title: Coronary evaginations and peri-scaffold aneurysms following implantation of bioresorbable scaffolds: incidence, outcome, and optical coherence tomography analysis of possible mechanisms.
abstract: Peri-stent coronary evaginations may disturb flow and have been proposed as possible risk factor for late stent thrombosis. We describe incidence, predictors, and possible mechanisms of coronary evaginations 12 months after implantation of bioresorbable vascular scaffolds (BVS).
  
  
  
  One hundred and two BVS implanted in 90 patients (age 63 ± 13 years, 71 males, 14 diabetics) were analysed with angiography and optical coherence tomography (OCT) 12 months after implantation. Evaginations were identified as any hollow in the luminal vessel contour between well-apposed struts and were classified as major when extending ≥3 mm with a depth ≥10% of the BVS diameter. Fifty-five (54%) of the BVS (50(56%) of the patients) had at least one evagination (6.1 ± 6.2 evaginations per BVS), with a mean volume of 1.9 ± 1.9 mm(3). Major evaginations were only found in one patient, and in-BVS aneurysms in three patients (4BVS). The presence of evaginations was strongly associated with that of malapposition (P = 0.003) and strut fractures (P = 0.01). No association could be shown between the presence and volume of the evaginations and any clinical variable or the presence of uncovered struts (P > 0.5). Peri-strut low-intensity areas (PSLIA) were present in 29 (53%) of the BVS with evaginations and 12 (26%) of those without (P = 0.0049); their presence was independently associated with the presence, the number (P < 0.003) and volume of the evaginations (P = 0.004) and with that of strut fracture.
  
  
  
  Optical coherence tomography-detected evaginations are relatively common after BVS implantation, but, as for modern drug-eluting metallic stents, major evaginations are very rare. Optical coherence tomography evidence of immature neointima and strut fractures were associated with more severe development of evaginations.
authors.affiliation: II. Medizinische Klinik und Poliklinik, University Medical Center Mainz, Langenbeckstrasse 1, Mainz 55131 and Deutsches Zentrum für Herz und Kreislauf Forschung, Standort Rhein-Main, Germany tommaso.gori@unimedizin-mainz.de.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Gori
authors.affiliation: II. Medizinische Klinik und Poliklinik, University Medical Center Mainz, Langenbeckstrasse 1, Mainz 55131 and Deutsches Zentrum für Herz und Kreislauf Forschung, Standort Rhein-Main, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Jansen
authors.affiliation: II. Medizinische Klinik und Poliklinik, University Medical Center Mainz, Langenbeckstrasse 1, Mainz 55131 and Deutsches Zentrum für Herz und Kreislauf Forschung, Standort Rhein-Main, Germany.
authors.forename: Melissa
authors.initials: M
authors.lastname: Weissner
authors.affiliation: National Heart Centre Singapore, Singapore, Singapore.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Foin
authors.affiliation: II. Medizinische Klinik und Poliklinik, University Medical Center Mainz, Langenbeckstrasse 1, Mainz 55131 and Deutsches Zentrum für Herz und Kreislauf Forschung, Standort Rhein-Main, Germany.
authors.forename: Philip
authors.initials: P
authors.lastname: Wenzel
authors.affiliation: II. Medizinische Klinik und Poliklinik, University Medical Center Mainz, Langenbeckstrasse 1, Mainz 55131 and Deutsches Zentrum für Herz und Kreislauf Forschung, Standort Rhein-Main, Germany.
authors.forename: Eberhard
authors.initials: E
authors.lastname: Schulz
authors.affiliation: Hospital and University of Fribourg, Fribourg, Switzerland.
authors.forename: Stephane
authors.initials: S
authors.lastname: Cook
authors.affiliation: II. Medizinische Klinik und Poliklinik, University Medical Center Mainz, Langenbeckstrasse 1, Mainz 55131 and Deutsches Zentrum für Herz und Kreislauf Forschung, Standort Rhein-Main, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Münzel
mesh_terms: D020341:Absorbable Implants; D000783:Aneurysm; D003331:Coronary Vessels; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome
keywords: Bioresorbable scaffolds; Coronary artery disease; Immature neointima