Quantitative multi-modality imaging analysis of a fully bioresorbable stent: a head-to-head comparison between QCA,IVUS and OCT |
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Authors: | Juan Luis Gutiérrez-Chico Patrick W Serruys Chrysafios Girasis Scot Garg Yoshinobu Onuma Salvatore Brugaletta Héctor García-García Gerrit-Anne van Es Evelyn Regar |
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Institution: | (1) Erasmus Medical Centre, Thoraxcenter, Ba583a, ‘s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands;(2) Cardialysis BV, Rotterdam, The Netherlands; |
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Abstract: | The bioresorbable vascular stent (BVS) is totally translucent and radiolucent, leading to challenges when using conventional
invasive imaging modalities. Agreement between quantitative coronary angiography (QCA), intravascular ultrasound (IVUS) and
optical coherence tomography (OCT) in the BVS is unknown. Forty five patients enrolled in the ABSORB cohort B1 study underwent
coronary angiography, IVUS and OCT immediately post BVS implantation, and at 6 months. OCT estimated stent length accurately
compared to nominal length (95% CI of the difference: −0.19; 0.37 and −0.15; 0.47 mm2 for baseline and 6 months, respectively), whereas QCA incurred consistent underestimation of the same magnitude at both time
points (Pearson correlation = 0.806). IVUS yielded low accuracy (95% CI of the difference: 0.77; 3.74 and −1.15; 3.27 mm2 for baseline and 6 months, respectively), with several outliers and random variability test–retest. Minimal lumen area (MLA)
decreased substantially between baseline and 6 months on QCA and OCT and only minimally on IVUS (95% CI: 0.11; 0.42). Agreement
between the different imaging modalities is poor: worst agreement Videodensitometry-IVUS post-implantation (ICCa 0.289); best
agreement IVUS-OCT at baseline (ICCa 0.767). All pairs deviated significantly from linearity (P < 0.01). Passing-Bablok non-parametric orthogonal regression showed constant and proportional bias between IVUS and OCT.
OCT is the most accurate technique for measuring stent length, whilst QCA incurs systematic underestimation (foreshortening)
and solid state IVUS incurs random error. Volumetric calculations using solid state IVUS are therefore not reliable. There
is poor agreement for MLA estimation between all the imaging modalities studied, including IVUS-OCT, hence their values are
not interchangeable. |
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