Angiographic and Optical Coherence Tomography Insights Into Bioresorbable Scaffold Thrombosis

Καρανάσος, Αντώνιος; Mieghem, Nicolas Van; Ditzhuijzen, Nienke van; Felix, Cordula; Daemen, Joost; Autar, Anouchska; Onuma, Yoshinobu; Kurata, Mie; Diletti, Roberto; Valgimigli, Marco; Kauer, Floris; Beusekom, Heleen van; Jaegere, Peter de; Zijlstra, Felix; Geuns, Robert Jan van; Regar, Eveline

doi:10.1161/circinterventions.114.002369

Cited by 89 publications

(49 citation statements)

References 29 publications

(53 reference statements)

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“…However, clinical evidence has reported same angiographical and OCT findings as risk factors for intrastent thrombosis either in DES or BVS: stent underexpansion, malapposition and incomplete strut coverage [16]. In this line, Campodanno et al [17] .…”

Section: Discussionmentioning

confidence: 93%

“Assessment of effectiveness and security in high pressure postdilatation of bioresorbable vascular scaffolds during percutaneous coronary intervention. Study in a contemporary, non-selected cohort of Spanish patients”

Abellás-Sequeiros¹,

Ocaranza-Sánchez²,

Braga

et al. 2016

International Journal of Cardiology

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Objectives: To determine security and benefits of high pressure postdilatation (HPP) of bioresorbable vascular scaffolds (BVS) in percutaneous coronary intervention (PCI) of complex lesions whatever its indication is. Background: Acute scaffold disruption has been proposed as the main limitation of BVS when they are overexpanded. However, clinical implications of this disarray are not yet clear and more evidence is needed. Methods: A total of 25 BVS were deployed during PCI of 14 complex lesions after mandatory predilatation. In all cases HPP was performed with NC balloon in a 1:1 relation to the artery. After that, optical coherence tomography (OCT) analyses were performed. Results: Mean and maximal postdilatation pressure were 17 ± 3.80 and 20 atmospheres (atm) respectively. Postdilatation balloon/scaffold diameter ratio was 1.01. A total of 39,590 struts were analyzed. Mean, minimal and maximal scaffold diameter were respectively: 3.09 ± 0.34 mm, 2.88 ± 0.31 mm and 3.31 ± 0.40 mm. Mean eccentricity index was 0.13 ± 0.05. ISA percentage was 1.42% with a total of 564 malapposed struts. 89 struts were identified as disrupted, which represents a percentage of disrupted struts of 0.22%. At 30 days, none of our patients died, suffered from stroke, stent thrombosis or needed target lesion revascularization (TLR). Conclusions: NC balloon HPP of BVS at more than 17 atm (up to 20 atm) is safe during PCI and allows to achieve better angiographic and clinical results.

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Section: Discussionmentioning

confidence: 93%

“Assessment of effectiveness and security in high pressure postdilatation of bioresorbable vascular scaffolds during percutaneous coronary intervention. Study in a contemporary, non-selected cohort of Spanish patients”

Abellás-Sequeiros¹,

Ocaranza-Sánchez²,

Braga

et al. 2016

International Journal of Cardiology

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“…It is indicated that suboptimal BVS implantation such as ISA, underexpansion, and disruption (fracture) may increase the risk of TLR and ST 25 and are well known for PCI with DES. 26,27 The differences in the physiological properties of BVS and DES such as strut thickness and bioabsorption should be taken into account; however, high-pressure postdilatation with appropriate size of noncompliant balloon would be recommended for the best possible results while minimizing the risk of scaffold fracture and edge dissections.…”

Section: Discussionmentioning

confidence: 99%

Bioresorbable Vascular Scaffolds for the Treatment of Chronic Total Occlusions

Mitomo

Naganuma

Fujino

et al. 2017

Circ: Cardiovascular Interventions

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Background— There are only limited studies reporting clinical outcomes after bioresorbable vascular scaffold (BVS; Absorb; Abbott Vascular, Santa Clara, CA) implantation for coronary chronic total occlusions (CTO). The aim of this study was to evaluate the real-world feasibility and safety of BVS implantation for the treatment of CTO. Methods and Results— We retrospectively evaluated CTO cases treated with BVS from a multicenter registry. The primary end point was target lesion failure defined as a composite of cardiac death, target vessel myocardial infarction, and clinically driven target lesion revascularization. From September 2012 to November 2015, 65 patients with CTO were successfully treated with BVS. The mean age of patients was 60.8±11.0 years; 89.2% were male and 40.0% diabetic. The mean ejection fraction was 57.7±10.8%. The mean reference vessel diameter and CTO lesion length were 3.0±0.4 and 20.2±3.0 mm, respectively. The mean number of BVS deployed per patient was 1.8±0.7, of which mean diameter and total length were 3.0±0.4 and 47.6±19.9 mm, respectively. Postdilatation with noncompliant balloons (mean diameter 3.3±0.3 mm) was performed at high pressures (18.6±5.3 atm) in all cases. Intravascular ultrasound (n=34) or optical coherence tomography (n=31) was performed in all cases. During the follow-up period (median: 453 days, 25th and 75th percentiles: 230 and 703), there were no occurrences of target lesion failure or scaffold thrombosis. Conclusions— BVS implantation for the treatment of CTO seems feasible and safe. Appropriate lesion preparation, high-pressure postdilatation, and the use of intravascular imaging are recommended to obtain the best possible final result.

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“…The importance of pre and post-dilatation in optimizing scaffold implantation and expansion should not be underestimated, particularly in the case of complex lesions Antonio H. Frangieh et al, Impact of post-dilatation on strut apposition of BVS (i.e. bifurcations, long lesions, calcified plaques and acute coronary syndromes) [6] where BVS underexpansion, and malapposition are considered main pathomechanisms for both sub-acute or late thrombotic events [7,8]. Additionally, post-dilatation after a BVS implantation seems to be beneficial even for soft lesions [9,10].…”

Section: This Paper Was Guest Edited By Prof Marek Kozińskimentioning

confidence: 99%

Impact of post-dilatation on strut apposition of second-generation bioresorbable vascular scaffolds: Key role for scaffold thrombosis and prognosis?

et al. 2018

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Angiographic and Optical Coherence Tomography Insights Into Bioresorbable Scaffold Thrombosis

Abstract: Supplemental Digital Content is available in the text.

Cited by 89 publications

References 29 publications

“Assessment of effectiveness and security in high pressure postdilatation of bioresorbable vascular scaffolds during percutaneous coronary intervention. Study in a contemporary, non-selected cohort of Spanish patients”

“Assessment of effectiveness and security in high pressure postdilatation of bioresorbable vascular scaffolds during percutaneous coronary intervention. Study in a contemporary, non-selected cohort of Spanish patients”

Bioresorbable Vascular Scaffolds for the Treatment of Chronic Total Occlusions

Impact of post-dilatation on strut apposition of second-generation bioresorbable vascular scaffolds: Key role for scaffold thrombosis and prognosis?

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