Bioresorbable vascular scaffold: a step back thinking of the future

Polimeni, Alberto; Gori, Tommaso

doi:10.5114/aic.2018.76401

Cited by 3 publications

(3 citation statements)

References 18 publications

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“…Notably, the use of post-dilatation balloons larger than the nominal BRS diameters was associated with a paradoxically lower MLD/RVD. Although the observational nature of the present data does not allow for making inferences, it could be hypothesized that an excessively aggressive BRS overexpansion might have led to an increased incidence of strut fractures and recoil [30]. In line with this, Yamaji et al observed that high-pressure post-dilatation yields a small improvement in in-device minimal lumen area, while being associated with significantly larger angiographic late lumen loss at six months [31].…”

Section: Discussionmentioning

confidence: 82%

Procedural Predictors for Bioresorbable Vascular Scaffold Thrombosis: Analysis of the Individual Components of the “PSP” Technique

Dimitriadis

Polimeni

Anadol

et al. 2019

JCM

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The technique used at the time of implantation has a central role in determining the risk of thrombosis in bioresorbable vascular scaffolds (BRS). Different definitions of the “optimal” implantation technique exist, however. The impact of individual procedural characteristics on the risk of scaffold thrombosis (ScT) was evaluated in a single-center observational study that enrolled 657 patients (79% males, mean age 63 ± 12 years) with 763 lesions who received a total of 925 BRS for de novo lesions. During a median 1076 (762–1206) days’ follow-up there were 28 cases of thrombosis. Independent predictors of ScT included the use of predilatation balloons bigger than the nominal BRS diameter (hazard ratio (HR) = 0.4 (0.16–0.98), p = 0.04), sizing (implantation in vessels with reference vessel diameter >3.5 mm or <2.5 mm: HR = 5.71 (2.32–14.05), p = 0.0002) and the degree of vessel expansion (ratio of minimum lumen to reference vessel diameter, HR: 0.005 (0.0001–0.23), p = 0.007). In addition, a mild BRS oversizing (final BRS diameter to vessel diameter 1.14–1.28) was associated with a lower thrombosis risk, whereas undersizing and more severe oversizing (final BRS diameter to vessel diameter <1.04 and >1.35, respectively) were associated with an increased risk of ScT (HR = 0.13 (0.02–0.59), p = 0.0007). In conclusion, different components of the “optimal” technique have different impacts on the risk of BRS thrombosis. Besides predilatation with a balloon larger than the BRS diameter, correct vessel size selection and a mild to moderate oversizing appear to be protective.

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Section: Discussionmentioning

confidence: 82%

Procedural Predictors for Bioresorbable Vascular Scaffold Thrombosis: Analysis of the Individual Components of the “PSP” Technique

Dimitriadis

Polimeni

Anadol

et al. 2019

JCM

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“…In summary, meticulous lesion preparation for appropriate expansion of BRS, postdilatation with an appropriately sized noncompliant balloons to maximize the chance of adequate apposition, careful lesion evaluation with intra-vascular imaging during all steps of the procedure and maintenance of long-term DAPT in case of suboptimal procedural results were the main PCI principles that may have contributed to the achievement of better outcomes in these later registries 30,31 . These analyses support the potential feasibility of BRS implantation in complex scenarios with adequate lesion selection and meticulous procedural steps in order to maximize scaffold dimensions, embed struts into plaque, avoid acute malapposition, and reduce shear stress which may thus have favorable effects on clinical outcomes during the scaffolds healing and resorption phases, even as late as 3 years 32 .…”

Section: Future Perspectivesmentioning

confidence: 99%

Percutaneous Coronary Intervention with Everolimus-Eluting Bioresorbable Vascular Scaffolds in Diffuse Coronary Artery Disease: Current Knowledge and Future Perspectives

Masiero¹,

Fovino²,

Schiavo³

et al. 2018

J Cardiol and Cardiovasc Sciences

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The optimal percutaneous treatment of diffuse coronary artery disease (CAD) remains an unsolved issue. Bioresorbable scaffold (BRS) technology has been developed to overcome the disadvantages of metallic drug-eluting stents (DES) due to their permanent struts. Through the resorption process, BRS may provide complete vascular restoration, which appears very attractive in the treatment of diffuse CAD. However, robust evidence on the use of BRS in this setting is lacking and recent data have raised concerns about the safety of this novel technology, especially when BRS are used in complex CAD or without adequate protocol implantation. This review aims at summarizing current evidence and future perspectives on Absorb BRS implantation in complex CAD, such as in distal coronary segments involvement and diffused disease.

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“…Culotte stenting, a technique involving the insertion of two stents in the bifurcation area, has demonstrated effectiveness in maintaining unobstructed blood ow but presents challenges due to its complexity and potential complications 4 [5]. Strategies for enhancing Culotte stenting involve personalized protocols, integration with other interventional methods, and exploring the use of BVS 5 .…”

Section: Introductionmentioning

confidence: 99%

Improving Bifurcated Scaffold Morphologies: The Feasibility of Culotte Techniques with Bioresorbable Vascular Scaffolds

Tu,

Zhang,

Tian

et al. 2024

Preprint

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Objectives: This study aimed to assess the bioresorbable vascular scaffold (BVS) performance with culotte stenting techniques and evaluate bifurcated scaffold morphologies. Methods: Conventional culotte stenting (CCS), double kissing mini-culotte stenting (DKMCS), and double kissing single-ring culotte stenting (DKSRCS) were executed in silicone bifurcated models. Procedures concluded with final kissing balloon inflation and proximal optimization technique. Microcomputed tomography assessed morphological parameters like side branch (SB) residual ostial stenosis and neocarina length (LNC) quantitatively. Optical coherence tomography (OCT) measured strut malapposition rates (SMR). Results: Quantitative assessments showed that BVS, in comparison with CCS, had significantly enhanced scaffold expansion at the SB ostium (6.29 ± 0.36 mm2 vs 6.71 ± 0.37 mm2, P = 0.05; 6.29 ± 0.36 mm2 vs 6.78 ± 0.26 mm2, P = 0.05, respectively), and decreased SB ostial stenosis(0.14% ± 0.04% vs 0.08% ± 0.04%, P < 0.05; 0.14% ± 0.04% vs 0.08 ± 0.03%, P < 0.05, respectively), LNC (0.49 ± 0.10 mm vs 0.30 ± 0.08 mm, P < 0.05; 0.49 ± 0.10 mm vs 0. 28 ± 0.06 mm, P < 0.05, respectively) and gap width(1.48 ± 0.06 mm vs 1.21 ± 0.06 mm, P < 0.05; 1.48 ± 0.06 mm vs 1.10 ± 0.04 mm, P < 0.05, respectively) in both DKMCS and DKSRCS. Notably, DKMCS and DKSRCS demonstrated reduced SMR, especially in scaffold overlap areas, as revealed by OCT. Conclusions: DKMCS and DKSRCS offer superior morphological outcomes for BVS models than CCS, suggesting BVS as a viable and effective technique for culotte stenting.

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Bioresorbable vascular scaffold: a step back thinking of the future

Cited by 3 publications

References 18 publications

Procedural Predictors for Bioresorbable Vascular Scaffold Thrombosis: Analysis of the Individual Components of the “PSP” Technique

Procedural Predictors for Bioresorbable Vascular Scaffold Thrombosis: Analysis of the Individual Components of the “PSP” Technique

Percutaneous Coronary Intervention with Everolimus-Eluting Bioresorbable Vascular Scaffolds in Diffuse Coronary Artery Disease: Current Knowledge and Future Perspectives

Improving Bifurcated Scaffold Morphologies: The Feasibility of Culotte Techniques with Bioresorbable Vascular Scaffolds

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