Very late scaffold thrombosis one week after the discontinuation of dual antiplatelet therapy

Excerpt

A 59-year-old man was admitted to the hospital due to effort angina pectoris; the coronary angiogram demonstrated critical stenosis in the distal right coronary artery (Fig. 1a). A bioresorbable vascular scaffold (BVS) 3.5–18 (Abbott’s Cor) was implanted (Fig. 1b, c), after which the symptoms improved. On the 1-year follow up, angiography demonstrated no restenosis at the BVS site, and 22 months later after the BVS implantation, clopidogrel treatment was discontinued (keeping an aspirin 100 mg/day). However, 1 week after the discontinuation of dual antiplatelet therapy, very late bioresorbable vascular scaffold thrombosis occurred (Fig. 1d). The clinical symptoms demonstrated sudden onset chest pain and ST elevation in II, III, and aVf. Emergency coronary angiography showed definite thrombosis according to the Valve Academic Research Consortium criteria. Following aspiration thrombectomy, antegrade flow recovered. Optical coherence tomography imaging demonstrated scaffold discontinuity with considerable thrombus (Fig. 1e, f, online Video).

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