Serial Angioscopic Evaluation of Arterial Repair After the Implantation of Drug-Coated Stent at the Culprit of Acute Coronary Syndrome

BioFreedom is drug-coated stent (DCS) which has polymer-free design. Although it is expected to achieve earlier arterial repair after DCS implantation as compared to the other drug-eluting stents, angioscopic findings have not been described to date. This is the first report of serial angioscopic observation of DCS implanted at acute coronary syndrome (ACS) culprit. A 75-year-old man was admitted with ACS. Coronary angiogram revealed severe stenosis and thrombus in a large diagonal artery. DCS (BioFreedom 3.0 × 18 mm) was implanted at the culprit of ACS. Coronary angioscopy was performed immediately, one and a half months, and 1 year after stent implantation to evaluate arterial repair after the implantation. Coronary angioscopy showed that uncovered stent struts on the white vessel wall and culprit ruptured yellow plaque with stent struts penetration were observed immediately after stent implantation. At one and a half months, majority of stent struts were not yet covered by neointima and the ruptured yellow plaque remained unhealed with thrombus adhesion. At one year under continued dual antiplatelet therapy, ruptured yellow plaque was covered by white neointima and no thrombus was observed. Although DCS implanted at ACS culprit was well covered by white neointima without thrombus at 1 year, arterial repair at one and half months after DCS implantation did not appear good yet.