TY - JOUR
T1 - Very Late Scaffold Thrombosis
T2 - Intracoronary Imaging and Histopathological and Spectroscopic Findings
AU - Räber, Lorenz
AU - Brugaletta, Salvatore
AU - Yamaji, Kyohei
AU - O'Sullivan, Crochan J.
AU - Otsuki, Shuji
AU - Koppara, Tobias
AU - Taniwaki, Masanori
AU - Onuma, Yoshinobu
AU - Freixa, Xavier
AU - Eberli, Franz R.
AU - Serruys, Patrick W.
AU - Joner, Michael
AU - Sabaté, Manel
AU - Windecker, Stephan
N1 - Publisher Copyright:
© 2015 American College of Cardiology Foundation.
PY - 2015/10/27
Y1 - 2015/10/27
N2 - Background Bioresorbable scaffolds provide transient lumen support followed by complete resorption. Objectives This study examined whether very late scaffold thrombosis (VLScT) occurs when resorption is presumed to be nearly complete. Methods Patients with VLScT at 3 tertiary care centers underwent thrombus aspiration followed by optical coherence tomography (OCT). Thrombus aspirates were analyzed by histopathological and spectroscopic examination. Results Between March 2014 and February 2015, 4 patients presented with VLScT at 44 (case 1), 19 (cases 2 and 4), and 21 (case 3) months, respectively, after implantation of an Absorb Bioresorbable Vascular Scaffold 1.1 (Abbott Laboratories, Abbott Park, Illinois). At the time of VLScT, all patients were taking low-dose aspirin, and 2 patients were also taking prasugrel. OCT showed malapposed scaffold struts surrounded by thrombus in 7.1%, 9.0%, and 8.9% of struts in cases 1, 2, and 4, respectively. Scaffold discontinuity with struts in the lumen center was the cause of malapposition in cases 2 and 4. Uncovered scaffold struts with superimposed thrombus were the predominant findings in case 3. OCT percent area stenosis at the time of VLScT was high in case 1 (74.8%) and case 2 (70.9%) without evidence of excessive neointimal hyperplasia. Spectroscopic thrombus aspirate analysis showed persistence of intracoronary polymer fragments in case 1. Conclusions VLScT may occur at advanced stages of scaffold resorption. Potential mechanisms specific for VLScT include scaffold discontinuity and restenosis during the resorption process, which appear delayed in humans; these findings suggest an extended period of vulnerability for thrombotic events.
AB - Background Bioresorbable scaffolds provide transient lumen support followed by complete resorption. Objectives This study examined whether very late scaffold thrombosis (VLScT) occurs when resorption is presumed to be nearly complete. Methods Patients with VLScT at 3 tertiary care centers underwent thrombus aspiration followed by optical coherence tomography (OCT). Thrombus aspirates were analyzed by histopathological and spectroscopic examination. Results Between March 2014 and February 2015, 4 patients presented with VLScT at 44 (case 1), 19 (cases 2 and 4), and 21 (case 3) months, respectively, after implantation of an Absorb Bioresorbable Vascular Scaffold 1.1 (Abbott Laboratories, Abbott Park, Illinois). At the time of VLScT, all patients were taking low-dose aspirin, and 2 patients were also taking prasugrel. OCT showed malapposed scaffold struts surrounded by thrombus in 7.1%, 9.0%, and 8.9% of struts in cases 1, 2, and 4, respectively. Scaffold discontinuity with struts in the lumen center was the cause of malapposition in cases 2 and 4. Uncovered scaffold struts with superimposed thrombus were the predominant findings in case 3. OCT percent area stenosis at the time of VLScT was high in case 1 (74.8%) and case 2 (70.9%) without evidence of excessive neointimal hyperplasia. Spectroscopic thrombus aspirate analysis showed persistence of intracoronary polymer fragments in case 1. Conclusions VLScT may occur at advanced stages of scaffold resorption. Potential mechanisms specific for VLScT include scaffold discontinuity and restenosis during the resorption process, which appear delayed in humans; these findings suggest an extended period of vulnerability for thrombotic events.
KW - bioresorbable scaffold
KW - coronary artery disease
KW - optical coherence tomography
KW - thrombosis
UR - http://www.scopus.com/inward/record.url?scp=84945971031&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2015.08.853
DO - 10.1016/j.jacc.2015.08.853
M3 - Article
C2 - 26493663
AN - SCOPUS:84945971031
SN - 0735-1097
VL - 66
SP - 1901
EP - 1914
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 17
ER -