Subacute thrombosis of a bioresorbable vascular scaffold implanted for recurrent in-stent restenosis

An 88-year-old diabetic man was admitted for progressive angina. Four years before, he required a bare metal stent (BMS) implantation in a severely calcified lesion at the ostium of the right coronary artery. Six months later he presented severe focal in-stent restenosis (ISR) which was treated with a new BMS. Urgent coronary angiography showed recurrent ISR (Figure 1A). Optical coherence tomography (OCT) revealed the classic “stent-sandwich” image with two well-expanded stents (Figure 1B). The tissue causing ISR was highly heterogeneous, suggestive of neoatherosclerosis (Figure 1B). After pre-treatment with 600 mg of clopidogrel, aggressive lesion dilation was performed. Then, a bioresorbable vascular ...