Unloading and successful treatment with bioresorbable stents during percutaneous coronary intervention: A case report

Abstract

Background: With the development of percutaneous coronary intervention (PCI), the number of interventional procedures without implantation, such as bioresorbable stents (BRS) and drug-coated balloons, has increased annually. Metal drug-eluting stent unloading is one of the most common clinical complications. Comparatively, BRS detachment is more concealed and harmful, but has yet to be reported in clinical research. In this study, we report a case of BRS unloading and successful rescue.

Case summary: This is a case of a 59-year-old male with the following medical history: "Type 2 diabetes mellitus" for 2 years, maintained with metformin extended-release tablets, 1 g PO BID; "hypertension" for 20 years, with long-term use of metoprolol sustained-release tablets, 47.5 mg PO QD; "hyperlipidemia" for 20 years, without regular medication. He was admitted to the emergency department of our hospital due to intermittent chest pain lasting 18 hours, on February 20, 2022 at 15: 35. Electrocardiogram results showed sinus rhythm, ST-segment elevation in leads I and avL, and poor R-wave progression in leads V1-3. High-sensitivity troponin I level was 4.59 ng/mL, indicating an acute high lateral wall myocardial infarction. The patient's family requested treatment with BRS, without implantation. During PCI, the BRS became unloaded but was successfully rescued. The patient was followed up for 2 years; he had no episodes of angina pectoris and was in generally good condition.

Conclusion: We describe a case of a 59-year-old male experienced BRS unloading and successful rescue. By analyzing images, the causes of BRS unloading and the treatment plan are discussed to provide insights for BRS release operations. We discuss preventive measures for BRS unloading.

Keywords: Bioresorbable stents; Case report; Coronary artery diseases; Intravascular ultrasound; Percutaneous coronary intervention; Stent release; Stent unloading.

Figure 1

Electrocardiogram examination on admission.

Figure 2

Preoperative images. Right coronary angiography (Left anterior position).

Figure 3

Preoperative images. A: Left coronary angiography (right shoulder position); B: Intravascular ultrasound (IVUS) of the proximal segments of the left anterior descending artery (LAD); C: IVUS of the middle segments of the LAD.

Figure 4

Intraoperative stent position. A: Angiography (right shoulder position) after balloon dilation of the proximal and middle segments of the left anterior descending artery; B: Angiography (spider position) Positioning of the second bioresorbable stents (BRS) after the first BRS implantation in the middle descending artery; C: Postoperative images after BRS in situ expansion from proximal segment to left main trunk in the right shoulder position.

Figure 5

Angiography (spider position). A: Imaging changes in the proximal segment of the left anterior descending artery; B: Intravascular ultrasound (IVUS) of the proximal end of the unloaded bioresorbable stents (BRS) stent; C: IVUS of the distal end of the unloaded BRS stent.

Figure 6

Postoperative images. A: After bioresorbable stents in situ expansion from proximal segment to left main trunk: In the spider position; B: Intravascular ultrasound of the proximal of left anterior descending artery after bioresorbable stents expansion: The minimum lumen area was 5.26 mm².