JACC: Cardiovascular Interventions
Immediate, Acute, and Subacute Thrombosis Due to Incomplete Expansion of Bioresorbable Scaffolds
Author + information
- Tommaso Gori, MD, PhD∗ (tommaso.gori{at}unimedizin-mainz.de),
- Eberhard Schulz, MD and
- Thomas Münzel, MD
- ↵∗Reprint requests and correspondence:
Dr. Tommaso Gori, Department of Cardiology, University Medical Center Mainz, Langenbeckerstrasse 1, 55131 Mainz, Germany.
We discuss 3 cases of incomplete scaffold expansion leading to early in-scaffold thrombosis. The first case is that of a 64-year-old man who received a bioresorbable coronary scaffold (12 atm, 3.0 × 18 mm) in the proximal left anterior descending artery (Figure 1A). Ticagrelor was administered. 15 min later, the patient underwent emergency angiography for angina and anterior ST-segment elevation. Optical coherence tomography (OCT) showed an in-scaffold, red blood cell–rich thrombus, a thin-cap calcific plaque, and mild scaffold underexpansion (Figures 1B and 1C, Online Video 1). The second case is that of a 53-year-old woman who received a scaffold (3.0 × 18 mm, 12 ATM) in the right coronary artery (Figures 2A and 2B). Ticagrelor was prescribed. Four days later, she presented with inferior ST-segment elevation. The vessel was completely occluded by intravascular thrombosis (Figures 2C and 2D). The third case is that of a 53-year-old diabetic woman who received a scaffold (2.5 × 18 mm, 14 ATM) in the proximal left anterior descending artery (Figure 3A). Ticagrelor was prescribed. Six days later, she returned with anterior ST-segment elevation and cardiogenic shock (Figure 3B). OCT demonstrated in-scaffold thrombosis, a severely calcified vessel, and incomplete scaffold expansion (Figures 3C and 3D, Online Video 2). OCT evidence of underexpansion emphasizes the importance of intracoronary imaging and effective, high-pressure postdilation at the time of implantation.
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).
Case 1.
OCT pullback showing red-blood cell-rich thrombus, calcific plaque preventing complete expansion of the scaffold.
Scaffold in the RCA
A scaffold implanted in the right coronary artery (RCA) (A, B). Intravascular thrombosis on day 4 after implantation (C, D).
Scaffold in the Proximal LAD of a Diabetic Patient
A scaffold implanted in the proximal left anterior descending artery (LAD) of a diabetic patient (A). Optical coherence tomography demonstrated in-scaffold thrombosis (B), a severely calcified vessel (C), and incomplete scaffold expansion (D) (Online Video 2).
Appendix
For supplemental videos, please see the online version of this article.
Footnotes
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.
- Received July 14, 2014.
- Accepted July 14, 2014.
- American College of Cardiology Foundation
