Author + information
- Jiang Ming Fam1,
- Yoshinobu Onuma2,
- Yuki Ishibashi2,
- Roberto Diletti2,
- Nicolas van Mieghem2,
- Ron van Domburg2,
- Jolanda Wentzel2,
- Frank Gijsen2 and
- Robert-Jan van Geuns2
Implantation of stiff permanent metallic implants alters blood rheology especially at the inflow and outflow edge of the stents probably contributing to early and late stent failure. Short Polymeric Bioresorbable vascular scaffolds (BVS) have shown to have less impact on the natural curvature of the stent vessel compared to Metal platform stents (MPS). The impact of long BVS on vessel curvature is unknown.
The aim of this study was to determine if there are any significant differences in terms of curvature of the treated vessel after the deployment of either a metallic stent or a polymeric scaffold device in long lesions.
This retrospective study compares 32 patients who received an MPS (Xience, Abbott Vascular, Santa Clara, CA, US) with 32 patients treated with the everolimus-eluting bioresorbable vascular scaffold (BVS-Absorb, Abbott Vascular, Santa Clara, California). All patients received 1 BVS Absorb or MPS with a length of 28mm deployed singly in long coronary lesions. The primary end point measured was the relative region curvature (%) evaluated with dedicated software by angiography.
There were 22 (68.8%) males in each group. There was no difference in median age [BVS vs MPS: 59.6 yrs vs 64.9 yrs, p=0.453)]. There was a significant difference in clinical presentation of ACS/STEMI (BVS vs MPS: 68.8% vs 40.6%, p= 0.024). The left anterior descending artery was the most treated vessel in both groups (BVS vs MPS: 46.9% vs 40.6%, p= 0.857). Pretreatment length was 22.19 mm vs 20.38 mm in the BVS and MPS groups respectively (p=0.803). There was no significant differences in reference vessel diameter, minimal lumen diameter and percentage diameter stenosis in both groups. Pretreatment Diastolic curvature (DC) was greater in the BVS group compared with the MPS group (0.305 cm-1 vs 0.257 cm-1, p= 0.803). There was a significant decrease in median DC in the MPS group post-treatment than pre-treatment (from 0.257 cm-1 to 0.199 cm-1, p= 0.001). There was a decrease in median DC in the BVS group post-treatment which trends towards significance (from 0.305 cm-1 to 0.283 cm-1, p= 0.056). Median Percentage relative change in DC was significantly lower in the BVS group compared with the MPS group (BVS vs MPS: 7.48% vs 29.4%, p= 0.024). By univariate analysis, device use was an independent predictor of change in curvature (p = 0.022).
In the deployment of long coronary scaffolds/ stents (28mm in length), bioresorbable vascular scaffolds provides better conformability compared with MPS.