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Open AccessArticle

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

1
Medical Clinic I, University Hospital of Giessen, Klinikstrasse 33, 35392 Giessen, Germany
2
Zentrum für Kardiologie, University Hospital Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany and German Center for Cardiac and Vascular Research (DZHK), Standort Rhein-Main
3
Department of Cardiology, University Hospital of Erlangen, Ulmenweg 18, 91054 Erlangen, Germany
4
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; https://doi.org/10.3390/jcm8050580
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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