Mechanisms of Very Late Bioresorbable Scaffold Thrombosis The INVEST Registry

被引：118

作者：

Yamaji, Kyohei ^{[1
,2
]}

Ueki, Yasushi ^{[1
]}

Souteyrand, Geraud ^{[3
]}

Daemen, Joost ^{[4
]}

Wiebe, Jens ^{[5
]}

Nef, Holger ^{[6
]}

Adriaenssens, Tom ^{[7
,8
]}

Loh, Joshua P. ^{[9
]}

Lattuca, Benoit ^{[10
]}

Wykrzykowska, Joanna J. ^{[11
]}

Gomez-Lara, Josep ^{[12
]}

Timmers, Leo ^{[13
]}

Motreff, Pascal ^{[3
]}

Hoppmann, Petra ^{[14
]}

Abdel-Wahab, Mohamed ^{[15
]}

Byrne, Robert A. ^{[5
]}

Meincke, Felix ^{[16
]}

Boeder, Niklas ^{[6
]}

Honton, Benjamin ^{[17
]}

O'Sullivan, Crochan J. ^{[18
]}

Ielasi, Alfonso ^{[19
]}

Delarche, Nicolas ^{[20
]}

Christ, Gunter ^{[21
]}

Lee, Joe K. T. ^{[1
,22
]}

Lee, Michael ^{[23
]}

Amabile, Nicolas ^{[24
]}

Karagiannis, Alexios ^{[25
,26
]}

Windecker, Stephan ^{[1
]}

Raber, Lorenz ^{[1
]}

机构：

[1] Bern Univ Hosp, Dept Cardiol, Swiss Cardiovasc Ctr Bern, Bern, Switzerland

[2] Kokura Mem Hosp, Div Cardiol, Kitakyushu, Fukuoka, Japan

[3] CHU Clermont Ferrand, Univ Hosp Clermont Ferrand, Dept Cardiol, Clermont Ferrand, France

[4] Erasmus MC, Thoraxctr, Dept Cardiol, Rotterdam, Netherlands

[5] Tech Univ Munich, Deutsch Herzzentrum Munchen, Munich, Germany

[6] Univ Giessen, Dept Cardiol, Giessen, Germany

[7] Univ Hosp Leuven, Dept Cardiovasc Med, Leuven, Belgium

[8] Katholieke Univ Leuven, Dept Cardiovasc Sci, Leuven, Belgium

[9] Natl Univ Heart Ctr, Dept Cardiol, Singapore, Singapore

[10] Univ Hosp Caremeau, Dept Cardiol, Nimes, France

[11] Univ Amsterdam, Acad Med Ctr, Amsterdam, Netherlands

[12] Univ Barcelona, Inst Invest Biomed Bellvitge, Hosp Univ Bellvitge, Barcelona, Spain

[13] Univ Med Ctr Utrecht, Dept Cardiol, Utrecht, Netherlands

[14] Tech Univ Munich, Klinikum Rechts Isar, Klin & Poliklin Innere Med 1, Munich, Germany

[15] Segeberger Kliniken GmbH, Heart Ctr, Bad Segeberg, Germany

[16] Asklepios Klin St Georg, Dept Cardiol, Hamburg, Germany

[17] Clin Pasteur, Dept Intervent Cardiol, Toulouse, France

[18] Stadtspital Triemli, Dept Cardiol, Zurich, Switzerland

[19] Bolognini Hosp, ASST Bergamo Est, Div Cardiol, Seriate, BG, Italy

[20] Pau Univ Cedex, CH F Mitterand, Dept Cardiol, Pau, France

[21] Kaiser Franz Josef Hosp, Med Dept Cardiol 5, Vienna, Austria

[22] Pamela Youde Nethersole Eastern Hosp, Dept Med, Div Cardiol, Chaiwan, Hong Kong, Peoples R China

[23] Queen Elizabeth Hosp, Dept Med, Div Cardiol, Kowloon, Hong Kong, Peoples R China

[24] Inst Mutualiste Mt Souris, Dept Cardiol, Paris, France

[25] Univ Bern, CTU Bern, Bern, Switzerland

[26] Univ Bern, Inst Social & Prevent Med, Bern, Switzerland

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2017年 / 70卷 / 19期

关键词：

bioresorbable coronary scaffolds; coronary artery disease; stent; stent thrombosis; OPTICAL COHERENCE TOMOGRAPHY; CORONARY-ARTERY-DISEASE; ELUTING METALLIC STENTS; VASCULAR SCAFFOLD; MYOCARDIAL-INFARCTION; ABSORB JAPAN; FOLLOW-UP; II TRIAL; EVEROLIMUS; IMPLANTATION;

D O I：

10.1016/j.jacc.2017.09.014

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND Very late scaffold thrombosis (VLScT) occurs more frequently after bioresorbable scaffold (Absorb BVS 1.1, Abbott Vascular, Santa Clara, California) implantation than with metallic everolimus-eluting stents. OBJECTIVES The purpose of this study was to elucidate mechanisms underlying VLScT as assessed by optical coherence tomography (OCT). METHODS The INVEST (Independent OCT Registry on Very Late Bioresorbable Scaffold Thrombosis) registry is an international consortium of investigators who used OCT to examine patients with VLScT. RESULTS Between June 2013 and May 2017, 36 patients with 38 lesions who had VLScT underwent OCT at 19 centers. VLScT occurred at a median of 20 months (interquartile range: 16 to 27 months) after implantation. At the time of VLScT, 83% of patients received aspirin monotherapy and 17% received dual-antiplatelet therapy. The mechanisms underlying VLScT were (in descending order) scaffold discontinuity (42.1%), malapposition (18.4%), neoatherosclerosis (18.4%), underexpansion or scaffold recoil (10.5%), uncovered struts (5.3%), and edge-related disease progression (2.6%). Discontinuity (odds ratio [OR]: 110; 95% confidence interval [CI]: 73.5 to 173; p < 0.001), malapposed struts (OR: 17.0; 95% CI: 14.8 to 19.7; p < 0.001), and uncovered struts (OR: 7.3; 95% CI: 6.2 to 8.8; p < 0.001) were more frequent in the thrombosed than the nonthrombosed scaffold regions. In 2 of 16 patients with scaffold discontinuity, intercurrent OCT before VLScT provided evidence of circularly apposed scaffold struts with minimal tissue coverage. CONCLUSIONS The leading mechanism underlying VLScT was scaffold discontinuity, which suggests an unfavorable resorption-related process, followed by malapposition and neoatherosclerosis. It remains to be determined whether modifications in scaffold design and optimized implantation can mitigate the risk of VLScT. (Independent OCT Registry on Very Late Bioresorbable Scaffold Thrombosis [INVEST]; NCT03180931) (C) 2017 by the American College of Cardiology Foundation.

引用

页码：2330 / 2344

页数：15

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