Author + information
- Sergio G. Tarbine,
- Costantino R. Costantini,
- Costantino O. Costantini,
- Marcelo F. Santos,
- Daniel Anibal Zanuttini,
- Rafael Macedo and
- Marco A. Denk
Recently, bioresorbable vascular scaffolds (BVS) were related to an unexpected high incidence of thrombosis. The aim of this study was to analyze in a single center experience, the impact of intravascular imaging (intravascular ultrasound-IVUS; optical coherence tomography-OCT) identifying and treating mechanical factors related to stent failure that would act as possible predictors of thrombosis and MACE.
Between 11/2014 and 10/2016, consecutive unselected patients (pts.) were treated with one or more Absorb BVS. Predilatation before stent deployment and post dilatation, IVUS and OCT were used in 99% of cases. Identified mechanical factors possibly related with stent failure were: stent malapposition, wall hematoma, stent underexpansion, border dissection, device fracture, thrombus and/or plaque protrusion. Customized measures were taken for each case. All pts. are under clinical follow up.
100 pts. (88% male, mean age 58,1 yo) were included in this analysis. Baseline characteristics show real world population (31% diabetics, 52% multivessel ds). A total of 141 lesions were treated (LAD 74%), being B/C class in 60%. Median SYNTAX score was 14,2±8.8. 190 Absorb BVS were implanted (1,9 stent/pt.). Further intervention following intravascular imaging with balloon optimization and/or new stent implantation was necessary in 16% of cases because of previously described mechanical factors, not seen by angiography. After optimal result was obtained, oral anticoagulation in addition to double antiplatelet therapy was indicated during the first 45 days in those pts having thrombus and/or plaque protrusion in OCT analysis. With 100% procedure success, 100% completed 1 yr follow up. MACE shows definite/probable scaffold thrombosis in 0%, with 4% TLR and 3% TVR.
The follow up analysis of this cohort of patients is showing no thrombosis so far, in a real world all comers setting. Detection of implantation defects by intravascular imaging and not seen by angiography, followed by customized treatment with balloon/stent, seems to be responsible for the low adverse event rate, caused in these pts., by focal restenosis.