Author + information
- Giampiero Vizzari1,
- Antonio Trivisonno2,
- Giuseppe Biondi Zoccai3,
- Giuseppe Andò1,
- Laura Gatto4,
- Francesco Prati4,
- Francesco Romeo5 and
- Francesco Versaci6
- 1Department of Clinical and Experimental Medicine - University of Messina, Messina, Italy
- 2Department of Cardiology - “A. Cardarelli” Hospital, Campobasso, Italy
- 3Department of Medico-Surgical Sciences and Biotechnologies - Sapienza University of Rome, Roma, Italy
- 4San Giovanni Addolorata Hospital - Centro per la Lotta Contro l'Infarto - CLI Foundation, Roma, Italy
- 5Department of Cardiology and Interventional Cardiology - “Tor Vergata” University, Rome, Italy
- 6Division of Cardiology - “S. Maria Goretti” Hospital, Latina, Italy
Bioresorbable Vascular Scaffold (BVS) represented an innovation in the field of PCI. Some technical issues have emerged, related to “structural” limitations of the first models: fast resorption with poor vascular support; acute recoil due to low radial strength; struts fracture over nominal diameter. These issues have led to the development “second generation” BVS, with innovative features: bioresorption profile, self-correction of diameter, fracture resistance.
We assessed mid-term performances of two generations of BVS in a single Center and investigated the feasibility of Computed Tomography for non-invasive follow-up of BVSs.
Patients receiving two different BVS, Absorb (Abbott Vascular) and DESolve (Elixir Medical) in a single Center, have been followed-up (mean 18 months) with clinical examination, coronary CT-scan and eventually coronary angiography. Quantitative Coronary Angiography (QCA), performed before and after BVS implantation, measured: Minimal Lumen Diameter and Area (MLD; MLA) and % Stenosis. CT images have been post-processed by experienced operators, to get similar measurements.
Within 2 years, 50 patients (M/F= 4/1; mean age 54±8 years) have been treated with BVS (26 Absorb; 24 DESolve) for: stable angina (30%), UA/NSTEMI (52%), STEMI (18%). Mean diameter of implanted scaffolds was higher in the Absorb group (3.25±0.4 vs 2.97±0.39; p=0.016), but postdilation diameters were similar (3.44±0.5 vs 3.24±0.54; p=0.2) due to the higher confidence to overdilate the DESolve scaffold. CT highlighted 4 cases of restenosis (Absorb), only 2 confirmed by angiography. Comparison among QCA after-BVS and CT follow-up showed “positive” differences, at 18 months, only in the DESolve group, where significant late Lumen Gain resulted: MLD (2.13±0.5 vs 2.33±0.5; p=0.03); MLA (3.73±1.6 vs 4.45±2; p=0.03). Measures from different techniques (QCA and CT) showed significant correlation. Direct comparison Absorb vs DESolve showed no differences at the follow-up.
Our experience with two generations BVS showed no acute recoil or mid-term clinical events, with two cases of Absorb failure (TLF). CT resulted a useful tool for qualitative and quantitative BVS assessment, showing good correlation with QCA measures. BVSs kept similar diameters at 18m follow-up. DESolve scaffold showed greater lumen gain compared to the other BVS, due to innovative features.