Use of Bioresorbable Vascular Scaffold technology in treating coronary bifurcation lesions: A report about long-term clinical results and review of available literature.

Abstract

BVS proved safe in humans. ABSORB trials showed them performing similar to Drug Eluting Stents in simple coronary interventions. We assessed a registry of 63 patients with bifurcation lesions, treated by BVS and followed their outcomes up-to 5 years. Patients who satisfied the inclusion criteria were included. Data about contact information, baseline characteristics, findings of coronary angiogram, details of their interventional treatment; short and long-term outcomes up till 5 years was collected. Acute feasibility of implantation in bifurcation was high (98 %). Rate of stent thrombosis, acute or sub-acute, was 3.1 %. Rate of re-intervention was 38 %. The average time for an event to occur was 1.6±0.8 years. Over 5 years, 56 % had developed MACE. Patients with MACE were more likely females, hypertensive, smokers, with acute presentations (p=NS), and diabetic (72 % vs 33 % non-diabetic; p=0.002). Patients treated with hybrid strategy of BVS and DES were more likely to develop MACE (64 % vs 49 % for others; P=ns). Patients treated by simple provisional stenting were less likely to develop MACE (45 % vs 60.5 %; p=ns). The average SYNTAX score of MACE patients was 27 vs 20; p=0.06). Diabetes was independently associated with MACE. Hypertension was of borderline statistical significance (2-sided Log rank for Hypertension p=0.06, for Diabetes p=0.01). The use of multiple stenting strategies to treat true bifurcation lesions using BVS is feasible with low rate of serious adverse events, albeit on the long run, the rate of re-intervention is high and stringent follow up is required (Tab. 7, Fig. 3, Ref. 37).