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Bioabsorbable scaffold optimization in provisional stenting: insight from optical coherence tomography

Authors:
Nicolas Foin at National Heart Centre Singapore
Nicolas Foin
Matteo Ghione
Matteo Ghione
Matteo Ghione
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Alessio Mattesini at Azienda Ospedaliero Universitaria Careggi
Alessio Mattesini
Justin Davies at Imperial College Healthcare NHS Trust
Justin Davies
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Abstract

Since the emergence of biabsorbable vascular scaffolds (BVS), treatment of bifurcation lesions with these devices has remained a source of question. Although SB dilatation has been previously performed with BVS, it is not yet clear how dilatation across BVS strut may impact scaffold structure. A74-year-old lady with hypercholesterolaemia and type 2 diabetes was admitted to our centre due to non-ST elevation myocardial infarction. Patient underwent percutaneous coronary intervention and an everolimus 3.0 × 28 mm BVS (Absorb BVS, Abbott Vascular, Santa Clara, CA, USA) was implanted in the left anterior descending artery at the level of the well developed second diagonal branch with a moderate lesion involving the first diagonal branch. The scaffold was post-dilated to 3.5 mm proximally and dilated through the origin of the side branch with a 2.0-mm semi-compliant balloon, slowly inflated at 12 ATM. Final angiogram showed satisfactory results with TIMI 3 flow in the both branches. Frequency domain optical coherence tomography (FD-OCT) pullback was performed on the implanted scaffold (C7 System, St Jude Medical, St Paul, USA). Longitudinal view and crosssections (Panel A, 1–4) demonstrate the good side branch access after dilatation of side-branch ostium through the scaffold strut. Threedimensional OCT reconstruction of the main vessel reveals mild distortions of the scaffold observed distally at the level of the carina (arrow) (Panels B and C). Despite the distortions of the scaffold strut observed distally on the three-dimensional reconstructions (arrow), all struts remained well apposed to the vessel (Panel A, 2).
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IMAGE FOCUS
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doi:10.1093/ehjci/jet137
Online publish-ahead-of-print 24 July 2013
Bioabsorbable scaffold optimization in provisional stenting: insight from
optical coherence tomography
Nicolas Foin
1
, Matteo Ghione
2
, Alessio Mattesini
2
, Justin E. Davies
1
, and Carlo Di Mario
2
*
1
International Centre for Circulatory Health, Imperial College London, London, UK and
2
NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
* Corresponding author: Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK. Tel: +44 (0)207 3518616; fax: +44 (0)207 3518104, Email: c.dimario@rbht.nhs.uk
Since the emergence of biabsorbable vascular
scaffolds (BVS), treatment of bifurcation lesions
with these devices has remained a source of ques-
tion. Although SB dilatation has been previously
performed with BVS, it is not yet clear how
dilatation across BVS strut may impact scaffold
structure.
A 74-year-old lady with hypercholesterolaemia
and type 2 diabetes was admitted to our centre
due to non-ST elevation myocardial infarction.
Patient underwent percutaneous coronary inter-
vention and an everolimus 3.0 × 28 mm BVS
(Absorb BVS, Abbott Vascular, Santa Clara, CA,
USA) was implanted in the left anterior descend-
ing artery at the level of the well developed
second diagonal branch with a moderate lesion
involving the first diagonal branch. The scaffold
was post-dilated to 3.5 mm proximally and
dilated through the origin of the side branch with
a 2.0-mm semi-compliant balloon, slowly inflated
at 12 ATM.
Final angiogram showed satisfactory results with TIMI 3 flow in the both branches. Frequency domain optical coherence tomography
(FD-OCT) pullback was performed on the implanted scaffold (C7 System, St Jude Medical, St Paul, USA). Longitudinal view and cross-
sections (Panel A, 1–4) demonstrate the good side branch access after dilatation of side-branch ostium through the scaffold strut. Three-
dimensional OCT reconstruction of the main vessel reveals mild distortions of the scaffold observed distally at the level of the carina
(arrow) (Panels B and C ).
Despite the distortions of the scaffold strut observed distally on the three-dimensional reconstructions (arrow), all struts remained well
apposed to the vessel (Panel A, 2).
Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2013. For permissions please email: journals.permissions@oup.com
Insights from a porcine model of chronic pressure overload 1149
by guest on January 23, 2015Downloaded from
... In this context, caution is mandatory since few data are available and long-term evidences are not universal. Finally, OCT guidance for BVS implantation could be even more useful in special conditions such as complex lesions, bifurcations and CTOs [57][58][59]. In conclusion, intracoronary imaging with IVUS and OCT is a useful tool in guiding BVS implantation, and the two modalities seem to be complementary. ...
Absorb Bioresorbable Vascular Scaffold: What Have We Learned after 5 Years of Clinical Experience?
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... OCT IN BIOABSORBABLE STENTS MATTESINI out of 7 cases in which stent rewiring was deemed necessary, in order to optimize the result in bifurcation lesions. 24,25 Kissing balloon postdilatation was performed only in one case. 26,27 OCT for procedural guidance Seventy-seven pullbacks were acquired during different PCI's steps. ...
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Fully biodegradable L-polylactic acid stents (biodegradable vascular scaffold, BVS), the latest breakthrough in the area of coronary implants, entered clinical trials in 2005 and became commercially available in 2011. Optical coherence tomography (OCT) was used from the first implants to study the vessel wall response and the timing of the resorption process in man. Analysis of BVS with OCT has several advantages over that of metallic stents. BVS polymeric struts are transparent to the light so that scaffold integrity, apposition to the underlying wall, presence of thrombus and hyperplasia, and changes in the strut characteristics over time can be easily studied. We present a comprehensive review of the findings OCT provided when used as a research tool in serial examination up to five years for investigation of the mechanism of resorption, neointimal coverage, shrinkage and late lumen enlargement. We also report our experience with OCT in 47 lesions of various complexity as a practical means of percutaneous coronary intervention guidance during BVS implantation.
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Bioresorbable vascular scaffold (BVS) has been introduced as the latest revolution in the field of percutaneous coronary intervention (PCI), which could overcome the long-term limitations of the permanent stent implantation [1]. This device is designed to provide the temporary scaffolding of the vessel before being resorbed completely within the vessel, leaving nothing behind. It makes BVS offer a potential solution to the weakness of drug-eluting stents, which include endothelial dysfunction and hypersensitivity reactions, leading to late stent failure, and disturbance of future surgical revascularization at the same lesion [2–4].
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Introduction According to contemporary experience, bioabsorbable vascular scaffolding (BVS) implantation represents promising perspective in cardiology interventions. In the cathlab of Central Military Hospital in Prague, the program of BVS implantation started in June 2013. Patient cohort and methods From June 2013 to October 2015, 107 procedures of BVS implantation in 98 patients were performed. Total of 110 lesions were treated. In 9 patients BVS was implanted in two stages. In 3 patients, the intervention of two vessels was performed during one procedure, always using BVS. Non-randomized data of three cohorts of patients were evaluated: STEMI (45 patients), NSTEMI (34 patients), and elective BVS implantations (31 patients). The three groups did not differ in basic demographic features. In STEMI group, initial thrombotic occlusion and consequent thrombaspiration were more often. In this (STEMI) group, the evaluation of the procedure is supplemented by CT performance after 12 months. Results The procedure was always technically successful except 1 case (NSTEMI). Residual diameter stenosis >20% was registered in 1 patient in each group. Except 1 case in STEMI group, final TIMI III flow was achieved in all cases. One patient died in NSTEMI group in consequence of definite stent thrombosis. The final angiographic result (recoil, residual stenosis) was evaluated with the aid of quantitative coronary analysis (QCA). It did not prove any statistically significant difference among the groups. The value of immediate recoil did not exceed 10% in all groups. Target lesion revascularization (TLR) was performed in two patients in STEMI group. Up to now, performed CT scans demonstrated persisting good results. Conclusion In accordance with contemporary literary data, our experience proves safety and efficacy of BVS implantation during coronary interventions in selected patients.
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Pro-gressive changes in right ventricular geometric shortening and long-term survival in pulmonary arterial hypertension
  • Jan 2012
  • 935-43
  • Mauritz Gj
  • Marcus T Jt Kind
  • Bogaard
  • Hj
  • Van
  • M Veerdonk
  • Pe
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