Author + information
- Mariusz Tomaniak1,
- Cordula Felix2,
- Jiang Ming Fam2,
- Robert-Jan van Geuns2,
- Nicolas Van Mieghem2,
- Evelyn Regar2,
- Joost Daemen2,
- Felix Zijlstra2 and
- Roberto Diletti2
Calcified lesions represent a challenging subset with an increased risk of device underexpansion. Optimal implantation technique, namely, appropriate vessel sizing, predilatation and postdilatation has been proposed as a strategy to improve bioresorbable vascular scaffold (BVS) deployment and expansion. We evaluated the impact of optimal implantation technique on the angiographic and clinical outcomes of acute coronary syndromes (ACS) patients with calcified and non-calcified culprit lesions treated with BVS.
Patient data were pooled from the BVS STEMI First and BVS Expand studies. Patients were categorized according to lesion calcification and optimal implantation technique. Scaffold underexpansion was evaluated assessing final MLD, %diameter stenosis (%DS), %scaled residual diameter stenosis (%scDS), maximal footprint (MFP). Final TIMI flow and one-year clinical outcomes were reported.
A total of 214 patients were evaluated. There were 68 patients (83 lesions) with calcified lesions and 146 patients (172 lesions) without calcifications by fluoroscopy. An optimal implantation strategy was significantly more often applied in the calcification group (47.0% vs 27.3%, p=002). In the 27 patients (39 lesions) with calcifications who were treated according to the optimal technique, there was a similar final MLD (2.4%±0.3 vs. 2.5%±0.4, p=0.142) and %DS (16.7±8.5 vs 15.0±8.4, p=0.263) as compared with the overall no-calcification group. The %scDS (24.3%±11.2 vs. 23.1%±11.2, p=0.550) and MFP (34.7%±5.2 vs 33.5%±5.6, p=0.214) were comparable between groups. There were no differences in the pre- and postprocedural TIMI flow between the groups (TIMI 3: 94.9% vs 94.8%, p=0.886). At one year follow-up there was a numerically higher rate of clinical events in calcified lesion group, although this did not reach a significant level (MACE:11.1% vs 4.8%, p=0.188).
Optimal BVS-specific implantation strategy with both pre- and postdilatation allows to achieve in calcified lesion similar scaffold expansion in terms of minimal lumen diameter, diameter stenosis and scaled residual diameter stenosis as compared with non calcified lesions.
CORONARY: Bioresorbable Vascular Scaffolds