Evolving changes in vessel wall as seen in OCT over the years after Bioresorbable scaffold (BRS) implantation @mmamas1973 @ziadalinyc @DrJayMohan @SripalBangalore #BRS #OCT #cardiotwitter #imagingfirst
1/ Immediate post-implantation: "Preserved Box" appearance (Meryl MeRes 100 BRS)
2/ Preserved Boxes which is defined as a box appearance with sharply defined borders w/ bright reflection while strut body shows the low reflection 
3/ The polymeric struts of scaffold are translucent to light, hence OCT can be used to evaluate the vessel wall behind the scaffolds unlike the metal struts which give shadowing effect
4/ "Preserved box" pattern changes to "Open boxes" in 2nd stage.
Open box: Long axis is seen but short axis of box is not seen.
Open box: Long axis is seen but short axis of box is not seen.
5/ The later changes of BVS resorption in the vessel wall are seen as "black and white dissolving boxes" These are usually seen after 2-3 years of implantation.
6/ Stage1: Preserved boxes
Stage2: Open boxes
Stage3: Dissolving black and white boxes
Stage2: Open boxes
Stage3: Dissolving black and white boxes
7/ Scaffold strut footprints as shown in OCT over the years after BRS implantation (picture sourced from internet)
8/ Practical tip on post-BRS OCT: The "Apposition marker" & "Rendered stent" option seen in post-PCI OCT images after metal stent implantation is not seen & seems to be disabled in post-BRS OCT evaluation.
9/ Reason: The scaffold is devoid of metal, hence OCT doesnt sense it; the appostion scale & rendered stent option is not seen in post BRS OCT.
The only option is to measure the malapposition manualy in post BRS OCT images.
The only option is to measure the malapposition manualy in post BRS OCT images.
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