OCT-Guided covered stent implantation for acquired coronary aneurysm after bioresorbable vascular scaffold: case report

Coronary artery aneurysm (CAA) formation following bioresorbable vascular scaffold (BVS) implantation is a rare but serious complication with no clear treatment guidelines. We report the case of a 56-year-old man with coronary artery disease (CAD) and a chronic total occlusion (CTO) in the left anterior descending artery (LAD) underwent full revascularization with BVS in 2016. Seven years later, he experienced recurrent angina, and angiography revealed 80% stenosis in the proximal LAD and a large coronary aneurysm in the middle LAD. Optical coherence tomography (OCT) confirmed a 5.88 mm aneurysm, which was treated with a PK Papyrus covered stent, while the proximal LAD stenosis was addressed with a Resolute Onyx drug-eluting stent (DES). After six months of standard dual antiplatelet therapy (DAPT) followed by three months of single antiplatelet therapy (SAPT), the patient developed in-stent restenosis (ISR) in the covered stent. This was successfully treated with high-pressure balloon angioplasty and a drug-eluting balloon (DEB). At the nine-month follow-up, the patient remained symptom-free. This case highlights the utility of OCT in evaluating CAAs and guiding covered stent deployment, while prolonged DAPT may help reduce the risk of very late stent thrombosis and future ischemic events, though further studies are needed.