Expansion and malapposition characteristics after bioresorbable vascular scaffold implantation

Brown, Adam; McCormick, Liam; Braganza, Denise; Bennett, Martin R.; Hoole, Stephen P.; West, Nick E.J.

doi:10.1002/ccd.25378

Cited by 50 publications

(36 citation statements)

References 30 publications

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“…Acute stent malapposition (ASM) is common at the time of stent implantation1, 2, 3, 4, 5, 6; however, it is still controversial whether ASM impacts long‐term clinical outcomes in patients undergoing percutaneous coronary intervention (PCI). For example, Kimura et al7 reported that although most ASM after sirolimus‐eluting stent implantation did not resolve completely, the incidence of restenosis or thrombosis was not affected.…”

Section: Introductionmentioning

confidence: 99%

Predictors and Long‐Term Clinical Impact of Acute Stent Malapposition: An Assessment of Dual Antiplatelet Therapy With Drug‐Eluting Stents (ADAPT‐DES) Intravascular Ultrasound Substudy

Wang

Mintz

Witzenbichler

et al. 2016

JAHA

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BackgroundThe impact of acute stent malapposition (ASM) on long‐term clinical outcomes in patients undergoing percutaneous coronary intervention is still controversial. We sought to evaluate predictors and long‐term clinical outcomes of ASM.Methods and Results ADAPT‐DES (Assessment of Dual Antiplatelet Therapy With Drug‐Eluting Stents) was a prospective multicenter study of 8663 patients undergoing percutaneous coronary intervention using drug‐eluting stents. In a prespecified intravascular ultrasound–guided substudy, 2072 patients with 2446 culprit lesions had post–percutaneous coronary intervention intravascular ultrasound and were classified according to the presence or absence of ASM. After intravascular ultrasound–guided percutaneous coronary intervention, the overall prevalence of ASM after successful drug‐eluting stents implantation was 14.4% per patient and 12.6% per lesion. Compared to lesions without ASM, lesions with ASM had larger in‐stent lumen areas, larger stent areas, and larger in‐stent vessel areas. A larger mean plaque area along with more attenuated plaque was observed in lesions with ASM versus lesions without ASM. Lesions with ASM had greater proximal and distal reference lumen areas and more distal, but not proximal, reference calcium compared to lesions without ASM. At 2‐year follow‐up, there was no significant difference in the incidence of cardiac death; myocardial infarction; early, late, or very late stent thrombosis; or clinically driven target lesion revascularization in patients with ASM versus those without ASM. Furthermore, ASM was not an independent predictor of 2‐year major adverse cardiac events or target lesion revascularization even when forced into the multivariate model.ConclusionsIn patients treated with intravascular ultrasound–guided drug‐eluting stents implantation, ASM was not associated with adverse clinical events during long‐term follow‐up including, but not limited to, stent thrombosis.Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT00638794.

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Section: Introductionmentioning

confidence: 99%

Predictors and Long‐Term Clinical Impact of Acute Stent Malapposition: An Assessment of Dual Antiplatelet Therapy With Drug‐Eluting Stents (ADAPT‐DES) Intravascular Ultrasound Substudy

Wang

Mintz

Witzenbichler

et al. 2016

JAHA

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“…20 Similarly, the use of OCT to guide implantation of BRS has demonstrated that scaffold underexpansion, eccentricity and incomplete strut apposition are more related to the extent and thickness of calcification 21 compared with other lesions. 22 …”

Section: Increasing Patient/lesion Complexity and Accurate Implantatimentioning

confidence: 99%

Optical Coherence Tomography for Online Guidance of Complex Coronary Interventions

Shimamura

Guagliumi

2016

Circ J

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Decision making on lesion preparation and stent/scaffold optimization are cornerstones of patient outcome. Intravascular imaging recently emerged as a critical modality to achieve better results of stent/scaffold implantation and superior clinical outcomes compared with coronary angiography alone. Optical coherence tomography (OCT), a light-based intravascular imaging modality with high frame rate in acquisition and very high speed pullback, can interrogate the target vessel in a couple of seconds, and immediately display a pristine longitudinal lumen contour with automatic detection of lesion severity, site and lumen/stent areas. Further, OCT provides pivotal information on sites of calcium, with accurate measurements of the minimum distance from the lumen, a major determinant of stent/ scaffold underexpansion, malapposition and eccentricity. Finally, to guide the PCI procedure using OCT without operator misjudgment, a real-time point-to-point correspondence between angiographic and OCT images has been recently created. Co-registration of OCT with angiography with direct tableside control of acquisition and analysis enables the operator to plan and map optimal stent/scaffold implantation. To prove the clinical relevance of OCTguided PCI, simple, standardized interventional planning, including pre-and postprocedural automatic lumen detection metrics, has to be translated into effective treatment flow algorithms. A similar OCT algorithm is being tested in the ongoing prospective, randomized, multicenter ILUMIEN III study, to demonstrate that OCT-guided stent placement is superior to angiography-guided and non-inferior to IVUS-guided stent implantation. (Circ J 2016; 80: 2063 -2072

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“…Periprocedural features such as device-related structural aspects (ie, strut thickness: 150 μm for BVS, similar to that of 1st-generation DES), implantation technique (ie, scaffold expansion optimization, intracoronary imaging guidance etc) or patient/lesion characteristics might represent important adjunctive factors. 44, 45 The importance of predilatation before BVS implantation is widely recognized, especially given the lower radial strength and higher propensity to scaffold recoil. Brown et al 45 recently reported excellent acute results after OCT-guided BVS implantation, showing that 1:1 balloon/vessel predilatation improved scaffold expansion.…”

Section: Safety and Procedural Concerns Of Bvs: Scaffold Thrombosis mentioning

confidence: 99%

“…44, 45 The importance of predilatation before BVS implantation is widely recognized, especially given the lower radial strength and higher propensity to scaffold recoil. Brown et al 45 recently reported excellent acute results after OCT-guided BVS implantation, showing that 1:1 balloon/vessel predilatation improved scaffold expansion. 46 It is interesting to note in this study that post-dilatation was performed in approximately half of cases (59.3%), therefore not enabling definitive assessment of the net benefit given by predilatation.…”

Section: Safety and Procedural Concerns Of Bvs: Scaffold Thrombosis mentioning

confidence: 99%

“…Again, IC imaging modalities could be useful also for analyzing the characteristics of the plaque, thus providing prognostic information. In this regard, Brown et al 45 demonstrated that in BVS implantation an increased rate of malapposition was associated with fibrocalcific plaques. 46 Another concern related to acute BVS implantation is acute recoil.…”

Section: Disclosuresmentioning

confidence: 99%

See 1 more Smart Citation

ST-Segment Elevation Myocardial Infarction

Scalone

Brugaletta

Gómez-Monterrosas

et al. 2015

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp BVS as compared with metallic platform DES may include: decrease in late adverse events through complete biodegradation of stent struts preventing the risk of thrombus formation at the site of impaired endothelialization; normalization of vasomotion and compensatory remodeling during follow-up, thus suggesting restoration of normal vessel physiology after complete biodegradation of the stent struts; no interference with diagnostic or therapeutic measures (eg, coronary artery bypass graft) in case of disease progression; improved vascular healing; and discontinuation of long-term antiplatelet therapy in patients with single-vessel coronary artery disease. In particular, some crucial points in STEMI patients have to be emphasized. First of all, culprit lesions are frequently localized in the proximal segments of the coronary artery tree; restoration of physiological vasomotion may therefore have a greater effect in patients with STEMI as compared with patients with stable coronary artery disease. Secondly, vulnerable plaque of STEMI lesions, often characterized by necrotic core, interferes with vascular healing after metallic stent implantation, thus leading to coronary evagination or late acquired malapposition, both of which have been correlated with adverse ischemic outcomes. 14 Recent study suggests that BVS may eventually decrease the incidence of angina during follow-up, by reducing fixed and dynamic restenoses and by improving vasomotor responses. 15 Finally, the potential advantages of implanting BVS (vs. other DES) in STEMI may be mostly related to the young age of these patients. Indeed, they usually have less extensive coronary artery disease (compared with non-STrimary percutaneous coronary intervention (PCI) currently represents the first choice of treatment in experienced centers for patients presenting with ST-segment elevation myocardial infarction (STEMI) with limited time delay. 1 In this context, first-generation drug-eluting stents (DES) have reduced the need for repeat revascularization compared with bare metal stents (BMS). 2-4 However, the 1st-generation DES have been associated with late complications, such as neo-atherosclerosis, late restenosis, and stent thrombosis. 5 In particular, in the acute thrombotic setting, the antiproliferative drug elution used in DES has been shown to interfere with vascular healing processes, creating the background for delayed strut coverage, and persistent or acquired malapposition. 6,7 Possible explanations for this phenomenon are thrombus sequestration behind the struts, which subsequently resolves with acquired malapposition, and vasoconstriction during the acute phase. 8 The newer-generation DES with improved biocompatibility of polymers have also shown a lower rate of clinical events in acute patients as compared with either 1st-generation DES or BMS. 9-12 The clinical introduction of bioresorbable scaffolds resulted in a revolutionary change among local c...

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Expansion and malapposition characteristics after bioresorbable vascular scaffold implantation

Abstract: In this study, BVS expansion was significantly improved by 1:1 PreD, while increased rates of malapposition was associated with FCa plaques.

Cited by 50 publications

References 30 publications

Predictors and Long‐Term Clinical Impact of Acute Stent Malapposition: An Assessment of Dual Antiplatelet Therapy With Drug‐Eluting Stents (ADAPT‐DES) Intravascular Ultrasound Substudy

Predictors and Long‐Term Clinical Impact of Acute Stent Malapposition: An Assessment of Dual Antiplatelet Therapy With Drug‐Eluting Stents (ADAPT‐DES) Intravascular Ultrasound Substudy

Optical Coherence Tomography for Online Guidance of Complex Coronary Interventions

ST-Segment Elevation Myocardial Infarction

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