Key result
Scaffold discontinuity is linked to ~110-fold higher odds of very late bioresorbable scaffold thrombosis.
Why the study?
Very late scaffold thrombosis occurs more frequently after bioresorbable scaffold implantation than with metallic everolimus-eluting stents, but the underlying mechanisms remained to be elucidated.
Observational (n=36)
Yes
Answers are grounded in this paper and cite their sources.
May warrant caution with bioresorbable scaffolds; leaves open confirmation of inflammatory mechanisms in randomized trials.
BACKGROUND: Very late scaffold thrombosis (VLScT) occurs more frequently after bioresorbable scaffold (Absorb BVS 1.1, Abbott Vascular, Santa Clara, California) implantation than with metallic everolimus-eluting stents. OBJECTIVES: The purpose of this study was to elucidate mechanisms underlying VLScT as assessed by optical coherence tomography (OCT). METHODS: The INVEST (Independent OCT Registry on Very Late Bioresorbable Scaffold Thrombosis) registry is an international consortium of investigators who used OCT to examine patients with VLScT. RESULTS: Between June 2013 and May 2017, 36 patients with 38 lesions who had VLScT underwent OCT at 19 centers. VLScT occurred at a median of 20 months (interquartile range: 16 to 27 months) after implantation. At the time of VLScT, 83% of patients received aspirin monotherapy and 17% received dual-antiplatelet therapy. The mechanisms underlying VLScT were (in descending order) scaffold discontinuity (42.1%), malapposition (18.4%), neoatherosclerosis (18.4%), underexpansion or scaffold recoil (10.5%), uncovered struts (5.3%), and edge-related disease progression (2.6%). Discontinuity (odds ratio [OR]: 110; 95% confidence interval [CI]: 73.5 to 173; p < 0.001), malapposed struts (OR: 17.0; 95% CI: 14.8 to 19.7; p < 0.001), and uncovered struts (OR: 7.3; 95% CI: 6.2 to 8.8; p < 0.001) were more frequent in the thrombosed than the nonthrombosed scaffold regions. In 2 of 16 patients with scaffold discontinuity, intercurrent OCT before VLScT provided evidence of circularly apposed scaffold struts with minimal tissue coverage. CONCLUSIONS: The leading mechanism underlying VLScT was scaffold discontinuity, which suggests an unfavorable resorption-related process, followed by malapposition and neoatherosclerosis. It remains to be determined whether modifications in scaffold design and optimized implantation can mitigate the risk of VLScT. (Independent OCT Registry on Very Late Bioresorbable Scaffold Thrombosis [INVEST]; NCT03180931).
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Yamaji et al. (2017) conducted an observational in Very late bioresorbable scaffold thrombosis (n=36). Scaffold discontinuity vs. Nonthrombosed scaffold regions was evaluated on Presence of scaffold discontinuity in thrombosed versus nonthrombosed scaffold regions (OR 110, 95% CI 73.5-173, p=<0.001). Scaffold discontinuity was the leading mechanism of very late bioresorbable scaffold thrombosis, occurring significantly more frequently in thrombosed than nonthrombosed regions (OR 110; 95% CI 73.5-173; p<0.001).
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