BRS implantation in long lesions requiring device overlapping: myth or reality?

Abstract

Dealing with bioresorbable vascular scaffolds (BVS) implantation in long lesions requiring device overlapping in this particular moment might seem a little provocative for several reasons. First, most studies testing BVS have focused on their safety and efficacy profile in simple patients with simple lesions. Second, ABSORB II did not meet its primary endpoint, while ABSORB III showed a higher rate of target vessel-myocardial infarction (TV-MI) at 2 years. Third, data on porcine model showed that overlapping zone has delayed but greater neointimal proliferation with consequent higher risk for scaffold thrombosis in the short-term and of in-scaffold restenosis in the long-term. Fourth, recently published data showed higher risk of TVF in patients treated with ≥60 mm BVS. Given all these premises, it may seem right to put aside this technology, while it may seem inappropriate to hypothesize the use of BVS in long lesions. The aim of the present review is precisely to critically review the available evidences regarding BVS with particular regard to overlapping BVS in order to understand whether this technology has a future per se and especially in long coronary lesions requiring overlap.

Clinical results of bioresorbable drug-eluting scaffolds in short and long coronary artery lesions using the PSP technique

“…Late ones fail at malapposition (35%), discontinuity (31%), peri-strut low intensity area (19%) and incomplete lesion coverage (12%) [ 27 ]. Also the device overlap seems to be a factor increasing the scaffold thrombosis rate [ 28 ]. The study group of Polimeni et al enrolled 183 patients with ST-segment myocardial infarction in their study and could demonstrate that the scaffold thrombosis rate was reduced when an optimized implantation technique was used [ 29 ].…”

“…The study group of Polimeni et al enrolled 183 patients with ST-segment myocardial infarction in their study and could demonstrate that the scaffold thrombosis rate was reduced when an optimized implantation technique was used [ 29 ]. Many recent studies tried to find predictors for scaffold failure and figured out that the implantation technique is a very important factor in reducing cardiac events [ 28 , 30 – 36 ]. The use in acute coronary syndroms studied by Anadol et al seems to be safe as well [ 37 ].…”