Intracoronary Imaging for Assessment of Vascular Healing and Stent Follow-up in Bioresorbable Vascular Scaffolds

Abstract

Bioresorbable Vascular Scaffolds (BVS) are polymer-based materials implanted in the coronary arteries in order to treat atherosclerotic lesions, based on the concept that once the lesion has been treated, the material of the implanted stent will undergo a process of gradual resorption that will leave, in several years, the vessel wall smooth, free of any foreign material and with its vasomotion restored. However, after the first enthusiastic reports on the efficacy of BVSs, the recently published trials demonstrated disappointing results regarding long-term patency following BVS implantation, which were mainly attributed to technical deficiencies during the stenting procedure. Intracoronary imaging could play a crucial role for helping the operator to correctly implant a BVS into the coronary artery, as well as providing relevant information in the follow-up period. This review aims to summarize the role of intracoronary imaging in the follow-up of coronary stents, with a particular emphasis on the role of intravascular ultrasound and optical coherence tomography for procedural guidance during stent implantation and also for follow-up of bioabsorbable scaffolds.

CTA Evaluation of Bioresorbable Scaffolds versus Metallic Coronary Stents – a Feasibility Study

“…1 However, restenosis, occuring at the site of treated injuries, and the possible need for repeated revascularization are the main drawbacks encountered in interventional cardiology. 2 Restenosis represents a complex phenomenon that starts immediately after vessel barotrauma, induced by coronary angioplasty. [3][4][5] Based on the moment of occurrence, instent restenosis (ISR) can be classified in early ISR -due to elastic recoil and in-lumen axial plaque relocation, characterizes balloon angioplasty primarily, and late ISR -the consequence of thrombus reorganization, neointima formation, vascular remodeling, and resolution of the inflammatory process.…”

“…The need for adequate follow-up of patients undergoing coronary angioplasty emerged since the first angioplasty, performed more than 40 years ago. 2 After percutaneous coronary intervention (PCI), the patient falls into the category of patients that must be followed regularly, being at risk for stent occlusion by thrombosis or restenosis. 6 The complete assessment of the type of occlusion is essential in order to choose the optimal revascularization strategy (DES vs. DEB).…”

CTA Assessment of Coronary Atherosclerotic Plaque Evolution after BVS Implantation – a Follow-up Study

“…The use of conventional imaging as well as preand post-procedural intracoronary imaging techniques is encouraged to optimize the implantation and the subsequent monitoring of the device. 11 Given their structure and mechanical properties, compared to the pharmacologically-treated metallic stents, bioresorbable scaffolds require a meticulous evaluation of the lesion and also the frequent use of pre-and post-dilatation. As a result, the duration of the procedure and the use of contrast substance increases.…”