Implantation of bioresorbable vascular scaffolds following acute coronary syndrome is associated with reduced early neointimal growth and strut coverage

Abstract

Early neointimal growth and strut coverage are reduced following ACS in patients receiving BVS. These results may, in part, explain the high rates of ST in registry data.

Impact of Clinical Presentation on Early Vascular Healing After Bioresorbable Vascular Scaffold Implantation

“…Differences in values observed between these two studies might derive from variety of measurement methodology used, from different time points of OCT examination but they might also suggest a diverse healing pattern of BVS in ACS and stable lesions. Data from histopathology and virtual histology intravascular ultrasound studies have shown that culprit lesions of ACS patients present more frequently as thin‐cup fibro‐atheromas, with greater amounts of necrotic core and smaller amounts of fibro‐fatty plaque compared to target lesions in SA patients . Shaw et al observed a correlation between the plaque composition and scaffold expansion and eccentricity immediately after BVS implantation .…”

Impact of calcium on procedural and clinical outcomes in lesions treated with bioresorbable vascular scaffolds - A prospective BRS registry study

“…Implantation of a relatively small scaffold in a relatively larger vessel can result in incomplete apposition, predisposing to ST [35]. Higher rates of ST were also previously noted in patients with ACS which could be due to reduction of early neointimal growth and strut coverage [36,37]. Reasons for the increase in late ST in the Ca compared to the non Ca group include a role for technical factors such as suboptimal implantation with incomplete lesion coverage, underexpansion and malapposition [35,38] and possibly greater impact on the scaffold endothelization and resorption process from a reduced MLD in the Ca group.…”

Novel bioabsorbable polymer and polymer-free metallic drug-eluting stents

“…Interestingly, the BP-DES platform appeared to outperform Xience when utilized for ST-segment elevation MI, a predefined subgroup analysis. Although the mechanisms for this remain unclear, patients presenting with an acute coronary syndrome may exhibit impaired strut endothelialization [48] and thus a more biocompatible polymer may better facilitate arterial healing. Real-world experience with the Orsiro platform is now also available from a 1356 patient registry, showing a TLF rate of 5.1% at 1 year [49].…”