Appropriate use of bioresorbable vascular scaffolds in percutaneous coronary interventions: a recommendation from experienced users

Abstract

Percutaneous coronary interventions (PCI) have become a reliable revascularisation option to treat ischaemic coronary artery disease. Drug-eluting stents (DES) are widely used as first choice devices in many procedures due to their established good medium to long term outcomes. These permanent implants, however, do not have any residual function after vascular healing following the PCI. Beyond this initial healing period, metallic stents may induce new problems, resulting in an average rate of 2 % reinterventions per year. To eliminate this potential late limitation of permanent metallic DES, bioresorbable coronary stents or ‘vascular scaffolds’ (BVS) have been developed. In a parallel publication in this journal, an overview of the current clinical performance of these scaffolds is presented. As these scaffolds are currently CE marked and commercially available in many countries and as clinical evidence is still limited, recommendations for their general usage are needed to allow successful clinical introduction.

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

“…A similar observation regarding selection of patients and lesions for BVS implantation has been presented in a few large studies [2, 9]. Patient selection for BVS implantation in this registry was consistent with the main criteria of recommendations from both a European and a Netherlands consensus [14, 15], which indicate the highest beneficial effect on longtime clinical outcome after scaffold deployment. Procedural success depends not only on proper selection of patients but also lesions [16].…”

“…Several studies have suggested benefit from intracoronary imaging with IVUS and/or OCT for optimization of PCI results [17]. However, according to the European consensus it is not routinely recommended for this purpose [15]. Intravascular ultrasound is used for the evaluation of the plaque morphology and in the preparation phase.…”

“…Vessel visualization with these procedures was not mandatory, but it was performed in difficult cases with a questionable result of scaffold deployment. According to the European consensus, the new users of BVS should have a lower threshold for the use of imaging before and after BVS implantation [15]. Increased risk of ScT and myocardial infarction were early concerns raised with introduction of BVS utilization.…”

Are BVS suitable for ACS patients? Support from a large single center real live registry

“…Also, in our registry rate of definite ST (2.0% for ACS patients and 2.1% for stable patients) was higher compared to that of currently available metallic DES [35,36]. The importance of patient selection, lesion preparation, pre-and post-dilatation and also the consideration of intra-vascular imaging have to be underlined [37,38]. A pilot imaging study suggested suboptimal implantation as an important cause for BVS ST [28].…”

Differential aspects between cobalt-chromium everolimus drug-eluting stent and Absorb everolimus bioresorbable vascular scaffold: from bench to clinical use

“…As the largest commercially available size of Absorb BVS is 3.5 mm at nominal pressure, the vessel diameter above 4.0 mm should not be targeted because of the risk of extensive malapposition [40]. The device should not be implanted into the lesions that cannot be adequately prepared such as heavily calcified and unsatisfactorily predilatated lesions.…”