Anatomical features and management of bioresorbable vascular scaffolds failure: A case series from the GHOST registry

The Absorb bioresorbable vascular scaffold (Absorb BVS, Abbott Vascular, Santa Clara, California) promises to address some of the residual shortcomings of existing metallic stents, such as late events induced by permanent caging of the coronary vessel. Scaffold restenosis (ScR) of BVS has been poorly described so far and treatment strategies for this event remain to be codified. We report on a case series of 14 lesions in 12 patients presenting with ScR and discuss their anatomical features and management strategies. © 2015 Wiley Periodicals, Inc.     

Coronary artery aneurysm after implantation of a bioresorbable vascular scaffold: Case report and literature review

A 55‐year‐old man underwent successful percutaneous coronary intervention for the middle left circumflex artery with a 3.5 × 28‐mm bioresorbable vascular scaffold (BVS). At 18 months, follow‐up coronary angiography showed ectatic change with aneurysm formation over the BVS. Optical coherence tomography revealed absence of strut continuity at the aneurysm site, in the middle of the BVS. A literature review identified nine patients with intrascaffold aneurysm, including the present patient, which developed 6–32 months after BVS implantation. Of these nine patients, four underwent percutaneous coronary intervention for chronic total occlusion. The pathogenesis of coronary artery aneurysm is multifactorial. Most patients receive no further intervention, but long‐term dual antiplatelet therapy is sometimes prescribed in conjunction with regular follow‐up. © 2017 Wiley Periodicals, Inc.     

Proximal and distal maximal luminal diameters as a guide to appropriate deployment of the ABSORB everolimus‐eluting bioresorbable vascular scaffold

Objectives : Due to the limited distensibility of the everolimus‐eluting bioresorbable vascular scaffold (ABSORB) compared to metallic platform stents, quantitative coronary arteriography (QCA) is a mandatory requirement for ABSORB deployment in the on‐going ABSORB EXTEND Single‐Arm Study. Visual assessment of vessel size in the ABSORB Cohort B study often lead to under and over‐sizing of the 3 mm ABSORB in coronary vessels (recommended range of the vessel diameter ≥2.5 mm and ≤3.3 mm), with an increased risk of spontaneous incomplete scaffold apposition post ABSORB deployment. We report whether mandatory QCA assessment of vessel size pre‐implantation, utilizing the maximal luminal diameter (Dmax) and established interpolated reference vessel diameter (RVD) measurements, has improved device/vessel sizing. Methods : Pre‐implantation post‐hoc QCA analyses of all 101 patients from ABSORB Cohort B (102 lesions) and first consecutive 101 patients (108 lesions) from ABSORB EXTEND were undertaken by an independent core‐laboratory; all patients had a 3 mm ABSORB implanted. Comparative analyses were performed. Results : Within ABSORB Cohort B, a greater number of over‐sized vessels (>3.3 mm) were identified utilizing the Dmax compared to the interpolated RVD (17 vessels, 16.7% vs. 3 vessels, 2.9%; P = 0.002). Comparative analyses demonstrated a greater number of appropriate vessel‐size selection (75 vessels, 69.4% vs. 48 vessels, 47.1%; P = 0.001), a trend towards a reduction in implantation in small (<2.5 mm) vessels (29 vessels, 26.9% vs. 40 vessels, 39.2%; P = 0.057) and a significant decrease in the implantation in large (>3.3 mm) vessels (4 vessels, 3.7% vs. 17 vessels, 16.7%; P = 0.002) in ABSORB EXTEND. Bland–Altman plots suggested a good agreement between operator and core‐laboratory calculated Dmax measurements. Conclusions : The introduction of mandatory Dmax measurements of vessel size prior to ABSORB implantation significantly reduced the under‐sizing of the 3.0 mm scaffold in large vessels validating the use of this technique in vessel sizing prior to ABSORB implantation. © 2011 Wiley Periodicals, Inc.     

Everolimus‐eluting bioresorbable vascular scaffold implantation to treat saphenous vein graft disease,single‐center initial experience

Aims

Recent studies have shown favorable outcomes with everolimus‐eluting bioresorbable vascular scaffold (BVS) in patients with stable coronary artery disease. Data on the use of BVS in saphenous vein graft disease (SVG) is currently lacking.

Methods and Results

A total of 10 consecutive patients (13 lesions, including 6 in‐stent restenosis) who underwent BVS for SVG disease between May 2013 and June 2015 at a tertiary care institution were included. Median follow‐up period was 874 (720‐926) days. One patient had scaffold thrombosis (ScT) 15 months after implantation, which was treated medically. Another patient had target lesion revascularization (TLR) in two different lesions, where BVS was used to treat in‐stent restenosis. The composite endpoint of TLR, ScT, target vessel myocardial infarction, and cardiac death, was reached in two patients

Conclusions

This first real‐world data on the use of the ABSORB? BVS in patients with SVG disease shows that its implantation is technically feasible. The observed rate of target lesion revascularization was similar to those observed with drug‐eluting stents in similar settings. Larger studies are required to better define the optimal use of BVS to treat SVG disease.

     

Bioresorbable vascular scaffold to treat in‐stent restenosis: Single‐center experience

Aims

The management of patients with in‐stent restenosis (ISR) is still a major clinical challenge even in the era of drug‐eluting stents (DES). Recent studies have demonstrated acceptable clinical outcomes for the everolimus‐eluting bioresorbable vascular scaffold (BVS) ABSORB? in patients with stable coronary artery disease but data are scarce on its use in patients with ISR. We report the long‐term results of our preliminary experience with this novel approach at our institution.

Methods and Results

We investigated the safety and efficacy of BVS implantation to treat ISR. 34 consecutive patients (37 lesions) underwent PCI for ISR with BVS implantation between May 2013 and June 2015 at our institution and were included in the current analysis. Follow‐up was available in 91.9% of the patients. Mean follow‐up period was 801.9 ± 179 days. One patient had definite scaffold thrombosis (ScT) 2 months after stent implantation which was treated with DES. Five patients (six lesions) experienced target lesion revascularization (TLR). The composite endpoint rate of TLR, ScT, myocardial infarction, and death occured in 6/37 lesions at follow‐up (16.2%).

Conclusions

These real‐world data using BVS in patients with ISR demonstrates that ISR treatment with ABSORB? BVS is feasible but could have slightly higher target lesion failure rates as compared to DES. This proof of concept could be hypothesis‐generating for larger randomized controlled studies.

     

Delivery of a bioresorbable vascular scaffold to complex lesions

The use of bioresorbable vascular scaffolds (BVS) in percutaneous coronary interventions holds great promise and the Absorb® BVS is increasingly used in clinical practice outside of controlled studies. However, questions have been raised concerning the delivery of the scaffold to complex lesions. We describe a case of successful delivery and implantation of two overlapping Absorb® BVS to a complex lesion in the left anterior descending artery. The crossing of the lesions was uneventful and after implantation a good acute result could be documented. A follow‐up angiogram after 3 months proofed a stable midterm result. We thereby demonstrate the feasibility of delivering Absorb® BVS to more complex lesions than practiced so far in the setting of clinical trials. © 2013 Wiley Periodicals, Inc.     

Intraluminal bioresorbable vascular scaffold dismantling with aneurysm formation leading to very late thrombosis

Coronary artery aneurysm formation has been described in patients after the placement of first‐generation drug‐eluting stents (DES), but is less common with newer generation metallic stents. In contrast, coronary artery aneurysm formation may be more common with the use of bioresorbable vascular scaffolds (BVS) due to the frequent formation of evaginations in the arterial wall seen with BVS. In this article, we describe a unique case of BVS dismantling and thrombus formation leading to an acute coronary syndrome thirty‐two months after initial BVS placement. We also discuss existing literature and the pathophysiology of BVS degradation, in addition to the utility of optical coherence tomography in the identification of associated conditions, such as strut fracture, intraluminal scaffold dismantling (ILSD), under‐expansion, and/or malapposition. © 2017 Wiley Periodicals, Inc.     

Coronary artery spasm treated with intracoronary bioresorbable scaffold implantation under the guidance of treadmill test and optical coherence tomography: A case report

Coronary artery spasm (CAS) can cause unstable angina, and the treatment of this disease is controversial. We report an elderly male patient who was admitted to hospital due to chest tightness. CAG showed that 70% stenosis in the middle of the right coronary artery (RCA). A bioresorbable scaffold (BRS) was implanted in the lesion under the guidance of optical coherence tomography (OCT). One year later, the patient's symptoms were relieved. The repeated CAG showed that the stent was good. BRS implantation under the guidance of treadmill test and OCT is one of treatment options for CAS patients.     

Coronary artery perforation at the level of two‐overlapping bioresorbable vascular scaffolds: The importance of vessel sizing and scaffold thickness

Everolimus‐eluting bioresorbable vascular scaffolds (BVS) have emerged as an alternative to conventional metallic stents and have demonstrated favorable outcomes in simple coronary lesions. As the use of BVS increases and extends to more complex lesion subsets, intraprocedural complications are expected to occur. We describe for the first time the occurrence of a free coronary perforation localized at the exact point of overlap of two BVS. This case illustrates the importance of appropriate vessel sizing, especially when BVS overlapping is performed in a small vessel, and potential advantages of scaffold juxtaposition compared to overlapping when implanting BVS in series. © 2015 Wiley Periodicals, Inc.