Author + information
- Lorenz Räber, MD, PhD,
- Kyohei Yamaji, MD, PhD and
- Stephan Windecker, MD∗ ()
- ↵∗Department of Cardiology, Bern University Hospital, Freiburgstrasse, 3010 Bern, Switzerland
We appreciate the interest of Dr. Arroyo and colleagues in our paper (1). The authors suggest that peri-low strut intensity areas (PLSIA) may play a causal role in very late scaffold thrombosis. PLSIA constitute peri-strut signal-poor regions without significant attenuation by optical coherence tomography and have been correlated with variety of findings such as fibrin accumulation, proteoglycan rich tissue, inflammatory reactions, and organized thrombus on histologic examinations (2). Indeed, optical coherence tomography-detected PLSIA at follow-up represent a frequent finding (Cypher 58 to 67%, Taxus 80-96%, Biomatrix 40-57%, ABSORB BVS [ABSORB Bioresorbable vascular scaffold] 40%) rendering a causal relationship in the pathogenesis of very late scaffold thrombosis unlikely. Whether ABSORB BVS is more susceptible to PLSIA than other devices remains speculative in the absence of comparative studies.
Dr. Arroyo and colleagues suggest an association between PLSIA and late scaffold thrombosis by referring to an article by Cuculi et al (3). Although the authors of that article state that “late scaffold thrombosis is associated with lower peristrut light intensity” and suggest this to be a “prevailing pathophysioloigcal mechanism of late scaffold thrombosis,” quantitative data as well as any convincing visual representation are not provided in support of this conclusion.
PLSIA was observed in 4.3% (case 1), 4.0% (case 2), 11.9% (case 3), and 53% of scaffold struts (case 4), respectively in our case series (1). There was no frame-level correlation between PLSIA and thrombus. Accordingly, we consider PLSIA as optical coherence tomography finding without obvious association to very late scaffold thrombosis.
Please note: Dr. Windecker has received research grants and speaker fees from Abbott Vascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- American College of Cardiology Foundation
- Räber L.,
- Brugaletta S.,
- Yamaji K.,
- et al.
- Cuculi F.,
- Puricel S.,
- Jamshidi P.,
- et al.