Optical coherence tomography-guided versus angiography-guided implantation of everolimus-eluting bioresorbable vascular scaffolds: Comparison of coverage, apposition and clinical outcome. The ALSTER-OCT ABSORB registry

Abstract

Background: Suboptimal implantation of everolimus-eluting bioresorbable vascular scaffolds (EE--BVS) leading to strut malapposition and lack of neointima coverage has been hypothesized to be linked to late BVS-thrombosis. Optical coherence tomography (OCT) allows assessing subtle differences in BVS--healing. We aimed to link 6-months OCT-data on EE-BVS coverage and malapposition to implantation technique and clinical outcome. Methods: Twenty-nine consecutive EE-BVS-patients were included. EE-BVS-implantation was guided by angiography in the first 17 patients (group 1). Vessel sizing prior to implantation and implantation result was assessed by OCT in the 12 following patients (group 2). EE-BVS-implantation was performed in both groups with adequate lesion preparation, sizing and systematic high-pressure post-dilatation. All patients received 6-months invasive control including OCT-analysis and clinical follow-up for 2 years.Results: The rate of uncovered struts was group 1: 10.8 ± 10.0%; group 2: 10.6 ± 8.2%, p = 0.934. Target lesion failure due to BVS-thrombosis occurred in 2/17 patients at 9 and 18 months (11.8%, group 1), and no patients in group 2 (p = 0.218). (Cardiol J 2018; 25, 4: 459-469) Conclusions: Optical coherence tomography analysis at 6-months following EE-BVS-implantation finds almost 90% of struts to be covered. No difference between OCT vs. angiography-guided EE-BVS--implantation was observed. OCT at 6-months was not able to predict late BVS-thrombosis of EE-BVS.

Bioresorbable Vascular Scaffolds—Dead End or Still a Rough Diamond?

“…In line with this concept, the use of a longer inflation time, as suggested by the producer, allows better for device expansion and a more homogeneous apposition [53]. In order to select the proper size of BVS, the measurement of the target's diameter was observed to be equally accurate under the guidance of either angiography or OCT [139]. Eventually, MRI enables non-invasive and non-radiative assessment of BVS patency after implantation and may be an alternative for patients with recurrent angina after angioplasty [140].…”