Background: The 3-year clinical outcome data of ABSORB II study failed to reach the two co-primary endpoints of vasomotion and late loss, but also reported a higher risk of definite or probable stent thrombosis throughout 3 years (3% vs 0%, p=0.03) with the Absorb BVS compared with the metallic EES as well as myocardial infarction.(1) In addition, a numerically higher rate of definite very late device thrombosis (2% vs 0%, p=0.19) was observed. In ABSORB Japan study, malapposition and late strut discontinuities were observed at the timepoint of very late scaffold thrombosis in all the 4 cases of definite very late scaffold thrombosis.(2,3) There is mounting evidence from other studies with extended follow-up supporting the notion of an increased risk of very late scaffold thrombosis. While the causes of acute scaffold thrombosis are explained at least in part (i.e. underexpansion, increased strut thickness), the causes underlying thrombotic events occurring beyond one year after scaffold implantation remain unclear and require investigation in an independent manner.