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

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• 作者：Lorenz Rä ; ber ; MD ; PhD^&lowast ; ; Salvatore Brugaletta ; MD ; PhD^&dagger ; ; Kyohei Yamaji ; MD ; PhD^&lowast ; ; Crochan J. O&rsquo ; Sullivan ; MD^&Dagger ; ; Shuji Otsuki ; MD^&dagger ; ; Tobias Koppara ; MD^§ ; ; Masanori Taniwaki ; MD^&lowast ; ; Yoshinobu Onuma ; MD ; PhD^鈥?/sup> ; Xavier Freixa ; MD^&dagger ; ; Franz R. Eberli ; MD^&Dagger ; ; Patrick W. Serruys ; MD ; PhD^¶ ; ; Michael Joner ; MD^§ ; ; Manel Sabaté ; MD ; PhD^&dagger ; ; Stephan Windecker ; MD^&lowast ; ; ^{stephan.windecker@insel.ch" class="auth_mail" title="E-mail the corresponding author}
• 关键词：bioresorbable scaffold ; coronary artery disease ; optical coherence tomography ; thrombosis
• 刊名：Journal of the American College of Cardiology
• 出版年：2015
• 出版时间：27 October 2015
• 年：2015
• 卷：66
• 期：17
• 页码：1901-1914
• 全文大小：9049 K

文摘

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.