Author + information
- Gabriel Tensol Rodrigues Pereira1,
- Alessio La Manna2,
- Eligio Miccichè3,
- Guido D'Agosta3,
- Armando Vergara-Martel4,
- Giacomo Gravina5,
- Bruno Ramos Nascimento6,
- Guilherme F. Attizzani7,
- Davide Capodanno5 and
- Corrado Tamburino8
- 1University Hospitals - Harrington Heart & Vascular Institute, Cleveland, Ohio, United States
- 2University of Catania, Catania, Catania, Italy
- 3Ferrarotto Hospital, Catania, Catania, Italy
- 4University Hospitals Cleveland Medical Center, Cleveland Heights, Ohio, United States
- 5Ferrarotto Hospital, Cardiology Division, University of Catania, Catania, Catania, Italy
- 6Hospital das Clinicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- 7University Hospital Harrington Heart & Vascular Institute, Cleveland, Ohio, United States
- 8Ferrarotto Hospital, Cardiology Division, University of Catania, Catania, Italy
The Absorb®(Abbott Vascular, Santa Clara, CA) Bioresorbable Vascular Scaffold (BVS) has advantages over its predecessors, but has a drawback due to its large thickness, especially in regions of overlap. In this study we compared healing and performance between overlap (OL) and non-overlap regions (NOL) in coronary Chronic Total Occlusion (CTO) lesions treated with BVS, using intravascular imaging.
The present study is an 18-patient subset of the GHOST-CTO registry (single-center, prospective observational study, Ferrarotto Hospital, Catania, Italy) with 12 month follow-up by Optical Coherence Tomography (OCT), that had overlapping BVS implanted from May 2013 to May 2014, resulting in 33 OL and 18 NOL. Images were analyzed by an independent CoreLab at every 0.6mm using validated methods. Difference scores between OL and NOL regions were calculated for all variables. All tests were performed using SAS 9.4 using the Wilcoxon Signed Rank test.
The mean age was 63±7 years, 16 (89%) were males, 15 (83%) had hypertension, 6 (33%) had diabetes and 6 (33%) were smokers. Sixteen patients underwent PCI for stable coronary artery disease, and the SYNTAX-1 score was below 22 in all but one case. In the 12-month follow-up, mean stent area was similar between OL and NOL regions (10.6±2.7 vs. 10.3±2.2 mm2, p=0.25), whereas lumen area was smaller in the OL (6.9±2.2 vs. 7.8±1.9 mm2, p=0.003). There was a trend towards lower malapposition area (0.04±0.09 vs. 0.12±0.18 mm2, p=0.08), and lower % incomplete scaffold apposition (0.14±0.43 vs. 0.56±0.96 %, p=0.08) in OL region. The percent of uncovered struts was significantly lower in OL (1.27±2.96 vs. 4.77±5.88 %, p<0.001), as was the mean maximum malapposition distance (0.09±0.27 vs. 0.55±0.69 mm, p=0.004). However, neointima hyperplasia (NIH) was more pronounced in the OL (0.24±0.10 vs. 0.14±0.04 mm2, p<0.001).
The OL BVS segments showed favorable performance compared with to NOL. Despite NIH being more prominent in OL, both regions showed good healing pattern. The impact of these findings on clinical outcomes of patients undergoing BVS implantation needs further study.
CORONARY: Bioresorbable Vascular Scaffolds