Late and very late scaffold thrombosis

Bioresorbable scaffolds (BRSs) are a new treatment for coronary artery disease. As these devices are expected to resorb after providing the mechanical support required the first months after percutaneous coronary intervention (PCI), they could potentially be associated with several long-term advantages over the metallic stents, such as a lack of permanent vessel caging that enables restoration of the vessel vasomotor tone, adaptive shear stress, late luminal enlargement with late expansive remodeling, preservation of long-term side-branch patency, and allowing future revascularization options, while free of complications observed with metallic stents such as neoatherosclerosis and late failure [1]. First-in-human studies of BRSs have shown promising results demonstrating a favorable healing response at long-term with complete scaffold resorption, late lumen enlargement, recovery of vasomotion, and a potentially favorable plaque modification [2,3]. Furthermore, initial clinical results were also promising showing a low rate of adverse events and a complete absence of late and very late thrombotic events. Utilization of BRSs in more complex lesions and populations was associated with a higher event rate, while several cases of late and very late scaffold thrombosis were reported. In this chapter, we aim to briefly summarize current insights from late and very late metallic stent thrombosis, give basic insights into BVSs healing, review current experience on BRSs thrombosis, and suggest potential mechanisms and preventive measures for this complication.

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