- Email: [email protected]
Very Late Scaffold Thrombosis Due to Insufficient Strut Apposition
JACC: CARDIOVASCULAR INTERVENTIONS
VOL. 8, NO. 13, 2015
ª 2015 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION PUBLISHED BY ELSEVIER INC.
ISSN 1936-8798/$36.00 http://dx.doi.org/10.1016/j.jcin.2015.06.026
IMAGES IN INTERVENTION
Very Late Scaffold Thrombosis Due to Insufficient Strut Apposition Felix Meincke, MD,* Tobias Spangenberg, MD,* Christian-H. Heeger, MD,* Martin W. Bergmann, MD,y Karl-Heinz Kuck, MD,* Alexander Ghanem, MD*
A
46-year-old patient underwent implantation
due to acute BVS thrombosis. OCT revealed insuffi-
of a bioresorbable vascular scaffold (BVS)
cient wall apposition in the distal part of the scaffold
(Absorb 3.5 28 mm, Abbott Vascular, Abbott
with subsequent incomplete coverage with neointi-
Park, Illinois) in April 2013 for a de-novo stenosis of
mal tissue and resorption as compared with proximal
the right coronary artery (Figures 1A to 1B). A total of
wall-apposed parts as potential cause for the throm-
6 months after implantation, a follow-up angiography
bosis (Figures 1D to 1F, Online Video 2). After balloon
including optical coherence tomography (OCT) was
dilation, 3 zotarolimus-eluting stents were implanted
performed, showing a partial malapposition of the
covering the whole scaffold length.
scaffold (Figure 1C, Online Video 1). As the patient
These findings underline the importance of proper
had no angina and the angiographic picture was unre-
wall apposition of BVS, which is best verified by OCT
markable, the decision was made not to treat the mal-
imaging at the time of implantation. Insufficient wall
apposition, for example, by implantation of a metallic
contact might lead not only to delayed coverage but
stent. In October 2014, the patient was readmitted
also to delayed resorption with subsequent elevated
with ST-segment elevation myocardial infarction
risk for scaffold thrombosis.
From the *Asklepios Klinik St. Georg, Department of Cardiology, Hamburg, Germany; and the yCardiologicum, Hamburg, Germany. Dr. Kuck has relationships with St. Jude, Medtronic, and Biosense Webster. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Manuscript received May 15, 2015; revised manuscript received June 16, 2015, accepted June 19, 2015.
Meincke et al.
JACC: CARDIOVASCULAR INTERVENTIONS VOL. 8, NO. 13, 2015 NOVEMBER 2015:1768–9
Very Late Scaffold Thrombosis
F I G U R E 1 Angiographic and OCT Imaging at Baseline, Follow-Up, and Acute Scaffold Thrombosis
(A) Initial angiography showing the lesion before bioresorbable vascular scaffold (BVS) implantation. (B) Angiography after implantation of a BVS (Absorb 3.5 28 mm, scaffold markers visualized by white arrows). (C) Optical coherence tomography (OCT) of the distal BVS 6 months after implantation with documentation of insufficient wall apposition and coverage (white arrows mark the area of malapposition) (Online Video 1). (D) Angiography showing acute BVS thrombosis 18 months after implantation (scaffold markers visualized by arrows; bars mark the OCT imaging sites shown in E and F). (E) OCT of the distal BVS at the time of BVS thrombosis showing thrombus material attached to the struts and an insufficient wall apposition and coverage as potential reason for thrombosis (white arrows mark an area with malapposition and thrombus material attached to the struts). (F) OCT of the proximal BVS with good wall apposition and coverage at the time of BVS thrombosis (Online Video 2).
REPRINT REQUESTS AND CORRESPONDENCE: Dr.
Felix Meincke, Department of Cardiology, Asklepios Klinik St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany. E-mail: [email protected].
KEY WORDS acute scaffold thrombosis, bioresorbable scaffold, optical coherence tomography A PP END IX For supplemental videos and their legends, please see the online version of this article.
1769
VOL. 8, NO. 13, 2015
ª 2015 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION PUBLISHED BY ELSEVIER INC.
ISSN 1936-8798/$36.00 http://dx.doi.org/10.1016/j.jcin.2015.06.026
IMAGES IN INTERVENTION
Very Late Scaffold Thrombosis Due to Insufficient Strut Apposition Felix Meincke, MD,* Tobias Spangenberg, MD,* Christian-H. Heeger, MD,* Martin W. Bergmann, MD,y Karl-Heinz Kuck, MD,* Alexander Ghanem, MD*
A
46-year-old patient underwent implantation
due to acute BVS thrombosis. OCT revealed insuffi-
of a bioresorbable vascular scaffold (BVS)
cient wall apposition in the distal part of the scaffold
(Absorb 3.5 28 mm, Abbott Vascular, Abbott
with subsequent incomplete coverage with neointi-
Park, Illinois) in April 2013 for a de-novo stenosis of
mal tissue and resorption as compared with proximal
the right coronary artery (Figures 1A to 1B). A total of
wall-apposed parts as potential cause for the throm-
6 months after implantation, a follow-up angiography
bosis (Figures 1D to 1F, Online Video 2). After balloon
including optical coherence tomography (OCT) was
dilation, 3 zotarolimus-eluting stents were implanted
performed, showing a partial malapposition of the
covering the whole scaffold length.
scaffold (Figure 1C, Online Video 1). As the patient
These findings underline the importance of proper
had no angina and the angiographic picture was unre-
wall apposition of BVS, which is best verified by OCT
markable, the decision was made not to treat the mal-
imaging at the time of implantation. Insufficient wall
apposition, for example, by implantation of a metallic
contact might lead not only to delayed coverage but
stent. In October 2014, the patient was readmitted
also to delayed resorption with subsequent elevated
with ST-segment elevation myocardial infarction
risk for scaffold thrombosis.
From the *Asklepios Klinik St. Georg, Department of Cardiology, Hamburg, Germany; and the yCardiologicum, Hamburg, Germany. Dr. Kuck has relationships with St. Jude, Medtronic, and Biosense Webster. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Manuscript received May 15, 2015; revised manuscript received June 16, 2015, accepted June 19, 2015.
Meincke et al.
JACC: CARDIOVASCULAR INTERVENTIONS VOL. 8, NO. 13, 2015 NOVEMBER 2015:1768–9
Very Late Scaffold Thrombosis
F I G U R E 1 Angiographic and OCT Imaging at Baseline, Follow-Up, and Acute Scaffold Thrombosis
(A) Initial angiography showing the lesion before bioresorbable vascular scaffold (BVS) implantation. (B) Angiography after implantation of a BVS (Absorb 3.5 28 mm, scaffold markers visualized by white arrows). (C) Optical coherence tomography (OCT) of the distal BVS 6 months after implantation with documentation of insufficient wall apposition and coverage (white arrows mark the area of malapposition) (Online Video 1). (D) Angiography showing acute BVS thrombosis 18 months after implantation (scaffold markers visualized by arrows; bars mark the OCT imaging sites shown in E and F). (E) OCT of the distal BVS at the time of BVS thrombosis showing thrombus material attached to the struts and an insufficient wall apposition and coverage as potential reason for thrombosis (white arrows mark an area with malapposition and thrombus material attached to the struts). (F) OCT of the proximal BVS with good wall apposition and coverage at the time of BVS thrombosis (Online Video 2).
REPRINT REQUESTS AND CORRESPONDENCE: Dr.
Felix Meincke, Department of Cardiology, Asklepios Klinik St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany. E-mail: [email protected].
KEY WORDS acute scaffold thrombosis, bioresorbable scaffold, optical coherence tomography A PP END IX For supplemental videos and their legends, please see the online version of this article.
1769