Mechanisms of Very Late Bioresorbable Scaffold Thrombosis: The INVEST Registry

Abstract Background Very late scaffoldthrombosis (VLScT) occurs more frequently after bioresorbable scaffold(Absorb BVS 1.1, Abbott Vascular, Santa Clara, California) implantation than with metallic everolimus-eluting stents. Objectives The purpose of this study was to elucidate mechanisms underlying VLScT as assessed by optical coherence tomography (OCT). Methods The INVEST (Independent OCT Registry on Very Late Bioresorbable ScaffoldThrombosis) registry is an international consortium of investigators who used OCT to examine patients with VLScT. Results Between June 2013 and May 2017, 36 patients with 38 lesions who had VLScT underwent OCT at 19 centers. VLScT occurred at a median of 20 months (interquartile range: 16 to 27 months) after implantation. At the time of VLScT, 83% of patients received aspirin monotherapy and 17% received dual-antiplatelet therapy. The mechanisms underlying VLScT were (in descending order) scaffolddiscontinuity (42.1%), malapposition (18.4%), neoatherosclerosis (18.4%), underexpansion or scaffoldrecoil (10.5%), uncovered struts (5.3%), and edge-related disease progression (2.6%). Discontinuity (odds ratio [OR]: 110; 95% confidence interval [CI]: 73.5 to 173; p Conclusions The leading mechanism underlying VLScT was scaffolddiscontinuity, which suggests an unfavorable resorption-related process, followed by malapposition and neoatherosclerosis. It remains to be determined whether modifications in scaffolddesign and optimized implantation can mitigate the risk of VLScT. (Independent OCT Registry on Very Late Bioresorbable ScaffoldThrombosis [INVEST]; NCT03180931)