title: Optical Coherence Tomography Findings in Bioresorbable Vascular Scaffolds Thrombosis.
abstract: BACKGROUND
  Everolimus-eluting bioresorbable vascular scaffolds have been developed to improve late outcomes after coronary interventions. However, recent registries raised concerns regarding an increased incidence of scaffold thrombosis (ScT). The mechanism of ScT remains unknown.
  
  
  RESULTS
  The present study investigated angiographic and optical coherence tomography findings in patients experiencing ScT. Fifteen ScT (14 patients, 79% male, age 59±10 years) occurred at a median of 16 days (25%-75% interquartile range: 1-263 days) after implantation. Early ScT (<30 days) occurred in 8 cases (53%). Possible causal factors in these patients included insufficient platelet inhibition in 2 cases and procedural factors (scaffold underexpansion, undersizing, or geographical miss) in 4 cases. No obvious cause could be found in 2 early ScT. In late (>1 month) and very late (>1 year) ScT (respectively, 5 and 2 cases), 5 scaffolds showed intimal neovessels or marked peristrut low-intensity areas. Scaffold fractures were additionally found in 2 patients, and scaffold collapse was found in 1 patient with very late ScT. Extensive strut malapposition was the presumed cause for ScT in 1 case. One scaffold did not show any morphological abnormality. Thrombectomy specimens were analyzed in 3 patients and did not demonstrate increased numbers of inflammatory cells.
  
  
  CONCLUSIONS
  The mechanisms of early ScT seem to be similar to metallic stents (mechanical and inadequate antiplatelet therapy). The predominant finding in late and very late ScT is peristrut low-intensity area.
authors.affiliation: From the Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland (F.C., P.J., S.T.); Hospital and University of Fribourg, Fribourg, Switzerland (S.P., J.V., Z.K., S.C.); and Department of Medicine II, University Medical Center Mainz & German Center for Cardiovascular Research (DZHK e.V.), partner site Rhine Main, Mainz, Germany (M.W., T.M., T.G.).
authors.forename: Florim
authors.initials: F
authors.lastname: Cuculi
authors.affiliation: From the Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland (F.C., P.J., S.T.); Hospital and University of Fribourg, Fribourg, Switzerland (S.P., J.V., Z.K., S.C.); and Department of Medicine II, University Medical Center Mainz & German Center for Cardiovascular Research (DZHK e.V.), partner site Rhine Main, Mainz, Germany (M.W., T.M., T.G.).
authors.forename: Serban
authors.initials: S
authors.lastname: Puricel
authors.affiliation: From the Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland (F.C., P.J., S.T.); Hospital and University of Fribourg, Fribourg, Switzerland (S.P., J.V., Z.K., S.C.); and Department of Medicine II, University Medical Center Mainz & German Center for Cardiovascular Research (DZHK e.V.), partner site Rhine Main, Mainz, Germany (M.W., T.M., T.G.).
authors.forename: Peiman
authors.initials: P
authors.lastname: Jamshidi
authors.affiliation: From the Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland (F.C., P.J., S.T.); Hospital and University of Fribourg, Fribourg, Switzerland (S.P., J.V., Z.K., S.C.); and Department of Medicine II, University Medical Center Mainz & German Center for Cardiovascular Research (DZHK e.V.), partner site Rhine Main, Mainz, Germany (M.W., T.M., T.G.).
authors.forename: Jérémy
authors.initials: J
authors.lastname: Valentin
authors.affiliation: From the Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland (F.C., P.J., S.T.); Hospital and University of Fribourg, Fribourg, Switzerland (S.P., J.V., Z.K., S.C.); and Department of Medicine II, University Medical Center Mainz & German Center for Cardiovascular Research (DZHK e.V.), partner site Rhine Main, Mainz, Germany (M.W., T.M., T.G.).
authors.forename: Zacharenia
authors.initials: Z
authors.lastname: Kallinikou
authors.affiliation: From the Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland (F.C., P.J., S.T.); Hospital and University of Fribourg, Fribourg, Switzerland (S.P., J.V., Z.K., S.C.); and Department of Medicine II, University Medical Center Mainz & German Center for Cardiovascular Research (DZHK e.V.), partner site Rhine Main, Mainz, Germany (M.W., T.M., T.G.).
authors.forename: Stefan
authors.initials: S
authors.lastname: Toggweiler
authors.affiliation: From the Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland (F.C., P.J., S.T.); Hospital and University of Fribourg, Fribourg, Switzerland (S.P., J.V., Z.K., S.C.); and Department of Medicine II, University Medical Center Mainz & German Center for Cardiovascular Research (DZHK e.V.), partner site Rhine Main, Mainz, Germany (M.W., T.M., T.G.).
authors.forename: Melissa
authors.initials: M
authors.lastname: Weissner
authors.affiliation: From the Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland (F.C., P.J., S.T.); Hospital and University of Fribourg, Fribourg, Switzerland (S.P., J.V., Z.K., S.C.); and Department of Medicine II, University Medical Center Mainz & German Center for Cardiovascular Research (DZHK e.V.), partner site Rhine Main, Mainz, Germany (M.W., T.M., T.G.).
authors.forename: Thomas
authors.initials: T
authors.lastname: Münzel
authors.affiliation: From the Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland (F.C., P.J., S.T.); Hospital and University of Fribourg, Fribourg, Switzerland (S.P., J.V., Z.K., S.C.); and Department of Medicine II, University Medical Center Mainz & German Center for Cardiovascular Research (DZHK e.V.), partner site Rhine Main, Mainz, Germany (M.W., T.M., T.G.). stephane.cook@unifr.ch.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Cook
authors.affiliation: From the Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland (F.C., P.J., S.T.); Hospital and University of Fribourg, Fribourg, Switzerland (S.P., J.V., Z.K., S.C.); and Department of Medicine II, University Medical Center Mainz & German Center for Cardiovascular Research (DZHK e.V.), partner site Rhine Main, Mainz, Germany (M.W., T.M., T.G.). stephane.cook@unifr.ch.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Gori
mesh_terms: D000368:Aged; D001672:Biocompatible Materials / Q000008:administration & dosage; D019917:Blood Vessel Prosthesis Implantation; D054855:Drug-Eluting Stents / Q000009:adverse effects / Q000706:statistics & numerical data*; D019544:Equipment Failure Analysis / Q000706:statistics & numerical data*; D000068338:Everolimus / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013927:Thrombosis / Q000175:diagnosis / Q000453:epidemiology*; D041623:Tomography, Optical Coherence
chemical_list: D001672:Biocompatible Materials; D000068338:Everolimus
keywords: bioresorbable vascular scaffold; optical coherence tomography; percutaneous coronary intervention; peristrut low-intensity area; scaffold thrombosis; stent thrombosis