Lessons learned from acute and late scaffold failures in the ABSORB EXTEND trial

Aims: Bioresorbable scaffolds are increasingly used in patients with coronary artery disease undergoing percutaneouscoronary interventions. ABSORB EXTEND is an ongoing study that will recruit 800 patients. Thisreport evaluates acute and late scaffold failure in the first 450 patients enrolled in ABSORB EXTEND whohave completed 12 months follow-up.Methods and results: Clinical event data from the first 450 patients enrolled in ABSORB EXTEND havedemonstrated low rates of ischaemia-driven MACE (4.2%) and target vessel failure (4.7%) at 12 months.There have been seven cases of device failure in this study: three cases of scaffold dislodgement (0.67%) andfour cases of subacute or late scaffold thrombosis (0.89%). All scaffold dislodgements occurred in the leftcircumflex (LCX), and in two cases dislodgement was observed after reinsertion of the same device. Twocases of subacute scaffold thrombosis and two late scaffold thromboses were observed. Two out of four casesof scaffold thrombosis seemed to be related to either premature discontinuation of dual antiplatelet therapy(DAPT) or resistance to clopidogrel.Conclusions: This is the first report specifically describing the incidence and the potential mechanisms ofscaffold dislodgement and scaffold thrombosis as seen in the ABSORB EXTEND trial.