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Immediate, Acute, and Subacute Thrombosis Due to Incomplete Expansion of Bioresorbable Scaffolds
JACC: CARDIOVASCULAR INTERVENTIONS
VOL. 7, NO. 10, 2014
ª 2014 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION
ISSN 1936-8798/$36.00
PUBLISHED BY ELSEVIER INC.
http://dx.doi.org/10.1016/j.jcin.2014.07.004
IMAGES IN INTERVENTION
Immediate, Acute, and Subacute Thrombosis Due to Incomplete Expansion of Bioresorbable Scaffolds Tommaso Gori, MD, PHD, Eberhard Schulz, MD, Thomas Münzel, MD
W
e discuss 3 cases of incomplete scaffold
(OCT) showed an in-scaffold, red blood cell–rich
expansion leading to early in-scaffold
thrombus, a thin-cap calcific plaque, and mild scaffold
thrombosis. The first case is that of a
underexpansion (Figures 1B and 1C, Online Video 1).
64-year-old man who received a bioresorbable coro-
The second case is that of a 53-year-old woman who
nary scaffold (12 atm, 3.0 18 mm) in the proximal
received a scaffold (3.0 18 mm, 12 ATM) in the
left anterior descending artery (Figure 1A). Ticagrelor
right coronary artery (Figures 2A and 2B). Ticagrelor
was administered. 15 min later, the patient underwent
was prescribed. Four days later, she presented
emergency angiography for angina and anterior
with inferior ST-segment elevation. The vessel was
ST-segment elevation. Optical coherence tomography
completely occluded by intravascular thrombosis
F I G U R E 1 Bioresorbable Coronary Scaffold in the Proximal LAD
A bioresorbable coronary scaffold implanted in the proximal left anterior descending artery (LAD) (A). Optical coherence tomography shows in-scaffold, red blood cell–rich thrombus, a highly calcific plaque, and mild scaffold underexpansion (B and C) (Online Video 1).
From the Department of Cardiology, University Medical Center of Mainz, Mainz, Germany. Drs. Gori and Münzel have received Speakers’ Bureau honoraria from Abbott Vascular and St. Jude Medical. Dr. Schulz has reported that he has no relationships relevant to the contents of this paper to disclose. Manuscript received July 14, 2014; accepted July 14, 2014.
Gori et al.
JACC: CARDIOVASCULAR INTERVENTIONS VOL. 7, NO. 10, 2014 OCTOBER 2014:1194–5
In-Scaffold Thrombosis
F I G U R E 3 Scaffold in the Proximal LAD of a Diabetic Patient F I G U R E 2 Scaffold in the RCA
A scaffold implanted in the proximal left anterior descending A scaffold implanted in the right coronary artery (RCA) (A, B).
artery (LAD) of a diabetic patient (A). Optical coherence
Intravascular thrombosis on day 4 after implantation (C, D).
tomography demonstrated in-scaffold thrombosis (B), a severely calcified vessel (C), and incomplete scaffold expansion (D) (Online Video 2).
(Figures 2C and 2D). The third case is that of a 53-yearold diabetic woman who received a scaffold (2.5 18
REPRINT REQUESTS AND CORRESPONDENCE: Dr.
mm, 14 ATM) in the proximal left anterior descending
Tommaso Gori, Department of Cardiology, University
artery (Figure 3A). Ticagrelor was prescribed. Six days
Medical Center Mainz, Langenbeckerstrasse 1, 55131
later, she returned with anterior ST-segment elevation
Mainz, Germany. E-mail: tommaso.gori@unimedizin-
and cardiogenic shock (Figure 3B). OCT demonstrated
mainz.de.
in-scaffold thrombosis, a severely calcified vessel, and incomplete scaffold expansion (Figures 3C and 3D, Online Video 2). OCT evidence of underexpansion
KEY WORDS coronary artery disease, in-stent thrombosis, optical coherence tomography
emphasizes the importance of intracoronary imaging and effective, high-pressure postdilation at the time of implantation.
A PP END IX For supplemental videos, please see the online version of this article.
1195
VOL. 7, NO. 10, 2014
ª 2014 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION
ISSN 1936-8798/$36.00
PUBLISHED BY ELSEVIER INC.
http://dx.doi.org/10.1016/j.jcin.2014.07.004
IMAGES IN INTERVENTION
Immediate, Acute, and Subacute Thrombosis Due to Incomplete Expansion of Bioresorbable Scaffolds Tommaso Gori, MD, PHD, Eberhard Schulz, MD, Thomas Münzel, MD
W
e discuss 3 cases of incomplete scaffold
(OCT) showed an in-scaffold, red blood cell–rich
expansion leading to early in-scaffold
thrombus, a thin-cap calcific plaque, and mild scaffold
thrombosis. The first case is that of a
underexpansion (Figures 1B and 1C, Online Video 1).
64-year-old man who received a bioresorbable coro-
The second case is that of a 53-year-old woman who
nary scaffold (12 atm, 3.0 18 mm) in the proximal
received a scaffold (3.0 18 mm, 12 ATM) in the
left anterior descending artery (Figure 1A). Ticagrelor
right coronary artery (Figures 2A and 2B). Ticagrelor
was administered. 15 min later, the patient underwent
was prescribed. Four days later, she presented
emergency angiography for angina and anterior
with inferior ST-segment elevation. The vessel was
ST-segment elevation. Optical coherence tomography
completely occluded by intravascular thrombosis
F I G U R E 1 Bioresorbable Coronary Scaffold in the Proximal LAD
A bioresorbable coronary scaffold implanted in the proximal left anterior descending artery (LAD) (A). Optical coherence tomography shows in-scaffold, red blood cell–rich thrombus, a highly calcific plaque, and mild scaffold underexpansion (B and C) (Online Video 1).
From the Department of Cardiology, University Medical Center of Mainz, Mainz, Germany. Drs. Gori and Münzel have received Speakers’ Bureau honoraria from Abbott Vascular and St. Jude Medical. Dr. Schulz has reported that he has no relationships relevant to the contents of this paper to disclose. Manuscript received July 14, 2014; accepted July 14, 2014.
Gori et al.
JACC: CARDIOVASCULAR INTERVENTIONS VOL. 7, NO. 10, 2014 OCTOBER 2014:1194–5
In-Scaffold Thrombosis
F I G U R E 3 Scaffold in the Proximal LAD of a Diabetic Patient F I G U R E 2 Scaffold in the RCA
A scaffold implanted in the proximal left anterior descending A scaffold implanted in the right coronary artery (RCA) (A, B).
artery (LAD) of a diabetic patient (A). Optical coherence
Intravascular thrombosis on day 4 after implantation (C, D).
tomography demonstrated in-scaffold thrombosis (B), a severely calcified vessel (C), and incomplete scaffold expansion (D) (Online Video 2).
(Figures 2C and 2D). The third case is that of a 53-yearold diabetic woman who received a scaffold (2.5 18
REPRINT REQUESTS AND CORRESPONDENCE: Dr.
mm, 14 ATM) in the proximal left anterior descending
Tommaso Gori, Department of Cardiology, University
artery (Figure 3A). Ticagrelor was prescribed. Six days
Medical Center Mainz, Langenbeckerstrasse 1, 55131
later, she returned with anterior ST-segment elevation
Mainz, Germany. E-mail: tommaso.gori@unimedizin-
and cardiogenic shock (Figure 3B). OCT demonstrated
mainz.de.
in-scaffold thrombosis, a severely calcified vessel, and incomplete scaffold expansion (Figures 3C and 3D, Online Video 2). OCT evidence of underexpansion
KEY WORDS coronary artery disease, in-stent thrombosis, optical coherence tomography
emphasizes the importance of intracoronary imaging and effective, high-pressure postdilation at the time of implantation.
A PP END IX For supplemental videos, please see the online version of this article.
1195