Restenosis of a drug eluting stent on the previous bioresorbable vascular scaffold successfully treated with a drug-coated balloon: A case report

doi:10.12998/wjcc.v9.i3.758

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World Journal of Clinical Cases

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Case Report

World J Clin Cases. Jan 26, 2021; 9(3): 758-763
Published online Jan 26, 2021. doi: 10.12998/wjcc.v9.i3.758

Restenosis of a drug eluting stent on the previous bioresorbable vascular scaffold successfully treated with a drug-coated balloon: A case report

Hyun Gyung Jang, Kyehwan Kim, Hyun Woong Park, Jin-Sin Koh, Young-Hoon Jeong, Jeong Rang Park, Min Gyu Kang

Hyun Gyung Jang, Kyehwan Kim, Hyun Woong Park, Jin-Sin Koh, Jeong Rang Park, Min Gyu Kang, Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, South Korea

Young-Hoon Jeong, Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, South Korea

Author contributions: Kang MG were the patient’s interventional cardiologist, reviewed the literature and contributed to manuscript drafting; Jang HG reviewed the literature and contributed to manuscript drafting; Kim K and Park HW performed the interpretation of coronary imaging modality and contributed to manuscript drafting; Koh JS and Park JR analyzed and interpreted the imaging findings; Jeong YH performed the pharmacologic strategy for coronary artery diseases consultation, reviewed the literature and drafted the manuscript; Kang MG and Jang HG were responsible for the revision of the manuscript for important intellectual content; all authors issued final approval for the version to be submitted.

Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.

Conflict-of-interest statement: The authors declare that they have no conflict of interest.

CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).

Corresponding author: Min Gyu Kang, MD, PhD, Department of Internal Medicine, Gyeongsang National University of Medicine and Gyeongsang National University Hospital, 79 Gangnam-ro, Jinju 52727, South Korea. med2floyd@naver.com

Received: November 27, 2020
Peer-review started: November 27, 2020
First decision: December 21, 2020
Revised: December 22, 2020
Accepted: December 30, 2020
Article in press: December 30, 2020
Published online: January 26, 2021
Processing time: 54 Days and 5.4 Hours

Abstract

BACKGROUND

The in-stent restenosis (ISR) rates are reportedly inconsistent despite the increased use of second-generation drug eluting stent (DES). Although bioresorbable vascular scaffold (BVS) have substantial advantages with respect to vascular restoration, the rate of scaffold thrombosis is higher with BVS than with DES. Optimal treatment strategies have not been established for DES-ISR to date.

CASE SUMMARY

We report on a case of a 60-year-old man patient with acute coronary syndrome. He had a history of ST-segment elevation myocardial infarction associated with very late scaffold thrombosis and treated with a DES. Coronary angiography revealed significant stenosis, suggesting DES-ISR on the previous BVS. Optical coherence tomography (OCT) identified a plaque rupture and a disrupted scaffold strut in the neointimal proliferation of DES. To treat the DES-ISR on the previous BVS, we opted for a drug-coated balloon (DCB) after a balloon angioplasty using a semi-compliant and non-compliant balloon. The patient did not experience adverse cardiovascular events on using a DCB following the use of intensive dual antiplatelet therapy and statin for 24 mo.

CONCLUSION

This case highlights the importance of OCT as an imaging modality for characterizing the mechanism of target lesion failure. The use of a DCB following the administration of optimal pharmacologic therapy may be an optimal strategy for the treatment and prevention of recurrent BVS thrombosis and DES-ISR.

Keywords: Bioresorbable vascular scaffold thrombosis; In-stent restenosis; Drug-coated balloon; Optical coherence tomography; Intensive dual antiplatelet therapy; Case report

Core Tip: In-stent restenosis still poses a limitation of percutaneous coronary intervention and bioresorbable vascular scaffold are associated with a high rate of target lesion revascularization We present herein, a rare case of restenosis of a drug eluting stent on the previous bioresorbable vascular scaffold. Optical coherence tomography is an instrumental imaging modality for identifying the mechanisms underlying target lesion failure. Drug-coated balloon following the administration of optimal pharmacologic therapy may be an optimal strategy for the treatment and prevention of recurrent target lesion failure.