Optical coherence tomography guided additional noevas bioresorbable vascular scaffold in the treatment of iatrogenic coronary artery dissection: A case report

Optical coherence tomography guided additional noevas bioresorbable vascular scaffold in the treatment of iatrogenic coronary artery dissection: A case report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Optical coherence tomography guided additional noevas bioresorbable vascular scaffold in the treatment of iatrogenic coronary artery dissection: A case report Dengshuang Zhou, Bobin Huang, Jue Chen, Qiong You, Hailiang Mo, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5044262/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 01 Dec, 2025 Read the published version in BMC Cardiovascular Disorders → Version 1 posted 13 You are reading this latest preprint version Abstract Background: Iatrogenic coronary artery dissection is a potential complication during percutaneous coronary bioresorbable vascular scaffolds placement. We report that significant dissection occurred during post-expansion of the left rotatory branch bioresorbable vascular scaffolds to attach it to the wall. Additional resorbable stents successfully covered the dissection without blood flow restriction. Casereport: The patient was a 49-year-old male with strong coronary implantable concept and was diagnosed with stable angina pectoris and type 2 diabetes. Coronary angiography showed serious lesions in three vessels. After a Noevas stent was inserted in the proximal segment of the anterior descending branch, secondary dissection occurred in the distal segment of the stent during Optical coherence tomography（OCT） examination when Noevas stent was inserted in the proximal segment of the circumflex branch. A third BVS was inserted to cover the dissection and OCT reexamination showed good adherence. After 6 months of coronary angiography, OCT examination showed no deterioration of the circumflex branch dissection, and the proximal intimal hyperplasia in the proximal BVS was 95%. Scoring balloon and drug balloon dilatation were successfully performed, and right coronary artery dilatation with drug coated balloon was performed. The patient had no symptoms of chest pain after 2 years of follow-up. Conclusion: Additional bioresorbable vascular scaffold coverage of coronary D-type dissection with the help of imaging tools may be a practical strategy when patients have a strong desire for coronary metal-less implantation. Furthermore, imaging review is recommended especially for diabetics. Percutaneous coronary intervention dissection bioresorbable vascular scaffold，optical coherence tomography Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Implanting bioresorbable vascular scaffold stents is one of the major treatment interventions for coronary.Secondary coronary dissection implies that intima injury during percutaneous coronary intervention accompanied by local thrombosis, and severe dissection can cause coronary artery rupture [ 1 ] and large-scale myocardial necrosis [ 2 ]. However, there are limited treatment options for the emergence of dissection during BVS implantation.In this case, secondary dissection occurred in the distal segment of the stent when Noevas stent was inserted in the proximal segment of the circumflex branch. Additional BVS was inserted to cover the hematoma; with no deterioration of the circumflex branch dissection after 6 months. Case presentation A 49-year-old man, was admitted to the cardiology department due to repeated chest pain for 7 days and aggravation for 2 days on April 05, 2021. The patient complained of press-like dull pain in the lower sternum after the activity, The above symptoms could be relieved after taking nitroglycerin tablets. The above symptoms occurred frequently 2 days ago, and the pain was aggravated and unbearable. He has had type 2 diabetes for 10 years, taken gliclazide tablets for a long time, self-reported fasting blood glucose of 11mmol/L, a smoking history of 30 years, a drinking history of 30 years, and denied the history of hypertension and family history of coronary heart disease. Admission blood pressure 145/79mmHg, HR 80bpm, HbA1c 9.9%, LDL-C 4.1mmol/L, blood routine, liver and kidney function, thyroid function, N-terminal B-type brain natriuretic peptide precursor, D-dimer, and myocardial markers were all within the normal range. Color echocardiography: decreased left ventricular diastolic function. Combined with the patient's symptoms and history, the main diagnosis was considered to be coronary atherosclerotic heart disease: unstable angina pectoris, and treatment should be given to reduce blood glucose, double antiplatelet, plaque stabilization, coronary artery dilation, and reduce cardiac oxygen consumption. Communicate with family members about the condition, plan coronary angiography and possible interventional treatment, and sign informed consent. Transradial coronary angiography was performed under local anesthesia On April 6, 2021. The results revealed that the coronary artery was right-dominant; no obstructive lesions were found in the left major artery, and the proximal segment of the left anterior descending branch was 80%-99% stenosis, with grade II TIMI blood flow. The middle part of the left circumflex branch was 70%-90% stenosis, the middle part of the right coronary artery was 80%-90% stenosis, and the blood flow in TIMI was grade III. The patient preferred coronary interventional therapy the next day without metallic implantation. The left anterior descending and left circumflex branches were treated on April 8, 2021. As Medtronic semi-compliant balloon was used for pre-dilation ,The Neovas BVS accurately positioned the proximal segment of the left anterior descending branch and released it. A Neovas BVS (3.0mm×15mm) was accurately located in the proximal section of left circumflex branches and released at 12atm×30s follow after pre-expansion. The OCT showed that the internal distal section of the stent was not appropriately attached to the wall of LCX. The Neovas stent balloon was withdrawn to squeeze the stent at 12atm×15s. Angiography showed torn and dissected distal intima of the stent. Another 3.0mm×15mm Neovas BVS was connected in series with the proximal stent and released and a non-compliant balloon was expanded at 10atm×10s. The OCT showed a fully expanded and well-attached stent. No additional dissection or contrast agent retention was observed at the edge of the stent; no residual stenosis was observed, and the distal TIMI blood flow was grade III. The operation was completed without chest pain and shortness of breath. The patient was re-admitted to our department for coronary angiography. Firstly dilatational angioplasty with a drug-coated balloon was performed in the middle section of the right coronary artery, followed by the guide wire entering the circumflex branch. The OCT detected the hyperplasia of the near intimal in the original proximal section of the stent, and the lumen stenosis was approximately 95%.To our surprise, The previous dissection area has not been expanded. In the end stenosis was significantly reduced while scoring balloon and drug-coated balloon was used for dilatation. Discussion and Conclusion The factors causing dissection after PTCA(Percutaneous transluminal coronary angioplasty, PTCA) surgery are common, including calcification[ 1 ], balloon vascular diameter ratio and repeated balloon dilation[ 2 ]. This disease becomes the interventional complication caused by high pressure following expansion and tortuous vascular distal. According to the pathological features of the NHLBI classification system, the spiral dissection in this case belongs to type D[ 3 ], warranting necessary remedial treatment measures[ 4 ]. The common treatment of coronary dissection has the following risks:(a) the consequences are severe if the guide wire strays into the false cavity near the main branch or the opening; coronary artery bypass grafting is even necessary[ 5 ]. (b) Balloon dilation may induce the hematoma to move or even extend, causing stenosis or even obstruction of the dilated segment, which cannot be immediately supported and requires hematoma window opening[ 6 ] (c) Hematoma healing may cause stent dislocation or displacement (d) Slow blood flow or even no-reflow. PTCA may cause plaque rupture, intima tear, and local media tear by itself. Therefore, type A and type B dissection are more prevalent and usually treated conservatively[ 7 ]. Type C-F exposes collagen and tissue factors to the blood, therefore, stents are usually necessary to stabilize the lumen structure to prevent cardiovascular events caused by delayed exacerbation of hematoma during and after surgery[ 8 ]. In this case, the proximal BVS stent beam network was slightly 140µm thick, and the posterior dilatation pressure potentially exceeded the elastic tension of the tube wall, and the vascular shap around the dissection are tortuous, causing coronary artery dissection. However, the middle and distal segment of the LCX had features including no severe calcification, no OM branch, a diameter greater than 2.5mm, and grade III TIMI blood flow. Studies have reported the placement of BVS in spontaneous coronary dissection with the help of intracavity imaging[ 9 ]; nonetheless, the situation in secondary dissection is seldom. At this time, DES implantation was not the first selection for patients, and no apparent limitation was observed in coronary blood flow observation. Thus, using a cutting balloon was inappropriately. After repeated measurement and comparison, BVS was closely connected to the original proximal BVS, and then OCT was re-examined. The BVS completely covered the hematoma, and the two BVS did not overlap. We avoided the use of anticoagulants following surgery, as this could have aggravated the dissection[ 10 ]. However the coronary artery dissection did not get worse when re-examined 6 months later, arteries heal slowly. It may be shown that insufficient repair ability of vascular endothelial cells in diabetic patients[ 11 ]. Additional BVS coverage of coronary D-type dissection with the help of imaging tools may be a practical strategy when patients have a strong desire for coronary metal-less implantation. Furthermore, imaging review is recommended especially for diabetics. Abbreviations PCI: Percutaneous coronary intervention; PTCA：Percutaneous transluminal coronary angioplasty; LDL-C Low-density lipoprotein cholesterol TIMI：Thrombolysis in myocardial infarction trial; LAD: Left anterior descending; LCX: Left circumfex; OM:obtuse; marginal DES: Drug eluting stent; BVS: Bioresorbable vascular scaffold; OCT: Optical coherence tomography; NHLBI：National heart lung and blood institute. Declarations Acknowledgements Not applicable. Authors’ contributions Dengshuang Zhou was a major contributor in writing the manuscript. Bobin Huang and Jue Chen contributed to the writing of the manuscript and its editing. Qiong You and Hailiang Mo were the principal operators and contributed to the suggestions of the manuscript. Zijun Wu and Yubiao Lin contributed to the acquisition and annotation of images. Junyu Fan and Wenyu Deng contributed to the collection of patient data. Keng Wu contributed to case presentations and discussions.All authors read and approved the final manuscript. Funding No funding was obtained during the publication of this case. Availability of data and materials Not applicable. Ethics approval and consent to participate Ethics approval—not applicable. Written consent was obtained for the procedure. Consent for publication Written consent was obtained for publication of this case report. Competing interests The authors declare they have no competing interests. References Zasada W and D. A, Dissections after bioresorbable vascular scaffold implantation in the POLAR ACS Registry. Postepy Kardiol Interwencyjnej. 2022. 18(2): 131-136. Lin Hui, et al. Impact of Dissection after Drug Coated Balloon Treatment of De Novo Coronary Lesions Angiographic and Clinical Outcomes. Yinsei Medical Journal, 2020. 61(12): 1004-1012. Huber MS, Mooney JF and M. Madison J, Use of a morphologic classification to predict clinical outcome after dissection from coronary angioplasty. Use of a morphologic classification to predict, 1991. 68(5): 467-471. Anantharaman R, et al., Iatrogenic catheter induced ostial coronary artery dissections Prevalence, management, and mortality from a cohort of 55,968 patients over 10 years. Catheter Cardiovasc Interv, 2020. 98(4): 649-655. John H and J.P. G, Iatrogenic Aortocoronary Dissection During Percutaneous Coronary Intervention_ Investigation and Management. JACC Case Rep, 2021. 3(1): 1-5. Aikawa T, et al., Treatment of an iatrogenic left main coronary artery dissection and intramural hematoma by fenestration instead of stent implantation. Hellenic J Cardiol, 2022. 65: 61-63. Albertal M, et al., Uncomplicated moderate coronary artery dissections after balloon angioplasty good outcome without stenting. Heart, 2021. 86: 193-198. Toshiki K, et al., Long term outcomes of periprocedural coronary dissection and perforation for patients undergoing percutaneous coronary intervention in a Japanese multicenter registry. Sci Rep, 2023. 13(1): e20318. Mahmood M and A. D, IVUS and OCT guided primary percutaneous coronary intervention for spontaneous coronary artery dissection with bioresorbable vascular scaffolds. Cardiovasc Revasc Med, 2017. 18(1): 53-57. Takeshi O, et al., Intramural hematoma extending from a dissection within an implanted stent: a case report treated with fenestration using a cutting balloon. Eur Heart J Case Rep, 2024. 8(5): e223. Krishnara BS, et al., Vascular Regenerative Cell Deficiencies in South Asian Adults. J of the American college of cardiology, 2024. 83(7): 755-769. Additional Declarations No competing interests reported. Supplementary Files supplementary.rar Cite Share Download PDF Status: Published Journal Publication published 01 Dec, 2025 Read the published version in BMC Cardiovascular Disorders → Version 1 posted Editorial decision: Revision requested 08 Nov, 2024 Reviews received at journal 07 Nov, 2024 Reviewers agreed at journal 06 Nov, 2024 Reviewers agreed at journal 23 Oct, 2024 Reviews received at journal 21 Oct, 2024 Reviews received at journal 14 Oct, 2024 Reviewers agreed at journal 14 Oct, 2024 Reviewers agreed at journal 10 Oct, 2024 Reviewers invited by journal 08 Oct, 2024 Editor invited by journal 25 Sep, 2024 Editor assigned by journal 21 Sep, 2024 Submission checks completed at journal 21 Sep, 2024 First submitted to journal 06 Sep, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5044262","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":375612500,"identity":"bb6a5b53-f7eb-479f-891d-40c9b98dcd59","order_by":0,"name":"Dengshuang Zhou","email":"","orcid":"","institution":"Affiliated Hospital of Guangdong Medical College Hospital","correspondingAuthor":false,"prefix":"","firstName":"Dengshuang","middleName":"","lastName":"Zhou","suffix":""},{"id":375612501,"identity":"7f4e9c96-4376-4502-b0f7-fcd30d7ddfbd","order_by":1,"name":"Bobin Huang","email":"","orcid":"","institution":"Affiliated Hospital of Guangdong Medical College Hospital","correspondingAuthor":false,"prefix":"","firstName":"Bobin","middleName":"","lastName":"Huang","suffix":""},{"id":375612502,"identity":"b07690ae-72ca-4a11-826d-21d63ee886e2","order_by":2,"name":"Jue Chen","email":"","orcid":"","institution":"Affiliated Hospital of Guangdong Medical College Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jue","middleName":"","lastName":"Chen","suffix":""},{"id":375612503,"identity":"48d3bdd7-16fb-4073-b50f-1b0ceed07ad9","order_by":3,"name":"Qiong You","email":"","orcid":"","institution":"Affiliated Hospital of Guangdong Medical College Hospital","correspondingAuthor":false,"prefix":"","firstName":"Qiong","middleName":"","lastName":"You","suffix":""},{"id":375612504,"identity":"a98faf42-b3fa-41cd-9adb-b264d571db11","order_by":4,"name":"Hailiang Mo","email":"","orcid":"","institution":"Affiliated Hospital of Guangdong Medical College Hospital","correspondingAuthor":false,"prefix":"","firstName":"Hailiang","middleName":"","lastName":"Mo","suffix":""},{"id":375612506,"identity":"45f828fd-02d0-4713-8004-c25c5fe80f8a","order_by":5,"name":"Zijun Wu","email":"","orcid":"","institution":"Affiliated Hospital of Guangdong Medical College Hospital","correspondingAuthor":false,"prefix":"","firstName":"Zijun","middleName":"","lastName":"Wu","suffix":""},{"id":375612507,"identity":"bc8ac926-8cc8-418f-88ef-504a779380da","order_by":6,"name":"Yubiao Lin","email":"","orcid":"","institution":"Affiliated Hospital of Guangdong Medical College Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yubiao","middleName":"","lastName":"Lin","suffix":""},{"id":375612508,"identity":"bc66e8ab-8f01-41d5-b798-f861d69e3168","order_by":7,"name":"Lujun Chen","email":"","orcid":"","institution":"Affiliated Hospital of Guangdong Medical College Hospital","correspondingAuthor":false,"prefix":"","firstName":"Lujun","middleName":"","lastName":"Chen","suffix":""},{"id":375612510,"identity":"50599836-5ee2-4201-95ab-430c8e5ba557","order_by":8,"name":"Junyu Fan","email":"","orcid":"","institution":"Affiliated Hospital of Guangdong Medical College Hospital","correspondingAuthor":false,"prefix":"","firstName":"Junyu","middleName":"","lastName":"Fan","suffix":""},{"id":375612511,"identity":"0ec95841-53bd-4cfb-973b-d31fd8c82507","order_by":9,"name":"Wenyu Deng","email":"","orcid":"","institution":"Affiliated Hospital of Guangdong Medical College Hospital","correspondingAuthor":false,"prefix":"","firstName":"Wenyu","middleName":"","lastName":"Deng","suffix":""},{"id":375612512,"identity":"7e5ab9d5-4f64-45d3-a941-427bb4e68549","order_by":10,"name":"Keng Wu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAz0lEQVRIiWNgGAWjYBACfvmDjY9/VPyT42dvIFKL5AzmZmOGMweMJXsOEKnF4AZ7mzRj24HEDTMSiHXZ7cZm44Izd4wNJB9vvMFQYxNNUAfjHKBfZlQ8kzOXTiu2YDiWlttASAszQ2KzAc8ZZmPL2TlmEowNhwlrYWNIbJPgbWNO3HDzDJFaeCQS26R52w4nbrjBQ6QWCZ6DzYYzzqQBAxnolwRi/GJ/vP3hgw8VNsCoPLzxxocaG8JakIGBRAIpyiFaSNUxCkbBKBgFIwMAAMCORdv248tGAAAAAElFTkSuQmCC","orcid":"","institution":"Affiliated Hospital of Guangdong Medical College Hospital","correspondingAuthor":true,"prefix":"","firstName":"Keng","middleName":"","lastName":"Wu","suffix":""}],"badges":[],"createdAt":"2024-09-06 12:27:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5044262/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5044262/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12872-025-05243-0","type":"published","date":"2025-12-01T15:57:11+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":71559308,"identity":"e6451513-7faa-4825-8bda-7e33dafa8eed","added_by":"auto","created_at":"2024-12-16 16:42:21","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":183261,"visible":true,"origin":"","legend":"\u003cp\u003eThe patient's first coronary angiography (A-F). (A-B)The proximal circumflex branch is severely narrow, and A tortuous aneurysm can be observed after narrowing section. (C-D) Diffuse long stenosis appeared in proximal segment of the left anterior descending branch. (E-F) Severe stenosis in the middle section of the right coronary artery. Aneurysm present after stenosis..\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5044262/v1/404f310af5320352d588d807.png"},{"id":71559309,"identity":"d9f88b86-8db0-45f5-993a-2d59d3c244b7","added_by":"auto","created_at":"2024-12-16 16:42:21","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":255920,"visible":true,"origin":"","legend":"\u003cp\u003eOCT images of the anterior descending branch after BVS implantation(a-d). The 2.75mm*24mm Neovas absorbable stent was accurately positioned near the left anterior descending branch and released at 12 atm. The diagonal branch guide wire was withdrawn, and the 3.0mm non-compliant balloon was expanded at 10atm. OCT showed good adherence(b-d). a. distance reference, lumen area 4.15 mm\u003csup\u003e2\u003c/sup\u003e, mean diameter 2.30 mm. b.the edge of distance scaffold, lumen area 4.82 mm\u003csup\u003e2\u003c/sup\u003e. c.max lumen area 6.55 mm\u003csup\u003e2\u003c/sup\u003e, mean diameter 2.88 mm. d.the edge of proximal scaffold, lumen area 4.26mm\u003csup\u003e2\u003c/sup\u003e.e.The final coronary angiogram following the BVS implantation. f.Abbreviations: Dist, distance;Prox, proximal; Max LA, maximum lumen area; Mean D,mean diameter\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5044262/v1/2dc91d9f789a6f85d766cf8f.png"},{"id":71559311,"identity":"1bb29e37-a0df-49da-9468-b45f5fcff4c3","added_by":"auto","created_at":"2024-12-16 16:42:21","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":296508,"visible":true,"origin":"","legend":"\u003cp\u003eThe OCT images of BVS before and after the circumflex stent placement（A-B-E,C-D-F）.(A) Minimum lumen area 1.19mm\u003csup\u003e2\u003c/sup\u003e mean diameter 1.22mm. (B)LCX proximal reference data. Lumen area 9.07mm\u003csup\u003e2\u003c/sup\u003e, mean diameter 3.41mm.(C)The BVS is not fully expanded(red arrow) ,stent area 9.8mm\u003csup\u003e2\u003c/sup\u003e, lumen area 10.45mm\u003csup\u003e2\u003c/sup\u003e. (D)Secondary dissection 1mm after the distal of first stent, with average diameter 1.40mm and area about 1.51mm\u003csup\u003e2\u003c/sup\u003e. (E) vascular profile of Preoperative OCT. (F)vascular profile of Postoperative OCT. (G)Preoperative coronary angiography of LCX stenosis . (H) Coronary angiography after BVS implantation. (I) A spiralendo vascular dissection occured after post-dilatation.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-5044262/v1/56bb45c05876a53e4e2667bc.png"},{"id":71559917,"identity":"27cc6566-0998-4ec7-9b30-b1a768964363","added_by":"auto","created_at":"2024-12-16 16:50:21","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":330538,"visible":true,"origin":"","legend":"\u003cp\u003eThe OCT images of the second LCX BVS closed dissection(A, B, E)and reexamination 6 months later(C, D, G). (A) distal vascular references，(B) the dissection is closed .average diameter 1.28mm, erea 1.20mm\u003csup\u003e2\u003c/sup\u003e. (C) distal vascular references of reexamination (D) the dissection of reexamination. average diameter 1.40mm, erea 1.51mm\u003csup\u003e2\u003c/sup\u003e. No deterioration was observed. (E) vascular profile of treatment for the dissection.(F) Coronary angiography of the dissection closed. (G) vascular profile of reexamination for the dissection. (H) Coronary angiography of reexamination.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-5044262/v1/385b4e2b9f83fbfee43a786c.png"},{"id":71559310,"identity":"202280da-59e7-4106-8018-930e69765e2e","added_by":"auto","created_at":"2024-12-16 16:42:21","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":63715,"visible":true,"origin":"","legend":"\u003cp\u003eTimeline events\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-5044262/v1/14f229359d7611c395b1fff5.png"},{"id":97723781,"identity":"937f9bb5-03b9-488a-a5a1-e32a90232f7e","added_by":"auto","created_at":"2025-12-08 16:06:08","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1617993,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5044262/v1/72292bb8-0110-424b-95ec-ab6e0bb430cd.pdf"},{"id":71559340,"identity":"1757cba1-dd13-4e37-9f16-2915f23193c6","added_by":"auto","created_at":"2024-12-16 16:42:28","extension":"rar","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":338302026,"visible":true,"origin":"","legend":"","description":"","filename":"supplementary.rar","url":"https://assets-eu.researchsquare.com/files/rs-5044262/v1/afbf24bfeb4ace4480324a59.rar"}],"financialInterests":"No competing interests reported.","formattedTitle":"Optical coherence tomography guided additional noevas bioresorbable vascular scaffold in the treatment of iatrogenic coronary artery dissection: A case report","fulltext":[{"header":"Introduction","content":"\u003cp\u003eImplanting bioresorbable vascular scaffold stents is one of the major treatment interventions for coronary.Secondary coronary dissection implies that intima injury during percutaneous coronary intervention accompanied by local thrombosis, and severe dissection can cause coronary artery rupture [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] and large-scale myocardial necrosis [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. However, there are limited treatment options for the emergence of dissection during BVS implantation.In this case, secondary dissection occurred in the distal segment of the stent when Noevas stent was inserted in the proximal segment of the circumflex branch. Additional BVS was inserted to cover the hematoma; with no deterioration of the circumflex branch dissection after 6 months.\u003c/p\u003e"},{"header":"Case presentation","content":"\u003cp\u003eA 49-year-old man, was admitted to the cardiology department due to repeated chest pain for 7 days and aggravation for 2 days on April 05, 2021. The patient complained of press-like dull pain in the lower sternum after the activity, The above symptoms could be relieved after taking nitroglycerin tablets. The above symptoms occurred frequently 2 days ago, and the pain was aggravated and unbearable. He has had type 2 diabetes for 10 years, taken gliclazide tablets for a long time, self-reported fasting blood glucose of 11mmol/L, a smoking history of 30 years, a drinking history of 30 years, and denied the history of hypertension and family history of coronary heart disease. Admission blood pressure 145/79mmHg, HR 80bpm, HbA1c 9.9%, LDL-C 4.1mmol/L, blood routine, liver and kidney function, thyroid function, N-terminal B-type brain natriuretic peptide precursor, D-dimer, and myocardial markers were all within the normal range. Color echocardiography: decreased left ventricular diastolic function. Combined with the patient's symptoms and history, the main diagnosis was considered to be coronary atherosclerotic heart disease: unstable angina pectoris, and treatment should be given to reduce blood glucose, double antiplatelet, plaque stabilization, coronary artery dilation, and reduce cardiac oxygen consumption. Communicate with family members about the condition, plan coronary angiography and possible interventional treatment, and sign informed consent.\u003c/p\u003e \u003cp\u003eTransradial coronary angiography was performed under local anesthesia On April 6, 2021. The results revealed that the coronary artery was right-dominant; no obstructive lesions were found in the left major artery, and the proximal segment of the left anterior descending branch was 80%-99% stenosis, with grade II TIMI blood flow. The middle part of the left circumflex branch was 70%-90% stenosis, the middle part of the right coronary artery was 80%-90% stenosis, and the blood flow in TIMI was grade III. The patient preferred coronary interventional therapy the next day without metallic implantation. The left anterior descending and left circumflex branches were treated on April 8, 2021.\u003c/p\u003e \u003cp\u003eAs Medtronic semi-compliant balloon was used for pre-dilation ,The Neovas BVS accurately positioned the proximal segment of the left anterior descending branch and released it. A Neovas BVS (3.0mm×15mm) was accurately located in the proximal section of left circumflex branches and released at 12atm×30s follow after pre-expansion. The OCT showed that the internal distal section of the stent was not appropriately attached to the wall of LCX. The Neovas stent balloon was withdrawn to squeeze the stent at 12atm×15s. Angiography showed torn and dissected distal intima of the stent. Another 3.0mm×15mm Neovas BVS was connected in series with the proximal stent and released and a non-compliant balloon was expanded at 10atm×10s. The OCT showed a fully expanded and well-attached stent. No additional dissection or contrast agent retention was observed at the edge of the stent; no residual stenosis was observed, and the distal TIMI blood flow was grade III. The operation was completed without chest pain and shortness of breath.\u003c/p\u003e \u003cp\u003eThe patient was re-admitted to our department for coronary angiography. Firstly dilatational angioplasty with a drug-coated balloon was performed in the middle section of the right coronary artery, followed by the guide wire entering the circumflex branch. The OCT detected the hyperplasia of the near intimal in the original proximal section of the stent, and the lumen stenosis was approximately 95%.To our surprise, The previous dissection area has not been expanded. In the end stenosis was significantly reduced while scoring balloon and drug-coated balloon was used for dilatation.\u003c/p\u003e "},{"header":"Discussion and Conclusion","content":"\u003cp\u003eThe factors causing dissection after PTCA(Percutaneous transluminal coronary angioplasty, PTCA) surgery are common, including calcification[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], balloon vascular diameter ratio and repeated balloon dilation[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. This disease becomes the interventional complication caused by high pressure following expansion and tortuous vascular distal. According to the pathological features of the NHLBI classification system, the spiral dissection in this case belongs to type D[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], warranting necessary remedial treatment measures[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The common treatment of coronary dissection has the following risks:(a) the consequences are severe if the guide wire strays into the false cavity near the main branch or the opening; coronary artery bypass grafting is even necessary[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. (b) Balloon dilation may induce the hematoma to move or even extend, causing stenosis or even obstruction of the dilated segment, which cannot be immediately supported and requires hematoma window opening[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] (c) Hematoma healing may cause stent dislocation or displacement (d) Slow blood flow or even no-reflow. PTCA may cause plaque rupture, intima tear, and local media tear by itself. Therefore, type A and type B dissection are more prevalent and usually treated conservatively[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Type C-F exposes collagen and tissue factors to the blood, therefore, stents are usually necessary to stabilize the lumen structure to prevent cardiovascular events caused by delayed exacerbation of hematoma during and after surgery[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In this case, the proximal BVS stent beam network was slightly 140µm thick, and the posterior dilatation pressure potentially exceeded the elastic tension of the tube wall, and the vascular shap around the dissection are tortuous, causing coronary artery dissection. However, the middle and distal segment of the LCX had features including no severe calcification, no OM branch, a diameter greater than 2.5mm, and grade III TIMI blood flow. Studies have reported the placement of BVS in spontaneous coronary dissection with the help of intracavity imaging[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]; nonetheless, the situation in secondary dissection is seldom. At this time, DES implantation was not the first selection for patients, and no apparent limitation was observed in coronary blood flow observation. Thus, using a cutting balloon was inappropriately. After repeated measurement and comparison, BVS was closely connected to the original proximal BVS, and then OCT was re-examined. The BVS completely covered the hematoma, and the two BVS did not overlap. We avoided the use of anticoagulants following surgery, as this could have aggravated the dissection[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. However the coronary artery dissection did not get worse when re-examined 6 months later, arteries heal slowly. It may be shown that insufficient repair ability of vascular endothelial cells in diabetic patients[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAdditional BVS coverage of coronary D-type dissection with the help of imaging tools may be a practical strategy when patients have a strong desire for coronary metal-less implantation. Furthermore, imaging review is recommended especially for diabetics.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003ePCI: Percutaneous coronary intervention; PTCA：Percutaneous transluminal coronary angioplasty; LDL-C Low-density lipoprotein cholesterol \u0026nbsp;TIMI：Thrombolysis in myocardial infarction trial; LAD: Left anterior descending; LCX: Left circumfex; OM:obtuse; marginal DES: Drug eluting stent; BVS: Bioresorbable vascular scaffold; OCT: Optical coherence tomography; NHLBI：National heart lung and blood institute.\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDengshuang Zhou was a major contributor in writing the manuscript.\u0026nbsp;Bobin Huang and Jue Chen\u0026nbsp;contributed to the writing of the manuscript and its editing.\u0026nbsp;Qiong You and Hailiang Mo\u0026nbsp;were the principal operators and contributed to the suggestions of the manuscript.\u0026nbsp;Zijun Wu and Yubiao Lin\u0026nbsp;contributed to the acquisition and annotation of images.\u0026nbsp;Junyu Fan and Wenyu Deng\u0026nbsp;contributed to the collection of patient data. Keng Wu contributed to case presentations and discussions.All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was obtained during the publication of this case.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthics approval—not applicable. Written consent was obtained for the procedure.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten consent was obtained for publication of this case report.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare they have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eZasada W and D. A, Dissections after bioresorbable vascular scaffold implantation in the POLAR ACS Registry. Postepy Kardiol Interwencyjnej. 2022. 18(2): 131-136.\u003c/li\u003e\n\u003cli\u003eLin Hui, et al. Impact of Dissection after Drug Coated Balloon Treatment of De Novo Coronary Lesions Angiographic and Clinical Outcomes. Yinsei Medical Journal, 2020. 61(12): 1004-1012.\u003c/li\u003e\n\u003cli\u003eHuber MS, Mooney JF and M. Madison J, Use of a morphologic classification to predict clinical outcome after dissection from coronary angioplasty. Use of a morphologic classification to predict, 1991. 68(5): 467-471.\u003c/li\u003e\n\u003cli\u003eAnantharaman R, et al., Iatrogenic catheter induced ostial coronary artery dissections Prevalence, management, and mortality from a cohort of 55,968 patients over 10 years. Catheter Cardiovasc Interv, 2020. 98(4): 649-655.\u003c/li\u003e\n\u003cli\u003eJohn H and J.P. G, Iatrogenic Aortocoronary Dissection During Percutaneous Coronary Intervention_ Investigation and Management. JACC Case Rep, 2021. 3(1): 1-5.\u003c/li\u003e\n\u003cli\u003eAikawa T, et al., Treatment of an iatrogenic left main coronary artery dissection and intramural hematoma by fenestration instead of stent implantation. Hellenic J Cardiol, 2022. 65: 61-63.\u003c/li\u003e\n\u003cli\u003eAlbertal M, et al., Uncomplicated moderate coronary artery dissections after balloon angioplasty good outcome without stenting. Heart, 2021. 86: 193-198.\u003c/li\u003e\n\u003cli\u003eToshiki K, et al., Long term outcomes of periprocedural coronary dissection and perforation for patients undergoing percutaneous coronary intervention in a Japanese multicenter registry. Sci Rep, 2023. 13(1): e20318.\u003c/li\u003e\n\u003cli\u003eMahmood M and A. D, IVUS and OCT guided primary percutaneous coronary intervention for spontaneous coronary artery dissection with bioresorbable vascular scaffolds. Cardiovasc Revasc Med, 2017. 18(1): 53-57.\u003c/li\u003e\n\u003cli\u003eTakeshi O, et al., Intramural hematoma extending from a dissection within an implanted stent: a case report treated with fenestration using a cutting balloon. Eur Heart J Case Rep, 2024. 8(5): e223.\u003c/li\u003e\n\u003cli\u003eKrishnara BS, et al., Vascular Regenerative Cell Deficiencies in South Asian Adults. J of the American college of cardiology, 2024. 83(7): 755-769.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Percutaneous coronary intervention, dissection, bioresorbable vascular scaffold，optical coherence tomography","lastPublishedDoi":"10.21203/rs.3.rs-5044262/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5044262/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eIatrogenic coronary artery dissection is a potential complication during percutaneous coronary bioresorbable vascular scaffolds placement. We report that significant dissection occurred during post-expansion of the left rotatory branch bioresorbable vascular scaffolds to attach it to the wall. Additional resorbable stents successfully covered the dissection without blood flow restriction.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCasereport: \u003c/strong\u003eThe patient was a 49-year-old male with strong coronary implantable concept and was diagnosed with stable angina pectoris and type 2 diabetes. Coronary angiography showed serious lesions in three vessels. After a Noevas stent was inserted in the proximal segment of the anterior descending branch, secondary dissection occurred in the distal segment of the stent during Optical coherence tomography（OCT） examination when Noevas stent was inserted in the proximal segment of the circumflex branch. A third BVS was inserted to cover the dissection and OCT reexamination showed good adherence. After 6 months of coronary angiography, OCT examination showed no deterioration of the circumflex branch dissection, and the proximal intimal hyperplasia in the proximal BVS was 95%. Scoring balloon and drug balloon dilatation were successfully performed, and right coronary artery dilatation with drug coated balloon was performed. The patient had no symptoms of chest pain after 2 years of follow-up.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eAdditional bioresorbable vascular scaffold coverage of coronary D-type dissection with the help of imaging tools may be a practical strategy when patients have a strong desire for coronary metal-less implantation. Furthermore, imaging review is recommended especially for diabetics.\u003c/p\u003e","manuscriptTitle":"Optical coherence tomography guided additional noevas bioresorbable vascular scaffold in the treatment of iatrogenic coronary artery dissection: A case report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-16 16:42:17","doi":"10.21203/rs.3.rs-5044262/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-11-08T07:06:18+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-07T09:05:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"176061121345825268855284992173908283261","date":"2024-11-06T16:02:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"287636960269523532409998706251269464609","date":"2024-10-23T10:23:46+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-10-21T18:58:49+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-10-14T15:40:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"332465408546676874048724491241725840109","date":"2024-10-14T09:38:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"296698594184863236195044072128288278293","date":"2024-10-10T22:17:58+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-10-08T12:29:32+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-09-25T12:37:20+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-09-21T05:56:40+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-09-21T05:54:40+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Cardiovascular Disorders","date":"2024-09-06T12:25:54+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9cfd5842-ce60-4dd1-a89f-1d8b6879e078","owner":[],"postedDate":"December 16th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-08T15:59:46+00:00","versionOfRecord":{"articleIdentity":"rs-5044262","link":"https://doi.org/10.1186/s12872-025-05243-0","journal":{"identity":"bmc-cardiovascular-disorders","isVorOnly":false,"title":"BMC Cardiovascular Disorders"},"publishedOn":"2025-12-01 15:57:11","publishedOnDateReadable":"December 1st, 2025"},"versionCreatedAt":"2024-12-16 16:42:17","video":"","vorDoi":"10.1186/s12872-025-05243-0","vorDoiUrl":"https://doi.org/10.1186/s12872-025-05243-0","workflowStages":[]},"version":"v1","identity":"rs-5044262","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5044262","identity":"rs-5044262","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}