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
Accurate vessel size assessment is essential for proper device sizing of bioresorbable vascular scaffold (BVS). Theoretical concerns also remain for post-deployment angiographic assessment of BVS, due to possibly different vessel-contour projections between polymeric scaffolds and metallic stents.
To investigate possible device-specific differences between quantitative coronary angiography (QCA) and IVUS, index measurements at the target and reference segments independently performed at QCA and IVUS core labs were systematically compared in ABSORB Japan IVUS cohort (n=144, 97 Absorb BVS: 47 Xience). Proper device sizing was defined as (nominal device diameter - mean reference lumen diameter) ≤ ±0.25 mm.
Compared with IVUS, QCA underestimated reference diameters by up to -0.84 mm (-0.19±0.26 mm, p<0.0001), and 21% of the “properly sized” devices by QCA were considered as “undersized” by IVUS. In addition, 49% of proximal and 30% of distal references had significant (>50%) residual plaque burden. At in-device segments, minimum lumen diameter (MLD) by QCA was also smaller than IVUS-derived MLD (p=0.004) but with no device-specific difference between BVS and Xience (2.9±13.2% vs. 3.2±10.9%, p=0.91). In contrast, when compared with average lumen diameter at minimum lumen area site by IVUS, the difference between the 2 modalities was significantly larger in BVS than Xience (8.9±10.8% vs. 4.7±9.3%, p=0.02), likely attributable to greater lumen eccentricity in BVS.
Despite the overall underestimation by QCA compared to IVUS, no BVS-specific discrepancy was observed in post-deployment in-device MLD assessment. Further studies are warranted to investigate possible benefits of intravascular imaging guidance to improve long-term outcomes of BVS implantation.
CORONARY: Bioresorbable Vascular Scaffolds