Bioresorbable Coronary Scaffold Thrombosis
What are the incidence and predictors of bioresorbable vascular scaffold (BVS) thrombosis?
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.
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%.
Among a large cohort of patients undergoing BVS implantation, ScT occurred in 3% by 12 months and could be reduced by optimal implantation technique.
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.
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