Clinical, Angiographic, and Procedural Correlates of Very Late Absorb Scaffold Thrombosis

Abstract

In the present analysis, the largest to date of its type, relative scaffold undersizing was the strongest determinant of VLST. Given current understanding of "scaffold dismantling," this finding likely has ramifications for all bioresorbable scaffolds.

Three to four years outcomes of the absorb bioresorbable vascular scaffold versus second‐generation drug‐eluting stent: A meta‐analysis

“…Both meta‐analyses have looked at outcomes at early and mid‐term follow‐up period that is, before 3 years, which is the time taken for the PLLA polymer to resorb. This is an important factor, among others such as inappropriate patient selection, inherent limitations of first generation BVS with thick stent struts and limited expansion capability, poor implantation technique, shorter DAPT duration, and deployment of BVS in small vessels, which might have led to poorer outcomes compared to DES . Among these, the importance of proper implantation technique (adequate pre‐dilation with a non‐compliant balloon, BVS implantation only after confirmation of adequate pre‐dilations and post‐dilation with a non‐compliant balloon) was demonstrated by a study done by Puricel et al, which showed a decrease in DT from 3.3 to 1.1% at 12‐months follow‐up when proper implantation technique was used…”

Five Years Outcomes and Predictors of Events in a Single-Center Cohort of Patients Treated with Bioresorbable Coronary Vascular Scaffolds

“…Bioresorbable scaffolds were introduced based on the concept that a permanent implant may represent a continuous stimulus for inflammation, platelet activation, and neointima proliferation. In previous publications, the mechanisms and predictors of events up to ≈3 years after BRS implantation were described [5][6][7][8][9][10][11][12]. We extend this information with an analysis of the incidence and predictors of events up to 5 years in the present paper.…”

“…For instance, studies [8,10] identified a small (<2.5 mm) reference vessel size as the principal mechanism of early (<30 day) ScT; in contrast, implantation in large (>3.5 mm) vessels was associated with late events, suggesting that malapposition and scaffold strut discontinuities during resorption might predispose to this event. We and others previously described how the mechanical/physical characteristics of first-generation scaffolds may explain these associations [6,7]. In these papers, consistent evidence was produced that the thicker struts of BRS might cause flow turbulence leading, particularly in settings of incompletely expanded scaffolds (early device thrombosis) or malapposition (late thrombosis), to both platelet aggregation and neointima proliferation and to an increased risk of events.…”

“…The mechanisms and predictors of these events have been thoroughly studied [5][6][7][8][9][10][11][12]. In our previous papers [7,8], we reported that, although a difference between periods was observed, the major predictors and mechanisms of events up to 3 years after BRS implantation were device and procedural parameters.…”

“…The mechanisms and predictors of these events have been thoroughly studied [5][6][7][8][9][10][11][12]. In our previous papers [7,8], we reported that, although a difference between periods was observed, the major predictors and mechanisms of events up to 3 years after BRS implantation were device and procedural parameters. For instance, studies [8,10] identified a small (<2.5 mm) reference vessel size as the principal mechanism of early (<30 day) ScT; in contrast, implantation in large (>3.5 mm) vessels was associated with late events, suggesting that malapposition and scaffold strut discontinuities during resorption might predispose to this event.…”