Bioresorbable vascular scaffold restenosis treated with sirolimus-eluting balloon: Optical coherence tomography findings

A 60-year-old man was admitted for unstable angina. Twoyears ago he was treated with two bioresorbable vascular scaffolds (BVSs) on the proximal and distal segments of the left anterior descending coronary artery (Figure 1A, white arrows). Coronary angiography showed critical in-scaffold restenosis of the proximal BVS (Figure 1B, yellow arrow). Optical coherence tomography revealed heterogeneous tissue filling the BVS (Figure 2, A, B and D) with areas depicting bright neointimal hyperplasia with dorsal attenuation and marked shadowing of the underlying BVS struts. There was no evidence of scaffold disruption and neoatherosclerosis was considered the cause of late BVS failure. The patient was treated with a 3×15-mm sirolimus coated balloon catheter (drug-eluting balloon, DEB) (ratio of drug-eluting