EBC - ON DEMAND
Update on BRS thrombosis
European Bifurcation Club 2015 – EBC 2015 – Athens, Greece
BRS in bifurcations (2)
Update on BRS thrombosis
Author: Davide Capodanno, MD, PhD, Associate Professor, University of Catania, Italy
CLOSING REMARKS
- Device thrombosis remains an issue with contemporary BRS, with the timing of the event evenly distributed from acute to very late thrombosis.
- Similar to metallic stents, the leading morphological substrate of acute andsubacute BRS thrombosis is suboptimal implantation (i.e., incomplete lesion coverage, acute malapposition, and underexpansion)
- Late and very late BRS thrombosis is mostly observed in the presence of regional suboptimal flow conditions (i.e. overlaps, persistent and acquired malapposition, strut discontinuity) and delayed healing, and it is often triggered by DAPT discontinuation.
- Prevention of BRS thrombosis involves careful patient selection, best implantation practices and long-term DAPT.
- Optimal management of BRS thrombosis carries many unknowns, including the uncertain outcome of strategies that may be valid with metallic DES but potentially hazardous with a breakable device, particularly when bioresorption has started.