Bioresorbable Coronary Scaffold Thrombosis

Study Questions:

What are the incidence and predictors of bioresorbable vascular scaffold (BVS) thrombosis?

Methods:

The investigators reported their experience with scaffold thrombosis (ScT) from four centers (two Swiss and two German) with 1,305 patients who received 1,870 BVS.

Results:

The average age of the population was 64 years and the majority were men (78%). ScT occurred in 42 patients, with the incidence of ScT being 1.8% at 30 days and 3.0% at 12 months. Over one half (n = 22) of the ScT presented as ST-segment elevation myocardial infarction and six (17%) as sudden death. Lower post-procedural lumen was associated with higher risk of ScT. A dedicated BVS implantation policy was instituted, and this resulted in a decline in ScT from 3.3% to 1%.

Conclusions:

Among a large cohort of patients undergoing BVS implantation, ScT occurred in 3% by 12 months and could be reduced by optimal implantation technique.

Perspective:

ScT occurs more commonly with BVS compared with stent thrombosis with contemporary drug-eluting stents and remains a major drawback to this technology. This study demonstrates that the risk of ScT was high, but could be reduced with an optimal BVS implantation technique (optimal pre- and post-dilation). It would be important to assess if routine use of intravascular ultrasound and optical coherence tomography can help reduce the occurrence of ScT further.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Stable Ischemic Heart Disease

Keywords: Coronary Thrombosis, Death, Sudden, Incidence, Myocardial Infarction, Stents, Thrombosis


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