P67 MAGMARIS FRACTURE AND COLLAPSE DURING PCI: ACUTE TREATMENT AND FOLLOW–UP

Abstract

Abstract Resorbable Magnesium Scaffold (RMS) Magmaris represents an attractive alternative to permanent metal stenting in young patients undergoing PCI. Despite the promising long–term results, especially in terms of scaffold thrombosis, no data on acute RMS deployment failure and subsequent treatment are available. A 44–year–old gentleman with history of effort angina was admitted to our Department to perform coronary angiography. The exam showed an intermediate stenosis in the mid–tract of Left Anterior Descending (LAD, Figure 1, Panel A1), functionally significant (Instantaneous wave–free ratio 0.85). After Optical Coherence Tomography (OCT) evaluation (Panel A2), a wire was placed in Second Diagonal Branch (DG2) and predilation with a NC 3.5mm balloon on mid–tract of LAD was performed, followed by 3.5x25mm Magmaris implantation. Multiple runs performed after removing the jailed guidewire on Dg2, showed a remarkable angiographic result (Panel B1). However, OCT showed struts fracture near the distal RMS segment resulting in scaffold collapse as confirmed by 3D–reconstruction (Panel B2, B3). Therefore, scaffold dilatation with NC 3.5mm balloon was performed, followed by Magmaris 3.5x20mm intra–scaffold implantation. Panel C1 and C2 showed good angiographic and OCT results after postdilatation with NC 3.5 and 4.0mm balloon in the distal and proximal part, respectively. A planned one–year angiography (Panel D1) revealed a small aneurismatic enlargement in the previous overlapped segment, while no residual struts were visible at OCT. (Panel D2) To our knowledge we reported the first case of Magmaris acute fracture (probably due to a forced removal of the Dg2 jailed guidewire) treated with a second intra–scaffold RMS. The present case should emphasize the importance of intracoronary imaging guidance while more data are needed to clarify the optimal treatment of acute RMS implantation failure.