Very late scaffold thrombosis one week after the discontinuation of dual antiplatelet therapy
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IMAGES IN CARDIOVASCULAR INTERVENTION
Very late scaffold thrombosis one week after the discontinuation of dual antiplatelet therapy Futoshi Yamanaka1 · Koki Shishido1 · Shigeru Saito1
Received: 4 October 2016 / Accepted: 24 July 2017 © Japanese Association of Cardiovascular Intervention and Therapeutics 2017
Introduction
Discussion
A 59-year-old man was admitted to the hospital due to effort angina pectoris; the coronary angiogram demonstrated critical stenosis in the distal right coronary artery (Fig. 1a). A bioresorbable vascular scaffold (BVS) 3.5–18 (Abbott’s Cor) was implanted (Fig. 1b, c), after which the symptoms improved. On the 1-year follow up, angiography demonstrated no restenosis at the BVS site, and 22 months later after the BVS implantation, clopidogrel treatment was discontinued (keeping an aspirin 100 mg/day). However, 1 week after the discontinuation of dual antiplatelet therapy, very late bioresorbable vascular scaffold thrombosis occurred (Fig. 1d). The clinical symptoms demonstrated sudden onset chest pain and ST elevation in II, III, and aVf. Emergency coronary angiography showed definite thrombosis according to the Valve Academic Research Consortium criteria. Following aspiration thrombectomy, antegrade flow recovered. Optical coherence tomography imaging demonstrated scaffold discontinuity with considerable thrombus (Fig. 1e, f, online Video).
A study reported that late scaffold discontinuities without acute scaffold disruption is a normal bioresorption process and does not involve any major adverse cardiac clinical events [1]. However, that study contained a very limited number of cases. According to previous report, the occurrence of very late scaffold thrombosis is higher than that of drug-eluting stent, but that mechanism remains unclear. In this case, after thrombosis aspiration, OCT examination showed discontinued scaffold and protrude part of the scaffold, which accompanied with much thrombus, in the distal part of scaffold. It is still unclear if the acute disruption or late discontinuity might occur, because OCT examination after scaffold implantation could not be allowed by research protocol (this case from the ABSORB Japan trial [2]). But, discontinued scaffold, which was protruding into the lumen, might give impact on thrombogenesis. It is clinically more important that one week after discontinuing dual antiplatelet therapy, definite thrombosis occurred. The findings of this case question the issue regarding adequate dual antiplatelet therapy in the condition where thrombosis tendency might be high after BVS implantation.
Electronic supplementary material The online version of this article (doi:10.1007/s12928-017-0485-6) contains supplementary material, which is available to authorized users. * Futoshi Yamanaka futoshi‑[email protected] 1
Department of Cardiology and Catheterization Laboratory, Shonankamakura General Hospital, 1370‑1 Okamoto, Kamakura, Kanagawa, Japan
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Fig. 1 a Baseline coronary angiography image s
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