Conformability in everolimus-eluting bioresorbable scaffolds compared with metal platform coronary stents in long lesions

Jiang Ming Fam,Nicolas Van Mieghem,Evelyn Regar,Bu Chun Zhang,Yoshinobu Onuma,Roberto Diletti,Cordula Felix,Yuki Ishibashi,Ron Van Domburg,Robert-Jan Van Geuns

doi:10.1007/s10554-017-1193-0

Abstract

The aim of this study was to determine if there are significant differences in curvature of the treated vessel after the deployment of a polymeric BRS or MPS in long lesions. The impact of long polymeric bioresorbable scaffolds (BRS) compared with metallic platform stents (MPS) on vessel curvature is unknown. This retrospective study compares 32 patients who received a single everolimus-eluting BRS with 32 patients treated with a single MPS of 28 mm. Quantitative coronary angiography (QCA) was used to evaluate curvature of the treatment and peri-treatment region before and after percutaneous coronary intervention (PCI). Baseline demographic and angiographic characteristics were similar between the BRS and MPS groups. Pretreatment lesion length was 22.19 versus 20.38 mm in the BRS and MPS groups respectively (p = 0.803). After treatment, there was a decrease in median diastolic curvature in the MPS group (from 0.257 to 0.199 cm−1, p = 0.001). A similar trend was observed in the BRS group but did not reach statistical significance (median diastolic curvature from 0.305 to 0.283 cm−1, p = 0.056). Median Percentage relative change in diastolic curvature was lower in the BRS group compared with the MPS group (BRS vs. MPS: 7.48 vs. 29.4%, p = 0.013). By univariate analysis, use of MPS was an independent predictor of change in diastolic curvature (p = 0.022). In the deployment of long coronary scaffolds/stents (28 mm in length), BRS provides better conformability compared with MPS.

Highlights

The everolimus-eluting bioresorbable scaffolds (BRS) represented a novel change in the treatment of coronary artery lesions
This is a non-randomized, 2-arm, retrospective study performed with patients from the BVS Expand and BVS STEMI First registries that received a everolimus eluting BRS (ABSORB-BVS, Abbott Vascular, Santa Clara, CA, USA) compared with a subset of historical controls from the same institutional registries (X-SEARCH) who received a cobalt chromium- everolimus eluting stent (CoCr-eluting XIENCER family stent (EES); XIENCER stent, Abbott Vascular, Santa Clara, CA, US)
A total of 64 patients were involved in this study of which 32 were treated with the BRS and 32 with the metallic platform stents (MPS)

Summary

Introduction

The everolimus-eluting bioresorbable scaffolds (BRS) represented a novel change in the treatment of coronary artery lesions. Implantation of hard metallic implants straightens the coronary artery and modifies its curvature. A previous computational study demonstrated that after implantation of a metallic implant in a coronary artery, the curvature of the stent edges alters significantly which correlate to the changes in shear stress distribution and potentially with the neointimal proliferation pattern [2]. As implantation of coronary stents/scaffolds can alter blood rheology especially at the inflow and outflow edge of the stents, the vessel distortion post device implantation may contribute to early and late stent failure such as pertaining to stent fracture. A higher conformability of the stent is associated with less potential for vessel distortion and trauma [4]

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