title: Angiographic and optical coherence tomography insights into bioresorbable scaffold thrombosis: single-center experience.
abstract: BACKGROUND
  As bioresorbable vascular scaffolds (BVSs) are being increasingly used in complex real-world lesions and populations, BVS thrombosis cases have been reported. We present angiographic and optical coherence tomography (OCT) findings in a series of patients treated in our center for definite bioresorbable scaffold thrombosis.
  
  
  RESULTS
  Up to June 2014, 14 patients presented with definite BVS thrombosis in our center. OCT was performed in 9 patients at the operator's discretion. Angiographic and OCT findings were compared with a control group comprising 15 patients with definite metallic stent thrombosis. In the BVS group, time interval from index procedure to scaffold thrombosis ranged from 0 to 675 days. Incomplete lesion coverage by angiography was identified in 4 of 14 cases, malapposition by OCT in 5 of 9 cases, strut discontinuity in 2 of 9 cases, and underexpansion in 2 of 9 cases. Five patients had discontinued dual antiplatelet therapy, and in 3 of them discontinued dual antiplatelet therapy discontinuation had occurred the week preceding the event. There were no significant differences in angiographic or OCT findings between BVS and metallic stent thrombosis.
  
  
  CONCLUSIONS
  Suboptimal implantation with incomplete lesion coverage, underexpansion, and malapposition comprises the main pathomechanism for both early and late BVS thrombosis, similar to metallic stent thrombosis. Dual antiplatelet therapy discontinuation seems to also be a secondary contributor in several late events. Our observations suggest that several potential triggers for BVS thrombosis could be avoided.
authors.affiliation: From the Departments of Interventional Cardiology (A.K., N.V.M., N.v.D., C.F., J.D., Y.O., R.D., M.V., F.K., P.d.J., F.Z., R.-J.v.G., E.R.) and Experimental Cardiology (A.A., M.K., H.v.B.), Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Antonios
authors.initials: A
authors.lastname: Karanasos
authors.affiliation: From the Departments of Interventional Cardiology (A.K., N.V.M., N.v.D., C.F., J.D., Y.O., R.D., M.V., F.K., P.d.J., F.Z., R.-J.v.G., E.R.) and Experimental Cardiology (A.A., M.K., H.v.B.), Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Van Mieghem
authors.affiliation: From the Departments of Interventional Cardiology (A.K., N.V.M., N.v.D., C.F., J.D., Y.O., R.D., M.V., F.K., P.d.J., F.Z., R.-J.v.G., E.R.) and Experimental Cardiology (A.A., M.K., H.v.B.), Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Nienke
authors.initials: N
authors.lastname: van Ditzhuijzen
authors.affiliation: From the Departments of Interventional Cardiology (A.K., N.V.M., N.v.D., C.F., J.D., Y.O., R.D., M.V., F.K., P.d.J., F.Z., R.-J.v.G., E.R.) and Experimental Cardiology (A.A., M.K., H.v.B.), Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Cordula
authors.initials: C
authors.lastname: Felix
authors.affiliation: From the Departments of Interventional Cardiology (A.K., N.V.M., N.v.D., C.F., J.D., Y.O., R.D., M.V., F.K., P.d.J., F.Z., R.-J.v.G., E.R.) and Experimental Cardiology (A.A., M.K., H.v.B.), Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Joost
authors.initials: J
authors.lastname: Daemen
authors.affiliation: From the Departments of Interventional Cardiology (A.K., N.V.M., N.v.D., C.F., J.D., Y.O., R.D., M.V., F.K., P.d.J., F.Z., R.-J.v.G., E.R.) and Experimental Cardiology (A.A., M.K., H.v.B.), Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Anouchska
authors.initials: A
authors.lastname: Autar
authors.affiliation: From the Departments of Interventional Cardiology (A.K., N.V.M., N.v.D., C.F., J.D., Y.O., R.D., M.V., F.K., P.d.J., F.Z., R.-J.v.G., E.R.) and Experimental Cardiology (A.A., M.K., H.v.B.), Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Onuma
authors.affiliation: From the Departments of Interventional Cardiology (A.K., N.V.M., N.v.D., C.F., J.D., Y.O., R.D., M.V., F.K., P.d.J., F.Z., R.-J.v.G., E.R.) and Experimental Cardiology (A.A., M.K., H.v.B.), Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Mie
authors.initials: M
authors.lastname: Kurata
authors.affiliation: From the Departments of Interventional Cardiology (A.K., N.V.M., N.v.D., C.F., J.D., Y.O., R.D., M.V., F.K., P.d.J., F.Z., R.-J.v.G., E.R.) and Experimental Cardiology (A.A., M.K., H.v.B.), Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Roberto
authors.initials: R
authors.lastname: Diletti
authors.affiliation: From the Departments of Interventional Cardiology (A.K., N.V.M., N.v.D., C.F., J.D., Y.O., R.D., M.V., F.K., P.d.J., F.Z., R.-J.v.G., E.R.) and Experimental Cardiology (A.A., M.K., H.v.B.), Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Marco
authors.initials: M
authors.lastname: Valgimigli
authors.affiliation: From the Departments of Interventional Cardiology (A.K., N.V.M., N.v.D., C.F., J.D., Y.O., R.D., M.V., F.K., P.d.J., F.Z., R.-J.v.G., E.R.) and Experimental Cardiology (A.A., M.K., H.v.B.), Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Floris
authors.initials: F
authors.lastname: Kauer
authors.affiliation: From the Departments of Interventional Cardiology (A.K., N.V.M., N.v.D., C.F., J.D., Y.O., R.D., M.V., F.K., P.d.J., F.Z., R.-J.v.G., E.R.) and Experimental Cardiology (A.A., M.K., H.v.B.), Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Heleen
authors.initials: H
authors.lastname: van Beusekom
authors.affiliation: From the Departments of Interventional Cardiology (A.K., N.V.M., N.v.D., C.F., J.D., Y.O., R.D., M.V., F.K., P.d.J., F.Z., R.-J.v.G., E.R.) and Experimental Cardiology (A.A., M.K., H.v.B.), Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: de Jaegere
authors.affiliation: From the Departments of Interventional Cardiology (A.K., N.V.M., N.v.D., C.F., J.D., Y.O., R.D., M.V., F.K., P.d.J., F.Z., R.-J.v.G., E.R.) and Experimental Cardiology (A.A., M.K., H.v.B.), Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Felix
authors.initials: F
authors.lastname: Zijlstra
authors.affiliation: From the Departments of Interventional Cardiology (A.K., N.V.M., N.v.D., C.F., J.D., Y.O., R.D., M.V., F.K., P.d.J., F.Z., R.-J.v.G., E.R.) and Experimental Cardiology (A.A., M.K., H.v.B.), Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Robert-Jan
authors.initials: RJ
authors.lastname: van Geuns
authors.affiliation: From the Departments of Interventional Cardiology (A.K., N.V.M., N.v.D., C.F., J.D., Y.O., R.D., M.V., F.K., P.d.J., F.Z., R.-J.v.G., E.R.) and Experimental Cardiology (A.A., M.K., H.v.B.), Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands. e.regar@erasmusmc.nl.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Regar
mesh_terms: D020341:Absorbable Implants / Q000009:adverse effects*; D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000628:therapy*; D003328:Coronary Thrombosis / Q000175:diagnosis* / Q000209:etiology; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D000068338:Everolimus / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D054457:Tissue Scaffolds; D041623:Tomography, Optical Coherence
chemical_list: D007166:Immunosuppressive Agents; D000068338:Everolimus
keywords: bioabsorbable implants; coronary artery disease; drug-eluting stents; tomography, optical coherence