Very Late Magmaris Scaffold Restenosis: A 6-year Serial Optical Coherence Tomography Case Report

Abstract

Bioresorbable scaffolds (BRS) have been proposed as an alternative to drug-eluting stents (DES), offering radial support during the early phases of healing, while potentially reducing the risk of long-term complications. A magnesium-based BRS (MgBRS) have shown promising results after implantation. However, there is a lack of knowledge regarding the long-term outcomes. A 62-year old man with hypertension, dyslipidemia, family history of ischemic heart disease, and previous myocardial infarction, presented with Non ST-elevation myocardial infarction (NSTEMI). Six years prior he also had a NSTEMI and a mid left anterior descending artery (LAD) lesion was treated with a 3.0/25mm MgBRS. Post-implantation optical coherence tomography (OCT) revealed proximal edge dissection, and a second MgBRS 3.0/15mm was implanted. OCT of the scaffold-treated segment was performed after 6 and 12 months with no sign of restenosis. The current angiogram showed a restenosis in the previously MgBRS treated segment in LAD. OCT showed a plaque rupture in a thin cap fibro-atheroma and scaffold remnants. The lesion was pre-dilated and stented with a 3.0/20mm DES and post-dilated with a 3.5mm non-compliant balloon. Most cases of late scaffold failure showed acquired malapposition, which also can be related to the degrading process, or uncovered struts, none of which were seen in our case at 6 or 12 months. This case represents an insight into the vascular healing and potential mechanisms for failure of the MgBRS, with serial OCT recording at implantation, and after 6 months, 12 months and 6 years.