Intraluminal bioresorbable vascular scaffold dismantling with aneurysm formation leading to very late thrombosis

Coronary artery aneurysm formation has been described in patients after the placement of first-generation drug-eluting stents (DES), but is less common with newer generation metallic stents. In contrast, coronary artery aneurysm formation may be more common with the use of bioresorbable vascular scaffolds (BVS) due to the frequent formation of evaginations in the arterial wall seen with BVS. In this article, we describe a unique case of BVS dismantling and thrombus formation leading to an acute coronary syndrome thirty-two months after initial BVS placement. We also discuss existing literature and the pathophysiology of BVS degradation, in addition to the utility of optical coherence tomography in the identification of associated conditions, such as strut fracture, intraluminal scaffold dismantling (ILSD), under-expansion, and/or malapposition.