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.

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