresorbable Vascular Scaffoldby Optical Coherence TomographyImaging at 5 Years

Noriaki Moriyama, MD, Koki Shishido, MD, Kazuki Tobita, MD, Takuma Takada, MD,Tomoki Ochiai, MD, Saori Tsukuda, MD, Futoshi Yamanaka, MD, Kazuya Sugitatsu, MD, Shingo Mizuno, MD,Yutaka Tanaka, MD, PHD, Masato Murakami, MD, PHD, Junya Matsumi, MD, Saeko Takahashi, MD,Takeshi Akasaka, MD, PHD, Shigeru Saito, MD

A 74-year-old man included in theABSORB EXTEND Clinical Investigation(NCT01023789) underwent percutaneous cor-

onary intervention with an everolimus-eluting bio-resorbable vascular scaffold (BVS) (Absorb BVS1.1,Abbot Vascular, Santa Clara, California) 3.0 � 18 mmin proximal right coronary artery for stable angina.After post-dilation at high pressure (20 atm) with3.25 mm noncompliant balloon, an excellent angio-graphic result was obtained. Final optical coherence;tomography (OCT) imaging revealed adequate appo-sition and symmetrical expansion (Figures 1A to 1C).

Serial OCT imaging follow-up at 1 and 5 years wasperformed. At 1 year, OCT detected neointimalcoverage for the most part of strut with “black box”appearance. However, neointimal thickness at thedistal portion of BVS was significantly thinner thanother portions (Figures 1D to 1F and 1D’ to 1F’).At 5 years after implantation, OCT confirmed nearlycomplete scaffold resorption in the proximal seg-ments but “black box” objectives remained visibleat the distal end of BVS (Figures 1G to 1I). It looked likethe empty shell of a scaffold that was 140 to 150 mmthick. It was exactly equivalent to the thickness of

From the Department of Cardiology and Catheterization Laboratory, Shon

The authors have reported that they have no relationships relevant to the c

Manuscript received August 31, 2016; revised manuscript received October 2

Absorb BVS1.1 (Figures 2A and 2B). Additionally, a partof intima on “black box” was disconnected(Figure 2C).

In previous studies, mean intimal thickness wasover than thickness of BVS at 6 months (1); further-more, the struts were no longer discernable at 5 yearsby OCT (2,3). In contrast, “black box” structures,which had same configuration and thickness as theBVS, were confirmed in this case at 5 years. It hasbeen speculated that abnormal strut resorption pro-cess might be participated. OCT finding at 1 yearshowed unusual insufficient intimal growth only atthe distal end of scaffold. Delayed BVS endotheliali-zation might be one of the factors for abnormalresorption process. Here, we show the first case ofincomplete absorption for BVS at 5 years. This findingshould be investigated to figure out resorptionprocess of BVS in greater detail.

REPRINT REQUESTS AND CORRESPONDENCE: Dr.Noriaki Moriyama, Department of Cardiology andCatheterization Laboratory, Shonan Kamakura Gen-eral Hospital, 1370-1 Okamoto, Kamakura, Kanagawa247-8533, Japan. E-mail: e2718nm@gmail.com.

an Kamakura General Hospital, Kamakura, Japan.

ontents of this paper to disclose.

7, 2016, accepted November 3, 2016.

FIGURE 1 Angiographic Observations After BVS Implantation

(1 to 3) Serial angiographic observations after bioresorbable vascular scaffold (BVS) implantation at the 1- and 5-year follow-up. Optical coherence

tomography (OCT) images at matched sites (A, D, G, scaffold proximal end; B, E, H, right ventricular branch; C, F, I, distal end). Note the complete

resolution of good apposition at post-implantation in A to C. Sufficient intimal coverage at 1 year in D and E with the exception of scaffold distal end in F.

D’ to F’ are magnified figures in D to F. At 5-year follow-up, BVS was invisible by OCT in G and H. The sites previously occupied by polymeric struts have

preserved black box appearance on the 5-year OCT images in I. GW ¼ guidewire; LAO ¼ left anterior oblique; RAO ¼ right anterior oblique; RVB ¼ right

ventricular branch.

Moriyama et al. J A C C : C A R D I O V A S C U L A R I N T E R V E N T I O N S V O L . 1 0 , N O . 2 , 2 0 1 7

Visualization of Scaffold Remnants by OCT at 5 Years J A N U A R Y 2 3 , 2 0 1 7 : e 1 1 – 3

e12

FIGURE 2 OCT Images at Distal End of Scaffold in 5-Year Follow-Up

(A) The sites previously occupied by polymeric struts have preserved black box appearance. (B and C) Thickness of the objects (white bar),

which is same as that of BVS1.1. (C) Disconnected intima (white arrow).

J A C C : C A R D I O V A S C U L A R I N T E R V E N T I O N S V O L . 1 0 , N O . 2 , 2 0 1 7 Moriyama et al.J A N U A R Y 2 3 , 2 0 1 7 : e 1 1 – 3 Visualization of Scaffold Remnants by OCT at 5 Years

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RE F E RENCE S

1. Bourantas CV, Farooq V, Zhang Y,Muramatsu T, et al. Circumferential distributionof the neointima at six-month and two-yearfollow-up after a bioresorbable vascular scaf-fold implantation: a substudy of the ABSORBCohort B Clinical Trial. EuroIntervention 2015;10:1299–306.

2. Serruys PW, Ormiston J, van Geuns RJ, et al.A polylactide bioresorbable scaffold eluting ever-olimus for treatment of coronary stenosis: 5-yearfollow-up. J Am Coll Cardiol 2016;67:766–76.

3. Simsek C, Karanasos A, Magro M, et al. Long-term invasive follow-up of the everolimus-eluting

bioresorbable vascular scaffold: five-year resultsof multiple invasive imaging modalities. Euro-Intervention 2016;11:996–1003.

KEY WORDS bioresorbable vascularscaffold, optical coherence tomography