Abstract
Indo-Pakistan population has one of the highest risk of coronary artery disease (CAD) in the world. Percutaneous interventions with the use of stents has been the mainstay of treatment for CAD, evolving from balloon angioplasty to bare metal stents and then to drug eluting stents. However, there are a few drawbacks related to the metal implant in the coronary, leading to the development of bio-resorbable vascular scaffolds (BVS). This case series studies the implantation techniques and 24 month clinical outcome of bioresorbable stent Absorb at Rawalpindi Institute of Cardiology. From November 1, 2013 till June 30, 2018. Fifty patients undergoing angioplasty with Absorb BVS as elective or primary PCI were enrolled. Case selection was at the discretion of the operator. Patients were followed up clinically. Repeat angiogram was conducted if clinically indicated. The study population involved patients with mean age of 42±8.82. Fourty three (86%) were male and most had single or double vessel disease. The most common treated coronary was left anterior descending. Most of the lesions were predilated with 1:1 sizing. Most scaffolds were post dilated with 0.5mm larger diameter non-compliant balloon at nominal pressure. Angiographic success rate was 92%. On follow up, 4% had stent thrombosis (ST) (compared to <1% for latest generation drug eluting stents (DES) as per available literature). No death was reported. Majority of those with ST had longer median treated lesion length than those without stent thrombosis (32mm versus 28mm). Stent thrombosis occurred in 7.7% of cases with overlapping BVS while 2.8% in single BVS patients. To conclude, current generation Biovascular scaffold has higher thrombosis rates as compared to latest generation DES. Procedure/lesion related risk factors may predispose in addition to the thick stent struts.
Highlights
Coronary artery disease(CAD) is the leading cause of death worldwide being responsible for one in five deaths in US.[1,2] Indo-Pakistani populations have very high risk of CAD in the world, one in five urban Pakistanis may have underlyingCAD1
WHO statistics of 2017 showed that 21.76% of total deaths in Pakistan are due to CAD.[1]
Bioresorbable vascular scaffold (BVS) is interesting alternative because the polymer prosthesis remains in the vessel only transiently
Summary
Coronary artery disease(CAD) is the leading cause of death worldwide being responsible for one in five deaths in US.[1,2] Indo-Pakistani populations have very high risk of CAD in the world, one in five urban Pakistanis may have underlying. Bioresorbable vascular scaffold (BVS) is interesting alternative because the polymer prosthesis remains in the vessel only transiently This allows for vessel function to return in addition to reducing inflammation[3]. Results of Absorb III trial were discouraging During the time it remained in market, thousands of patients all over the world had Absorb implanted, including. Both elective and primary percutaneous coronary procedures, involving Absorb ov is io BVS implantation at Rawalpindi Institute of Cardiology over a 5 year period (November 2013-to June 2018) were studied. Stent thrombosis occurred in one out of 13cases (7.7%) with overlapping and one out of 37cases (2.8%) in non-overlapping scaffold patients, the difference was statistically non-significant (pvalue=0.435). In contrast among those without ST, the predilation was done at 1:1 size in 28 cases (58%), the difference was non-significant at p=0.225
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