Mechanisms of Very Late Bioresorbable Scaffold Thrombosis: The INVEST Registry.

Yamaji, Kyohei; Ueki, Yasushi; Souteyrand, Geraud; Daemen, Joost; Wiebe, Jens; Nef, Holger; Adriaenssens, Tom; Loh, Joshua P; Lattuca, Benoit; Wykrzykowska, Joanna J; Gomez-Lara, Josep; Timmers, Leo; Motreff, Pascal; Hoppmann, Petra; Abdel-Wahab, Mohamed; Byrne, Robert A; Meincke, Felix; Boeder, Niklas; Honton, Benjamin; O'Sullivan, Crochan J; ... (2017). Mechanisms of Very Late Bioresorbable Scaffold Thrombosis: The INVEST Registry. Journal of the American College of Cardiology, 70(19), pp. 2330-2344. Elsevier 10.1016/j.jacc.2017.09.014

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BACKGROUND Very late scaffold thrombosis (VLScT) occurs more frequently after bioresorbable scaffold (Absorb BVS 1.1, Abbott Vascular, Santa Clara, California) implantation than with metallic everolimus-eluting stents. OBJECTIVES The purpose of this study was to elucidate mechanisms underlying VLScT as assessed by optical coherence tomography (OCT). METHODS The INVEST (Independent OCT Registry on Very Late Bioresorbable Scaffold Thrombosis) registry is an international consortium of investigators who used OCT to examine patients with VLScT. RESULTS Between June 2013 and May 2017, 36 patients with 38 lesions who had VLScT underwent OCT at 19 centers. VLScT occurred at a median of 20 months (interquartile range: 16 to 27 months) after implantation. At the time of VLScT, 83% of patients received aspirin monotherapy and 17% received dual-antiplatelet therapy. The mechanisms underlying VLScT were (in descending order) scaffold discontinuity (42.1%), malapposition (18.4%), neoatherosclerosis (18.4%), underexpansion or scaffold recoil (10.5%), uncovered struts (5.3%), and edge-related disease progression (2.6%). Discontinuity (odds ratio [OR]: 110; 95% confidence interval [CI]: 73.5 to 173; p < 0.001), malapposed struts (OR: 17.0; 95% CI: 14.8 to 19.7; p < 0.001), and uncovered struts (OR: 7.3; 95% CI: 6.2 to 8.8; p < 0.001) were more frequent in the thrombosed than the nonthrombosed scaffold regions. In 2 of 16 patients with scaffold discontinuity, intercurrent OCT before VLScT provided evidence of circularly apposed scaffold struts with minimal tissue coverage. CONCLUSIONS The leading mechanism underlying VLScT was scaffold discontinuity, which suggests an unfavorable resorption-related process, followed by malapposition and neoatherosclerosis. It remains to be determined whether modifications in scaffold design and optimized implantation can mitigate the risk of VLScT. (Independent OCT Registry on Very Late Bioresorbable Scaffold Thrombosis [INVEST]; NCT03180931).

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Yamaji, Kyohei; Karagiannis Voules, Alexios; Windecker, Stephan and Räber, Lorenz

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0735-1097

Publisher:

Elsevier

Language:

English

Submitter:

Tanya Karrer

Date Deposited:

08 Jan 2018 15:05

Last Modified:

08 Jan 2018 15:05

Publisher DOI:

10.1016/j.jacc.2017.09.014

PubMed ID:

29096803

Uncontrolled Keywords:

bioresorbable coronary scaffolds coronary artery disease stent stent thrombosis

BORIS DOI:

10.7892/boris.106905

URI:

https://boris.unibe.ch/id/eprint/106905

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