A 44-year-old female was admitted for an anterior ST-segment elevation myocardial infarction (STEMI) and emergency coronary angiography revealed total occlusion of the mid segment of the left anterior descending artery (LAD). After thrombus aspiration, intracoronary nitrate administration and balloon predilatation, two overlapping Absorb™ bioresorbable vascular scaffolds (BVS) (3 mm×18 mm and 2.5 mm×28 mm; Abbott Vascular, Santa Clara, CA, USA) were implanted in the proximal, mid and distal LAD segments. A more distal obstructive lesion was treated with a 2.5 mm×18 mm Absorb™ BVS (Abbott Vascular, Santa Clara, CA, USA).

Seven months later, the patient was admitted with anemia (hemoglobin 7.9 g/dl) associated with subacute genital tract bleeding. In order to improve risk stratification of temporary discontinuation of dual antiplatelet therapy (DAPT), intracoronary imaging was performed. Optical coherence tomography (OCT) showed fully covered scaffolds with good apposition (Figure 1). Neointimal coverage was heterogeneous with an asymmetric distribution around the circumference of the vessel wall. Furthermore, neointimal hyperplasia was more marked in the distal segments, possibly because the hemodynamic microenvironment and endothelial shear stress are involved in its regulation.

Figure 1.

Primary angioplasty and seven-month follow-up coronary angiography and optical coherence tomography cross-sectional views.

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This case suggests the feasibility of implanting several BVS in long lesions of the culprit vessel in STEMI patients, achieving optimal results even without intracoronary imaging guidance at primary PCI. Assessment of scaffold endothelialization on OCT study influenced therapeutic decisions in this particular setting, as there are few data related to the minimum duration of DAPT after BVS implantation.