ABSORB everolimus-eluting bioresorbable vascular scaffold systems for the sealing of unstable plaques

Abstract

Purpose: We set out to investigate the outcome of patients receiving an Absorb bioresorbable vascular scaffold system in the setting of acute coronary syndromes. Background: Everolimus-eluting bioresorbable vascular scaffold systems have recently been introduced in the market for the treatment of coronary artery stenoses. Experience on the use of these devices is limited to type A lesions in elective settings. Treatment of ruptured plaques with bioresorbable scaffold systems might have the advantage to promote the formation of new fibrotic tissue (plaque sealing) without the disadvantages of permanent metal stent implantation. Methods and results: 64 culprit lesions in 63 patients (age 57±15) were treated with the Absorb everolimus-eluting bioresorbable scaffold system. 40 patients were classified as NSTEMI or unstable angina, 23 had STEMI, 9 were diabetics, 31 were smokers or previous smokers, 39 had hypertension and 15 dyslipidaemia, 19 were females. None had a history of previous myocardial infarction. The lesion was in the left anterior descending coronary in 27 cases, in the circumflex coronary in 10 and the right coronary in 27. Angiographic evidence of intravascular thrombosis was present in all lesions treated. 64 scaffold systems (mean diameter 3.1±0.3mm, mean length 18.9±4.2mm) were successfully implanted (100% device success rate). Mean fluoroscopic time was 8.4±5.8 and mean use of angiographic contrast was 153±57ml. Mean peak troponin I and creatinin-phosphokinase were 40±64ng/ml and 1275±1730 micrgr/lt (range <0.02 - 165ng/ml and 64-4611micrgr/lt). Mean hospital stay was 3±1 days. At one-month clinical follow-up, there was no death. There was one case of ST-elevation myocardial infarction due to in-scaffold thrombosis which was treated with PTCA. Seven patients underwent repeat percutaneous intervention in non-target lesions (5 of them were planned interventions). Outcome data are comparable to those recorded in an age- and gender matched group (n=65) of patients who received a Xience drug-eluting stent. Conclusions: Our data provide evidence that the use of bioresorbable scaffold systems is feasible and safe also in the setting of acute coronary syndromes.