Scaffold thrombosis following implantation of the ABSORB BVS in routine clinical practice: Insight into possible mechanisms from optical coherence tomography

Abstract

OCT performed in patients presenting with Absorb ScT demonstrated that malapposition of scaffold struts was more prominent in patients presenting with (very) late ScT, while underexpansion was more frequent in the early cases.

The Absorb bioresorbable vascular scaffold in real-world practice: long-term follow-up of the AMC Single Centre Real World PCI Registry

“…Several studies have, however, reported that (very) late ScT also frequently occurs between the 2nd and 3rd year after device implantation, and even beyond 3 years, with the latest case of ScT reported as late as 44 months after Absorb BVS implantation [5,6,8,9]. In these studies, the leading mechanisms of very late ScT were associated with (disintegrated) strut material that protruded into the coronary lumen, most likely as a consequence of intraluminal scaffold dismantling or late (acquired) malapposition [10]. DAPT is hypothesised to be an important factor in the prevention of thrombotic events after coronary stent implantation.…”

Comparison of an everolimus-eluting bioresorbable scaffold with an everolimus-eluting metallic stent in routine PCI: three-year clinical outcomes from the AIDA trial

“…The threeyear point after Absorb implantation is an important landmark as three years is the approximate period of scaffold polymer absorption 1 . Intraluminal scaffold dismantling and the bioresorption process are possibly underlying mechanisms of VLST 6 . Traces of scaffold have been seen beyond three years; whether DAPT should be continued after three years is still uncertain.…”

Complete two-year follow-up with formal non-inferiority testing on primary outcomes of the AIDA trial comparing the Absorb bioresorbable scaffold with the XIENCE drug-eluting metallic stent in routine PCI

“…Due to the complex process of scaffold degradation and coronary vessel healing, the exact cause of the reported higher rates of (very) late ScT remain partly understood. Early ScT is most often caused by scaffold underexpansion, and late ScT is caused by scaffold malapposition, either pre-existent or acquired 14 .…”