Scaffold underexpansion and late lumen loss after bioresorbable scaffold implantation: Insights from ABSORB JAPAN trial.
Int J Cardiol Heart Vasc
; 31: 100623, 2020 Dec.
Article
em En
| MEDLINE
| ID: mdl-32944608
ABSTRACT
BACKGROUND:
Device underexpansion is associated with late adverse outcomes after bioresorbable vascular scaffold (BVS) implantation. This study, representing official IVUS results of the ABSORB Japan trial, aimed to characterize IVUS findings, focusing specifically on acute device expansion, and to investigate its impact on late lumen loss (LLL) with Absorb-BVS compared with cobalt-chromium everolimus-eluting stents (CoCr-EES).METHODS:
ABSORB Japan enrolled 148 patients (21 randomization) in the IVUS cohort. Serial IVUS was prescheduled at post-procedure and 3 years. Acute device expansion was evaluated with respect to the degree and uniformity of the implanted device.RESULTS:
Overall, Absorb-BVS showed smaller and more nonuniform device expansion at post-procedure, compared with CoCr-EES, which was particularly prominent in small-vessel lesions. In serial analysis, Absorb-BVS showed unique associations of smaller device expansion (r = 0.40, p = 0.001) and more nonuniformity (r = 0.29, p = 0.007) at post-procedure with greater LLL at 3 years, primarily attributable to greater negative remodeling (r = 0.39, p = 0.006). In contrast, acute device expansion showed no relation with subsequent lumen change in CoCr-EES. In Absorb-BVS, ischemic-driven target lesion or vessel revascularization (ID-TLR or ID-TVR) at 3 years occurred more frequently in small- versus large-vessel lesions (12.5% vs. 0%, p = 0.04 for ID-TLR and 15.6% vs. 2.3%, p = 0.08 for ID-TVR). Conversely, Absorb BVS had no target lesion nor vessel failure, even in small-vessel lesions, when adequate device expansion was achieved at post-procedure.CONCLUSIONS:
Unlike CoCr-EES, underexpansion was associated with greater negative remodeling and LLL in Absorb-BVS. This may in part account for the poorer outcomes of Absorb-BVS than CoCr-EES when under-expanded.
Absorb BVS; BVS, bioresorbable vascular scaffolds; CV, coefficient of variation; CoCr-EES, cobalt-chromium everolimus-eluting stents; DS, diameter stenosis; ID-TLR, ischemic-driven target lesion revascularization; ID-TVR, ischemic-driven target vessel revascularization; ISA, incomplete strut apposition; IVUS, intravascular ultrasound; LISA, late-acquired incomplete strut apposition; LLL, late lumen loss; Late acquired ISA; Late lumen loss; MI, myocardial infarction; MLD, minimum lumen diameter; QCA, quantitative coronary angiography; RLD, reference lumen diameter; RVD, reference vessel diameter; ST, stent thrombosis; ScT, scaffold thrombosis; Scaffold underexpansion; TLF, target lesion failure; TVF, target vessel failure
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Coleções:
01-internacional
Base de dados:
MEDLINE
Tipo de estudo:
Clinical_trials
Idioma:
En
Revista:
Int J Cardiol Heart Vasc
Ano de publicação:
2020
Tipo de documento:
Article