Author + information
- Ioannis Andreou, MD, PhD∗ ( and )
- Dimitrios Alexopoulos, MD, PhD
- ↵∗2nd Department of Cardiology, Attikon University Hospital, Rimini 1, Chaidari 12462, Athens, Greece
We read with interest the paper by Moriyama et al. (1) that was published in the Journal. The authors investigated the serial neointimal tissue changes in terms of neoatherosclerosis between 1 and 5 years after bioresorbable scaffold implantation as assessed by optical coherence tomography. The reported incidence of neoatherosclerosis was 100% at 5 years.
A therapeutically relevant possibility not taken into account in this study is that the underlying atherosclerotic plaque progression might have as well led to the observed findings (2). If this holds true, the concept that bioresorbable scaffolds seal atherosclerotic plaques would be challenged. Because scaffold struts are no longer visible at 5 years, the authors have arbitrarily assumed a neointimal thickness of 200 μm to distinguish between neoatherosclerosis and underlying native plaque progression.
Bioresorbable scaffolds could serve as an ideal means to provide valuable insights into the mechanisms of periscaffold atherosclerosis development owing to the decreasing radial strength during bioresorption and the black box-like appearance without dorsal shadowing of the optically translucent polymeric struts. That would be interesting if the scaffolded segments could be serially assessed during an earlier timeframe during the bioresorption process when the radial strength of the scaffold has been lost, but the strut remnants are still visible (which could be a period from 6 months up to 2 years post-implantation) and may move freely due to neighboring mechanical forces (e.g., plaque progression or vessel remodeling). As the mechanical integrity of the degrading scaffold diminishes over time, native atherosclerotic plaque ingrowth may lead to dislocation of the strut remnants by pushing them toward the lumen (Figure 1). Accordingly, prospective serial optical coherence tomography assessments of bioresorbable scaffolds, combined with intravascular ultrasound to account for potential negative vessel remodeling, with meticulous observation of the strut footprints are warranted.
Please note: Both authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- 2018 American College of Cardiology Foundation
- Moriyama N.,
- Shishido K.,
- Tanaka Y.,
- et al.
- Andreou I.,
- Stone P.H.