极晚期冠脉可吸收支架内血栓一例
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-Otsuka F, et al . Circ Cardiovasc Interv.2014;7(3):330-42
Discussion
Very Late Scaffold Thrombus Rate
Follow up Absorb cohort B1 Absorb II2 Absorb III3 Absorb China4 Absorb Japan5 2y 1y 1y 1y 1y BVS (Absorb) 0% 0.9% 1.5% 0.4% 0.4% DES (Xinece) 0% 0% 0.7% 0% 0.8%
-Brugaletta S, et al . Eur Heart J. 2012;33:1325-33
The incremental effects of BVS on improving very late outcomes are likely to be shown after their complete resorption, which occurs in over 3 years for PLLA-Absorb scaffold.
PCI of PDA
Aspiration thrombectomy
Balloon angioplasty Emerge 1.5*12mm @ 18 atm
PCI of PDA
Trek 2.0*15mm @ 12atms
OCT-RCA
Length (5mm) Scaffold Thrombus Length (28mm)
Protrude into lumen
Strut discontinuity
Uncovered Strut
Aneurysm
Scaffold CSA : 5.04mm2
LumenΒιβλιοθήκη BaiduCSA : 7.76mm2
3.5*18mm
Collateral
Lesion
Thrombus
RCA prox: BVS 3.5*18 (2013. Absorb III) / Aneurysm PLV : unchanged CTO PDA : thrombus / stenosis
Coronary angiography
Patent stent: Left Anterior Descending- mid segment 1st Diagnal
1. 2. 3. 4. 5.
Diletti R, et al.Heart 2013;99:98-105 Serruys PW, Lancet 2015;385:43–54. Ellis SG, et al. N Engl J Med 2015; 373:1905-1915 Gao R, et al. J Am Coll Cardiol 2015;66:2298-309 Kimura T, et al. Eur Heart J 2015
Timing of ST After Stent Implantation
Very Late
> 1 year
Late
>30 days (but within 1 year)
Subacute
“Early”
24 hours to 30 days
Acute and Intraprocedural (IPST)*
<24 Hours
*IPST not counted in ARC definitions
Cutlip et al. Circulation. 2007;115:2344-51
Case 1
• 73 y.o. male
Chief complain: Acute chest pain early in the morning.
Discussion
ScT incidence from Recent Single/Multi-center Observational Studies and Meta-analysis
Follow up
BVS (Absorb)
GHOST-EU registry1
AMC registry2 Meta-analysis3
ECG: SR with new TWI in V1 Initial troponin 0.07 0.42ng/ml Antiplatelet therapy before VLScT: Aspirin 81mg Qdpo, Clopidogrel 75mg Qdpo
ECG
Coronary angiography
IVUS reading Very Late Scaffold Thrombus
Yang Cao
Background
BVS provide temporary mechanical support for at least 6 months and drug elution capability for the first 12 months post-implantation and completely resorb within 3 to 4 years of implantation with the objectives of preserving native vessel geometry.
6m
6m 6m
2.1%
3.0% 3.11%
Meta-analysis4
12m
3.0%
1. 2. 3. 4.
D. Capodanno, et al. EuroIntervention 2015;10:1144-53 Kraak RP,et al. EuroIntervention 2015;10:1160-8 Cassese S, et al. Lancet 2016; 387:537-44 Serban P, et al. JACC 2016;6:921-31
Medical History:
• CAD s/p 2 stent to mid/prox LAD, D1 in 2007 ; one BVS to mRCA in
2013
Cardiovascular risk factor:
• Former smoker, quit for 23ys • HTN , HLD
Discussion
Very Late Scaffold Thrombus Rate
Follow up Absorb cohort B1 Absorb II2 Absorb III3 Absorb China4 Absorb Japan5 2y 1y 1y 1y 1y BVS (Absorb) 0% 0.9% 1.5% 0.4% 0.4% DES (Xinece) 0% 0% 0.7% 0% 0.8%
-Brugaletta S, et al . Eur Heart J. 2012;33:1325-33
The incremental effects of BVS on improving very late outcomes are likely to be shown after their complete resorption, which occurs in over 3 years for PLLA-Absorb scaffold.
PCI of PDA
Aspiration thrombectomy
Balloon angioplasty Emerge 1.5*12mm @ 18 atm
PCI of PDA
Trek 2.0*15mm @ 12atms
OCT-RCA
Length (5mm) Scaffold Thrombus Length (28mm)
Protrude into lumen
Strut discontinuity
Uncovered Strut
Aneurysm
Scaffold CSA : 5.04mm2
LumenΒιβλιοθήκη BaiduCSA : 7.76mm2
3.5*18mm
Collateral
Lesion
Thrombus
RCA prox: BVS 3.5*18 (2013. Absorb III) / Aneurysm PLV : unchanged CTO PDA : thrombus / stenosis
Coronary angiography
Patent stent: Left Anterior Descending- mid segment 1st Diagnal
1. 2. 3. 4. 5.
Diletti R, et al.Heart 2013;99:98-105 Serruys PW, Lancet 2015;385:43–54. Ellis SG, et al. N Engl J Med 2015; 373:1905-1915 Gao R, et al. J Am Coll Cardiol 2015;66:2298-309 Kimura T, et al. Eur Heart J 2015
Timing of ST After Stent Implantation
Very Late
> 1 year
Late
>30 days (but within 1 year)
Subacute
“Early”
24 hours to 30 days
Acute and Intraprocedural (IPST)*
<24 Hours
*IPST not counted in ARC definitions
Cutlip et al. Circulation. 2007;115:2344-51
Case 1
• 73 y.o. male
Chief complain: Acute chest pain early in the morning.
Discussion
ScT incidence from Recent Single/Multi-center Observational Studies and Meta-analysis
Follow up
BVS (Absorb)
GHOST-EU registry1
AMC registry2 Meta-analysis3
ECG: SR with new TWI in V1 Initial troponin 0.07 0.42ng/ml Antiplatelet therapy before VLScT: Aspirin 81mg Qdpo, Clopidogrel 75mg Qdpo
ECG
Coronary angiography
IVUS reading Very Late Scaffold Thrombus
Yang Cao
Background
BVS provide temporary mechanical support for at least 6 months and drug elution capability for the first 12 months post-implantation and completely resorb within 3 to 4 years of implantation with the objectives of preserving native vessel geometry.
6m
6m 6m
2.1%
3.0% 3.11%
Meta-analysis4
12m
3.0%
1. 2. 3. 4.
D. Capodanno, et al. EuroIntervention 2015;10:1144-53 Kraak RP,et al. EuroIntervention 2015;10:1160-8 Cassese S, et al. Lancet 2016; 387:537-44 Serban P, et al. JACC 2016;6:921-31
Medical History:
• CAD s/p 2 stent to mid/prox LAD, D1 in 2007 ; one BVS to mRCA in
2013
Cardiovascular risk factor:
• Former smoker, quit for 23ys • HTN , HLD