Abstract

Revascularization of chronic total occlusions (CTO) with percutaneous coronary intervention is associated with favorable long-term clinical and echocardiographic outcomes. Whether bioresorbable vascular scaffolds (BVS) would be advantageous in the treatment of CTO is unknown as patients with these lesions were generally excluded from large BVS randomized trials. We performed a systematic review, which sought to summarize known data on mid- to long-term clinical outcomes for BVS in CTO. We searched MEDLINE, EMBASE, clinicaltrials.gov, and the Cochrane Library through April 2018 to look for studies on implantation of BVS in CTO. Outcomes of interest included myocardial infarction, cardiac death, all-cause mortality, major adverse cardiac events (MACE), vessel restenosis, scaffold thrombosis, and target lesion revascularization. A total of 13 articles met the inclusion criteria for analysis. All studies were observational with a total number of patients of 1,077. Only two studies included comparator groups which retrospectively compared BVS with drug-eluting stents (DES). The studies had variable size (21 to 537) and follow-up duration (3–23 months). The review showed favorable outcomes for BVS implantation in CTO with the reported incidence of MACE ranged from 0% to 6.7% with no significant differences between BVS and DES groups in double arm studies. Although data on the use of first-generation BVS in CTO are sporadic and limited by small sample observational studies, available evidence is promising and suggests of acceptable outcomes comparable with second generation DES. Further investigation with randomized clinical trials and use of newer generation scaffolds is required.

Highlights

  • BackgroundChronic total occlusion (CTO) of the coronary artery is defined as a complete vessel occlusion with thrombolysis in myocardial infarction (TIMI) flow grade of 0 lasting for more than three months [1]

  • Whether Bioresorbable vascular scaffolds (BVS) would be advantageous in treatment of chronic total occlusions (CTO) is currently unknown as patients with these lesions were generally excluded from large BVS randomized trials

  • Using the search strategy described above, we identified a total of 251 potentially relevances (Figure 1)

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Summary

Introduction

Chronic total occlusion (CTO) of the coronary artery is defined as a complete vessel occlusion with thrombolysis in myocardial infarction (TIMI) flow grade of 0 lasting for more than three months [1]. Revascularization of CTO with percutaneous coronary intervention (PCI) is associated with angina relief, improved left ventricular function, reduction in the rate of myocardial infarction, less need for subsequent coronary artery bypass grafting and better patient survival regardless of the presence of collateral circulation [3,4,5]. Because multiple sequential long stents are frequently required (termed vessel “caging”) to treat a chronically occluded vessel, the vessel is subject to risks of late stent thrombosis and restenosis [6,7,8]. We performed a systematic review, which sought to summarize known data on mid- to long-term clinical outcomes for BVS in chronic total occlusion

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