Is high pressure postdilation safe in bioresorbable vascular scaffolds? Optical coherence tomography observations after noncompliant balloons inflated at more than 24 atmospheres

Fabris, Enrico; Caiazzo, Gianluca; Kılıç, İsmail Doğu; Serdoz, Roberta; Secco, Gioel Gabrio; Sinagra, Gianfranco; Lee, Renick; Foin, Nicolas; Mario, Carlo Di

doi:10.1002/ccd.26222

Cited by 24 publications

(17 citation statements)

References 26 publications

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“…only 57% of total lesions underwent postdilatation in Yosinobu et al study [7]). Based on our results (which are consistent with one recently published study reported by Fabris et al [8].) we can state acute struts disruption is a very uncommon technical complication after high pressure postdilatation of BVS.…”

Section: Discussionsupporting

confidence: 93%

“…we achieved a very low rate of malapposition of the scaffolds implanted. ISA percentage showed by OCT analyses was 1.42% ( in line with recent published studies [8]). …”

Section: Discussionsupporting

confidence: 90%

“…we can state acute struts disruption is a very uncommon technical complication after high pressure postdilatation of BVS. In addition to this, we want to remark that although Fabris et al [8]. performed very high pressure postdilatation of the BVS (up to a maximal balloon inflation of 28 ± 3.8 atm) without procedural complications, our OCT results are better.…”

Section: Discussionmentioning

confidence: 75%

“…In addition to this, isolated malapposed struts (Fig. 2) were also considered as a mark of scaffold disruption when they were alone in lumen, with no connection with the stent circumference [7,8].…”

Section: Oct Offline Analysismentioning

confidence: 99%

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“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: Discussionsupporting

confidence: 93%

“…we achieved a very low rate of malapposition of the scaffolds implanted. ISA percentage showed by OCT analyses was 1.42% ( in line with recent published studies [8]). …”

Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 75%

Section: Oct Offline Analysismentioning

confidence: 99%

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“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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“…Despite this, our data suggest that a satisfactory scaffold expansion can be achieved also in complex coronary lesions, at least when appropriate lesion preparation and BRS deployment under OCT guidance is performed. Moreover, in a small subgroup of 22 calcified lesions we also showed the safety and feasibility of super high-pressure dilatation (max post dilatation pressure of 28±3 ATM) after BRS deployment without reporting any scaffold fractures (29).…”

Section: Review Articlementioning

confidence: 52%

Optical coherence tomography guidance during bioresorbable vascular scaffold implantation

Secco¹,

Verdoia²,

Pistis³

et al. 2017

J. Thorac. Dis.

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In the last decades angiography has been the keystone to assess coronary anatomy, leading to a rapid development of percutaneous revascularisation techniques. Despite the widespread dissemination and high reproducibility, angiography provides a limited analysis of arterial lumen profile without the possibility to disclose vessel wall characteristics and composition of coronary plaques. Intracoronary imaging techniques have been developed to overcome these limitations. Intravascular ultrasound (IVUS) was the first technique introduced in interventional cardiology in the early 90ies (1), followed more than a decade after by optical coherence tomography (OCT). OCT is a light-based technology that similar to IVUS provides information about intravascular anatomy that far exceeds the level of detail obtained from conventional angiography (2). The use of near-infrared light rather than ultrasound reflectance allows OCT to have greater resolution at the price of lower penetration power. Moreover, near-infrared light is scattered by red blood cells, and therefore OCT use for guidance of intervention is limited by the need of prolonged crystalloid infusion during imaging (3,4). In so forth, the penetrance of OCT in daily clinical practice was limited and the technology was mainly employed as a research tool to investigate plaque morphology and strut endothelialisation (5). The frequency domain OCT system (FD-OCT) has the advantage of a more rapid image acquisition due to the fast-scanning laser systems minimising the contrast use and increasing imaging speed while delivering an improved image quality than with the earlier time domain systems (TD-OCT) (6). This The high-resolution power together with the lack of shadowing observed beyond polymer struts makes optical coherence tomography (OCT) the optimal imaging technique to guide BRS implantation and identifies eventually scaffolds failures.

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Deploying bioresorbable vascular scaffolds—tardus, altius, amplius!!

Vallurupalli

Uretsky

2016

Cathet Cardio Intervent

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Current generation bioresorbable vascular scaffolds (BVS) have thick struts and relatively low radial strength; meticulous deployment is required to prevent underexpansion while avoiding stent fracture. The current study suggests safety of very high-pressure (mean 28 atm) post-dilation of BVS with a noncompliant balloon. Duration of inflation and inflation pressure stabilization are important factors that influence the extent of optimal stent expansion and should be studied in future attempts to optimize BVS deployment.

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Is high pressure postdilation safe in bioresorbable vascular scaffolds? Optical coherence tomography observations after noncompliant balloons inflated at more than 24 atmospheres

Abstract: BVS deployment optimization using HPPD does not cause BVS disruption and is associated with a good BVS expansion, low rate of strut malapposition and edge dissections.

Cited by 24 publications

References 26 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”

Optical coherence tomography guidance during bioresorbable vascular scaffold implantation

Deploying bioresorbable vascular scaffolds—tardus, altius, amplius!!

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