Lorenz Räber1, Salvatore Brugaletta2, Kyohei Yamaji1, Crochan J O'Sullivan3, Shuji Otsuki2, Tobias Koppara4, Masanori Taniwaki1, Yoshinobu Onuma5, Xavier Freixa2, Franz R Eberli3, Patrick W Serruys6, Michael Joner4, Manel Sabaté2, Stephan Windecker7. 1. Swiss Cardiovascular Center Bern, Department of Cardiology, Bern University Hospital, Bern, Switzerland. 2. Cardiology Department, Thorax Institute, IDIBAPS, Hospital Clinic, University of Barcelona, Barcelona, Spain. 3. Cardiology Department, Triemlispital, Zurich, Switzerland. 4. CvPath Institute, Gaithersburg, Maryland. 5. Thoraxcenter, Erasmus University Hospital, Rotterdam, the Netherlands. 6. International Centre for Cardiovascular Health, Imperial College London, London, United Kingdom. 7. Swiss Cardiovascular Center Bern, Department of Cardiology, Bern University Hospital, Bern, Switzerland. Electronic address: stephan.windecker@insel.ch.
Abstract
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.
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.
Authors: Vera S Schneider; Carsten Skurk; Matthias Riedel; Youssef S Abdelwahed; Ulf Landmesser; David M Leistner Journal: Clin Res Cardiol Date: 2017-04-03 Impact factor: 5.460
Authors: Daisuke Nakamura; Guilherme F Attizzani; Setsu Nishino; Kentaro Tanaka; Mohamad Soud; Gabriel T Pereira; Milana Leygerman; Anas Fares; Audrey Schnell; Marco A Costa; Andrejs Erglis; Hiram G Bezerra Journal: Int J Cardiovasc Imaging Date: 2017-06-08 Impact factor: 2.357