Absorb bioresorbable vascular scaffold: What have we learned after 5years of clinical experience?

Caiazzo, Gianluca; Kılıç, İsmail Doğu; Fabris, Enrico; Serdoz, Roberta; Mattesini, Alessio; Foin, Nicolas; Rosa, Salvatore De; Indolfi, Ciro; Mario, Carlo Di

doi:10.1016/j.ijcard.2015.07.101

Cited by 58 publications

(47 citation statements)

References 64 publications

(77 reference statements)

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“…In addition, it could be more useful in complex lesions or bifurcations [18]. Several studies have presented high variability in intravascular imaging utilization during PCI with BVS deployment [9, 19–21]. Our registry showed lower frequency of OCT and IVUS utilization in comparison with most of the above-mentioned studies.…”

Section: Discussionmentioning

confidence: 71%

Patient profile and periprocedural outcomes of bioresorbable vascular scaffold implantation in comparison with drug-eluting and bare-metal stent implantation. Experience from ORPKI Polish National Registry 2014–2015

Rzeszutko¹,

Tokarek²,

Siudak³

et al. 2016

pwki

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IntroductionThere are limited data on the comparison of bioresorbable vascular scaffold (BVS) and drug-eluting stent (DES)/bare-metal stent (BMS) implantation in an unselected population of patients with coronary artery disease.AimTo compare the periprocedural outcomes and patient profile of BVS and DES/BMS implantation in an all-comer population from the ORPKI Polish National Registry.Material and methodsA total of 141,324 consecutive patients from 151 invasive cardiology centers in Poland were included in this prospective registry between January 2014 and June 2015. Periprocedural data on patients with at least one BVS (Absorb, Abbott Vascular, Santa Clara, CA, USA), DES or BMS (all available types) implantation in de novo lesions during index percutaneous coronary intervention for stable angina (SA) or acute coronary syndrome were collected.ResultsBioresorbable vascular scaffold was the most often used in patients with SA, in single-vessel disease and in younger male patients. Bioresorbable vascular scaffold implantation was significantly more often associated with periprocedural administration of ticagrelor/prasugrel (6.8% vs. 3.6%; p = 0.001) and use of intravascular ultrasound and optical coherence tomography in comparison with the DES/BMS group (2.8% vs. 0.6% and 1.8% vs. 0.1%, respectively; p = 0.001 for both). The incidence of periprocedural death was significantly lower in the BVS group than the DES/BMS group (0.04% vs. 0.32%; p = 0.02), but this difference was no longer significant after adjustment for covariates. On the other hand, coronary artery perforation occurred significantly more often during BVS delivery (0.31% vs. 0.12%; p = 0.01), and BVS implantation was identified as an independent predictor of coronary artery perforation in multivariate logistic regression analysis (OR = 6.728, 95% CI: 2.394–18.906; p = 0.001).ConclusionsPatients treated with BVS implantation presented an acceptable safety and efficacy profile in comparison with the DES/BMS group. However, lower risk patients were the most frequent candidates for BVS implantation.

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Section: Discussionmentioning

confidence: 71%

Patient profile and periprocedural outcomes of bioresorbable vascular scaffold implantation in comparison with drug-eluting and bare-metal stent implantation. Experience from ORPKI Polish National Registry 2014–2015

Rzeszutko¹,

Tokarek²,

Siudak³

et al. 2016

pwki

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“…Indeed, the actual duration of resorption of the second-generation scaffold in vivo is ≈18 months longer than the first generation, and its mass loss takes ≈36 months. 13,14 Reabsorption time is critical for the device performance, with mechanical integrity required for a period of 6 months to avoid vessel recoil. 15 Loss of structural integrity and radial support depends on initial focal degradation within the more amorphous regions, whereas significant mass loss requires much longer, with the polymer replaced by a provisional matrix of proteoglycan followed by collagen fibers.…”

mentioning

confidence: 99%

Coronary Bioresorbable Vascular Scaffold Use in the Treatment of Coronary Artery Disease

Testa

Latib

Montone

et al. 2016

Circ: Cardiovascular Interventions

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Bioresorbable vascular scaffolds (BVS) represent a promising novel approach for the treatment of coronary artery disease. BVS promise to address some of the well-known limitations of current drug-eluting stents, while providing a transient scaffolding of the vessel to prevent acute vessel closure/recoil. Drug elution by BVS prevents neointimal proliferation in a similar fashion to drug-eluting stents, and complete bioresorption is associated with late vessel lumen enlargement, plaque regression, and restoration of vasomotion. Based on the pathophysiological reasons and on the results derived from clinical studies, BVS are increasingly being used in clinical practice. The aim of this review is to provide an overview of the current evidence supporting the use of BVS in clinical practice. In particular, we will discuss the randomized controlled trials and registries evaluating the clinical outcome of these devices, with a special focus on their application in patients with acute coronary syndrome and in specific lesion subsets (bifurcations, chronic total occlusions, and in-stent restenosis).

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“…However, intravascular imaging-guided PCI is associated with better clinical outcomes when compared with angiography alone, [17][18][19][20] and its use and importance in BVS implantation, especially in complex lesions, have been recognized widely. 21 First, intravascular imaging provides morphological information and precise vessel size in complex lesion, which is difficult to evaluate sufficiently with angiography alone. Appropriate lesion preparation based on these evaluation could facilitate adequate expansion of BVS.…”

Section: Discussionmentioning

confidence: 99%

Bioresorbable Vascular Scaffolds for the Treatment of Chronic Total Occlusions

Mitomo

Naganuma

Fujino

et al. 2017

Circ: Cardiovascular Interventions

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Background— There are only limited studies reporting clinical outcomes after bioresorbable vascular scaffold (BVS; Absorb; Abbott Vascular, Santa Clara, CA) implantation for coronary chronic total occlusions (CTO). The aim of this study was to evaluate the real-world feasibility and safety of BVS implantation for the treatment of CTO. Methods and Results— We retrospectively evaluated CTO cases treated with BVS from a multicenter registry. The primary end point was target lesion failure defined as a composite of cardiac death, target vessel myocardial infarction, and clinically driven target lesion revascularization. From September 2012 to November 2015, 65 patients with CTO were successfully treated with BVS. The mean age of patients was 60.8±11.0 years; 89.2% were male and 40.0% diabetic. The mean ejection fraction was 57.7±10.8%. The mean reference vessel diameter and CTO lesion length were 3.0±0.4 and 20.2±3.0 mm, respectively. The mean number of BVS deployed per patient was 1.8±0.7, of which mean diameter and total length were 3.0±0.4 and 47.6±19.9 mm, respectively. Postdilatation with noncompliant balloons (mean diameter 3.3±0.3 mm) was performed at high pressures (18.6±5.3 atm) in all cases. Intravascular ultrasound (n=34) or optical coherence tomography (n=31) was performed in all cases. During the follow-up period (median: 453 days, 25th and 75th percentiles: 230 and 703), there were no occurrences of target lesion failure or scaffold thrombosis. Conclusions— BVS implantation for the treatment of CTO seems feasible and safe. Appropriate lesion preparation, high-pressure postdilatation, and the use of intravascular imaging are recommended to obtain the best possible final result.

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Absorb bioresorbable vascular scaffold: What have we learned after 5years of clinical experience?

Cited by 58 publications

References 64 publications

Patient profile and periprocedural outcomes of bioresorbable vascular scaffold implantation in comparison with drug-eluting and bare-metal stent implantation. Experience from ORPKI Polish National Registry 2014–2015

Patient profile and periprocedural outcomes of bioresorbable vascular scaffold implantation in comparison with drug-eluting and bare-metal stent implantation. Experience from ORPKI Polish National Registry 2014–2015

Coronary Bioresorbable Vascular Scaffold Use in the Treatment of Coronary Artery Disease

Bioresorbable Vascular Scaffolds for the Treatment of Chronic Total Occlusions

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