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Open AccessArticle

Incidental Finding of Strut Malapposition Is a Predictor of Late and Very Late Thrombosis in Coronary Bioresorbable Scaffolds

Medical Clinic I, University Hospital of Giessen, Klinikstrasse 33, 35392 Giessen, Germany
Zentrum für Kardiologie, University Hospital Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany and German Center for Cardiac and Vascular Research (DZHK), Standort Rhein-Main
Department of Cardiology, University Hospital of Erlangen, Ulmenweg 18, 91054 Erlangen, Germany
Department of Radiology, Leiden University Medical Center, P.O. Box 9600 (mailstop C2-S), 2300 Leiden, The Netherlands
Author to whom correspondence should be addressed.
These authors contributed equally.
J. Clin. Med. 2019, 8(5), 580;
Received: 19 March 2019 / Revised: 16 April 2019 / Accepted: 25 April 2019 / Published: 27 April 2019
Malapposition is a common finding in stent and scaffold thrombosis (ScT). Evidence from studies with prospective follow-up, however, is scarce. We hypothesized that incidental observations of strut malapposition might be predictive of late ScT during subsequent follow-up. One hundred ninety-seven patients were enrolled in a multicentre registry with prospective follow-up. Optical coherence tomography (OCT), performed in an elective setting, was available in all at 353 (0–376) days after bioresorbable scaffold (BRS) implantation. Forty-four patients showed evidence of malapposition that was deemed not worthy of intervention. Malapposition was not associated with any clinical or procedural parameter except for a higher implantation pressure (p = 0.0008). OCT revealed that malapposition was associated with larger vessel size, less eccentricity (all p < 0.01), and a tendency for more uncovered struts (p = 0.06). Late or very late ScT was recorded in seven of these patients 293 (38–579) days after OCT. OCT-diagnosed malapposition was a predictor of late and very late scaffold thrombosis (p < 0.001) that was independent of the timing of diagnosis. We provide evidence that an incidental finding of malapposition—regardless of the timing of diagnosis of the malapposition—during an elective exam is a predictor of late and very late ScT. Our data provide a rationale to consider prolonged dual antiplatelet therapy if strut malapposition is observed. View Full-Text
Keywords: stent thrombosis; bioresorbable scaffold; optical coherence tomography stent thrombosis; bioresorbable scaffold; optical coherence tomography
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Boeder, N.F.; Weissner, M.; Blachutzik, F.; Ullrich, H.; Anadol, R.; Tröbs, M.; Münzel, T.; Hamm, C.W.; Dijkstra, J.; Achenbach, S.; Nef, H.M.; Gori, T. Incidental Finding of Strut Malapposition Is a Predictor of Late and Very Late Thrombosis in Coronary Bioresorbable Scaffolds. J. Clin. Med. 2019, 8, 580.

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