“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”

Abstract

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.

Andamiajes bioresorbibles de magnesio versus poliméricos: comparación in vivo de su comportamiento mecánico por OCT

“…In all cases, OCT evaluation was done after lesion predilatation and both after scaffold deployment and postdilatation to warrant: (a) the best evaluation of the lesion, (b) appropriate size of the device, and (c) optimal scaffold expansion and apposition. Images acquisition technique has been previously described 4 .…”

“…Lumen, scaffold, and vessel diameters were measured, and malapposed and disrupted struts were also identified. Definitions and analysis methods have been previously published, and they were applied in both the Absorb ® and Magmaris ® groups 4,6 .…”

“…To reduce this resorption process, Magmaris ® scaffold (Biotronik AG, Bulach, Switzerland) was designed as the first non-polymeric scaffold, with a magnesium alloy backbone that can be completely degraded by 9-12 months after PCI 3 . Optimal expansion and apposition, with no significant scaffold disruption, have been demonstrated for Absorb ® BVS immediately after PCI 4 ; however, there is few evidence regarding Magmaris ® acute performance after PCI.…”

The clinical and angiographic outcomes of post-dilation after percutaneous coronary intervention in patients with acute coronary syndrome: a systematic review and meta-analysis

“…The CRUISE (Can Routine Ultrasound In uence Stent Expansion) study showed that target vessel revascularization had been reduced by 44% and the nal minimum stent area had been increased by 14% after the post-dilation with the guidance of intravascular ultrasound [32]. During the bioresorbable vascular scaffolds and sirolimus-eluting stents implantation, the post-dilation with high-pressure non-compliant balloon and large sizes balloon (balloons > 1 mm larger than the stent nominal size) also demonstrated safe clinical and angiographic results [33,34]. There were a few studies on the post-dilation at present, the majority of them were observational studies and excluded patients with ACS, only patients with stable coronary artery disease, long lesions or calci cation lesions were included.…”

Impact of post-dilatation on strut apposition of second-generation bioresorbable vascular scaffolds: Key role for scaffold thrombosis and prognosis?

“…bifurcations, long lesions, calcified plaques and acute coronary syndromes) [6] where BVS underexpansion, and malapposition are considered main pathomechanisms for both sub-acute or late thrombotic events [7,8]. Additionally, post-dilatation after a BVS implantation seems to be beneficial even for soft lesions [9,10]. On the other hand, it should be emphasized that balloon post-dilatation could result in BVS edge dissection or de-novo stenosis in case of "geographical miss" when the balloon markers are outside the scaffold markers during post-dilatation.…”