title: Differential thrombotic prolapse burden in either bioresorbable vascular scaffolds or metallic stents implanted during acute myocardial infarction: The snowshoe effect: Insights from the maximal footprint analysis.
abstract: BACKGROUND
  The hypothesized increased thrombus entrapment during bioresorbable vascular scaffold implantation in acute myocardial infarction, the so-called "snowshoe effect" has never been demonstrated.
  
  
  METHODS
  Patients enrolled in the BVS STEMI FIRST study matched with STEMI patients implanted with everolimus-eluting metal stents (EES) and undergoing optical coherence tomography (OCT) at the index procedure were compared. Quantitative coronary angiography analysis and optical coherence tomography data for evaluation of thrombotic prolapse were reported. Percentage maximal footprint (%MFP) analysis as an indicator of the snowshoe effect was performed.
  
  
  RESULTS
  A total of 302 patients were analyzed (151 with BVS and 151 with EES). Of those patients 30 implanted with BVS and 17 implanted with EES were imaged at the index procedure with OCT. Baseline clinical characteristics, TIMI-flow and thrombus burden were similar between groups. Aspiration thrombectomy was similarly performed in the two groups (BVS 83.3% vs 94.1% EES, p=0.405). At the end of the procedure, final TIMI 3 flow was achieved in 93.3% and 82.4% of BVS and EES patients respectively (p=0.296). The %MFP was significantly higher in the BVS treated patients (36.59±5.65% vs 17.61±4.30, p<0.001). The results of the OCT analysis showed a mean prolapse area (0.61±0.26mm(2) vs 0.90±0.31mm(2), p=0.001) and a percentage prolapse area (7.11±2.98mm(2) vs 9.98±2.90mm(2), p=0.002) significantly higher in the EES group.
  
  
  CONCLUSIONS
  Scaffold structural characteristics such as strut width may play a role in terms of thrombus dislodgment patterns and acute prolapsing material.
authors.affiliation: Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands. Electronic address: r.diletti@erasmusmc.nl.
authors.forename: Roberto
authors.initials: R
authors.lastname: Diletti
authors.affiliation: Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Jors
authors.initials: J
authors.lastname: van der Sijde
authors.affiliation: Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Antonios
authors.initials: A
authors.lastname: Karanasos
authors.affiliation: Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands; National Heart Centre Singapore, Singapore.
authors.forename: Jiang Ming
authors.initials: JM
authors.lastname: Fam
authors.affiliation: Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Cordula
authors.initials: C
authors.lastname: Felix
authors.affiliation: Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Nicolas M
authors.initials: NM
authors.lastname: van Mieghem
authors.affiliation: Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Regar
authors.affiliation: Abbott Vascular, Santa Clara, CA, United States.
authors.forename: Richard
authors.initials: R
authors.lastname: Rapoza
authors.affiliation: Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Felix
authors.initials: F
authors.lastname: Zijlstra
authors.affiliation: Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Robert Jan
authors.initials: RJ
authors.lastname: van Geuns
mesh_terms: D020341:Absorbable Implants / Q000009:adverse effects / Q000639:trends*; D000328:Adult; D000368:Aged; D017281:Cost of Illness; D054855:Drug-Eluting Stents / Q000009:adverse effects / Q000639:trends*; D000068338:Everolimus / Q000008:administration & dosage; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008670:Metals / Q000009:adverse effects; D008875:Middle Aged; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging* / Q000601:surgery*; D013927:Thrombosis / Q000000981:diagnostic imaging* / Q000209:etiology; D054457:Tissue Scaffolds / Q000009:adverse effects / Q000639:trends*; D041623:Tomography, Optical Coherence / Q000639:trends; D016896:Treatment Outcome
chemical_list: D008670:Metals; D000068338:Everolimus
keywords: Bioresorbable vascular scaffolds; Maximal footprint; ST-segment elevation myocardial infarction; Snowshoe effect