Very Late Scaffold Thrombosis: Intracoronary Imaging and Histopathological and Spectroscopic Findings.

Räber, Lorenz; Brugaletta, Salvatore; Yamaji, Kyohei; O'Sullivan, Crochan J; Otsuki, Shuji; Koppara, Tobias; Taniwaki, Masanori; Onuma, Yoshinobu; Freixa, Xavier; Eberli, Franz R; Serruys, Patrick W; Joner, Michael; Sabaté, Manel; Windecker, Stephan (2015). Very Late Scaffold Thrombosis: Intracoronary Imaging and Histopathological and Spectroscopic Findings. Journal of the American College of Cardiology, 66(17), pp. 1901-1914. Elsevier 10.1016/j.jacc.2015.08.853

[img] Text
1-s2.0-S0735109715058234-main.pdf - Published Version
Restricted to registered users only
Available under License Publisher holds Copyright.

Download (9MB) | Request a copy

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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Räber, Lorenz; Taniwaki, Masanori and Windecker, Stephan

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0735-1097

Publisher:

Elsevier

Language:

English

Submitter:

Judith Liniger

Date Deposited:

17 Mar 2016 11:47

Last Modified:

17 Mar 2016 11:47

Publisher DOI:

10.1016/j.jacc.2015.08.853

PubMed ID:

26493663

BORIS DOI:

10.7892/boris.75901

URI:

https://boris.unibe.ch/id/eprint/75901

Actions (login required)

Edit item Edit item
Provide Feedback