Author + information
- Stephen Hamshere1,
- Alex Byrne2,
- Roshan Weerackody3,
- Andrew Wragg4,
- Charles Knight5,
- Anthony Mathur6 and
- Daniel Jones7
- 1University Health Network
- 2Interventional Cardiology Unit, University of Palermo, Palermo, Italy
- 3Unknown, London, United Kingdom
- 4Barts and The London NHS Trust, London, United Kingdom
- 5London Chest Hospital, London, United Kingdom
- 6Barts and the London NHS Trust, London, United Kingdom
- 7London chest, london, United Kingdom
Bioresorbable Vascular Scaffolds (BVS) are the newest generation of stents for use during Percutaneous Coronary Intervention. However, as history has demonstrated, each development in stent technology has been associated with its own specific complications. With BVS, there are reports that recoil is greater compared to traditional metal scaffolding. Identifying stent malapposition is important, as it is associated with an increased risk of stent thrombosis. The aim of this study was to assess whether intracoronary imaging with optical computerised tomography (OCT) after implantation of a BVS resulted in significant improvements in clinical outcomes compared to visual angiographic assessment.
All patients undergoing PCI using BVS at a single centre between 2013-2015 were included (n=70). PCI with BVS was performed according to conventional practice: pre-dilatation, post-dilatation, and intra coronary assessment with OCT was performed according to operator’s preferences. Dual antiplatelet therapy with Aspirin and Clopidogrel or Ticagrelol was initiated prior to stent insertion and maintained for 12 months. Comparisons were made for 60-day outcomes between OCT and Angiography cohorts. The primary endpoints were Major Adverse Cardiovascular Events (MACE), including all cause mortality, myocardial infarction, and revascularization, at 60 days.
40 (57.1%) patients underwent OCT assessment and 30 (42.9%) patients underwent angiography alone post BVS insertion. There were no significant differences in baseline characteristics or procedural complications between both groups, a total of 13 (32.5%) patients who had intracoronary OCT imaging performed underwent repeat dilatation after malapposed struts were identified. Although no deaths were observed, there was a significant difference seen in MACE over the follow up period between OCT and angiography cohorts (5.6% vs. 20% respectively; p=0.039)
Since visual assessment with angiography has poor specificity for identifying strut malapposition, intracoronary OCT should be undertaken in all patients post insertion of BVS stents in order to appropriately assess for stent malapposition, and reduce the subsequent risk of MACE.
CORONARY: Bioresorbable Vascular Scaffolds