Author + information
- Kozo Okada1,
- Yasuhiro Honda2,
- Hideki Kitahara2,
- M. Brooke Hollak3,
- Paul G. Yock2,
- Jeffrey J. Popma4,
- Hajime Kusano5,
- Wai-Fung Cheong6,
- Krishna Sudhir5,
- Peter J. Fitzgerald2 and
- Takeshi Kimura7
- 1Stanford University School of Medicine, Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford, California, United States
- 2Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, United States
- 3Stanford University School of Medicine, Division of Cardiovascular Medicine, Stanford, California, United States
- 4Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
- 5Abbott Vascular, Santa Clara, California, United States
- 6Abbott Vascular, Los Altos, California, United States
- 7Kyoto University Hospital, Kyoto, Japan
Scaffold under-expansion has been reported to be associated with late adverse outcomes after bioresorbable vascular scaffold (BVS) implantation, while its underlying mechanism remains unknown. This study aimed to characterize detailed device performance and long-term vessel response after Absorb BVS implantation, compared to everolimus-eluting stents (EES).
In ABSORB Japan, volumetric IVUS was performed at post-procedure in 146 lesions (98 Absorb BVS: 48 EES). %Device Expansion was defined as a ratio of mean device area to mean reference lumen area at post-procedure. Serial QCA was performed to evaluate late lumen loss (LLL), defined as %change in in-segment minimum lumen diameter (MLD), from post-procedure to 3-year follow-up.
At post-procedural IVUS, BVS showed smaller minimum lumen and device areas/volumes than EES. By QCA, in-segment MLD also tended to be smaller in BVS than in EES at post-procedure, while it did not differ significantly between the 2 arms at 3 years. In BVS, %Device Expansion at post-procedure inversely correlated with LLL (r=0.27, p=0.03) and in-segment diameter stenosis (DS) (r=-0.23, p=0.06) at 3 years. In contrast, EES showed no statistically significant relationship between %Device Expansion and any of the above QCA indices at 3 years (LLL: p=0.14, DS: p=0.21).
Unlike EES, initial under-expansion of Absorb BVS appears to be associated with greater LLL at long-term follow-up. Although our findings need to be confirmed in large-scale IVUS studies, this may, in part, account for the poorer outcomes of Absorb BVS than EES in lesions with under-expansion.
CORONARY: Bioresorbable Vascular Scaffolds