Fracture of bioresorbable vascular scaffold after side-branch balloon dilation in bifurcation coronary narrowings

Abstract

The possibility of strut fractures after bioresorbable vascular scaffold (BVS) treatment is a new problem associated with the use of this novel technology. There is little in vivo information regarding the effects of lateral dilation on BVS. The present study aimed to evaluate the effects of lateral balloon dilation after bioresorbable vascular scaffold implantation in the treatment of bifurcation lesions. From January 2012 to February 2015, 49 patients with bifurcation lesions who had been treated with BVS required balloon dilation of the side branch (SB). Optical coherence tomographic studies were performed in each of these patients. In 3 patients (6%), the optical coherence tomographic results met the criteria for rupture. Prolonged inflation using a noncompliant balloon with a diameter within the expansion limits of the device resolved the complication in all patients. The clinical course was favorable in all patients, and there were no inhospital deaths or myocardial infarctions. At 14 +/- 8 months of follow-up, 2 patients with integrity of the BVS presented target lesion revascularization (4%). Another patient (2%) suffered a probable stent thrombosis 11 months after the procedure (myocardial infarction and death at home). The patients with the BVS rupture at the index procedure had a favorable clinical outcome, and the 6-month computed tomographic scan revealed maintenance of the initial good results. In conclusion, minor BVS rupture after 2.5-mm lateral balloon dilation may occur but is infrequent (6%). Prolonged balloon inflation of the main vessel may partially restore the geometry of the BVS.