Who Is Thrombogenic: The Scaffold or the Doctor? Back to the Future!

T wenty years ago, Drs. Patrick Serruys and Carlo Di Mario wrote an editorial in Circulation titled “Who Was Thrombogenic: The Stent or the Doctor?” (1), that discussed optimal stent implantation technique. They highlighted the critical roles played by both the use of intravascular ultrasound to optimize stent implantation and the administration of dual antiplatelet therapy (DAPT) to prevent metal stent thrombosis (ST) (2). These suggestions and considerations were particularly pertinent at the time, and although the designs of metallic stents have evolved to make the technology more forgiving, these factors are still valid and must be seriously revisited when considering the use of current early-generation bioresorbable scaffolds.