TY - JOUR
T1 - Long-Term Intracoronary Structural and Vasomotor Assessment of the ABSORB Bioresorbable Vascular Scaffold
AU - Altisent, Omar Abdul Jawad
AU - Goncalves-Ramírez, Luis Renier
AU - Fernández, Leticia
AU - Viladés, David
AU - Gutiérrez, Enrique
AU - Mitomo, Satoru
AU - Latib, Azeem
AU - Córdoba-Soriano, Juan Gabriel
AU - Adeliño, Raquel
AU - Amat-Santos, Ignacio
AU - Muñoz, Juan Francisco
AU - Elízaga, Jaime
AU - Bezzera, Hiram
AU - Pereira, Gabriel Tensol Rodrigues
AU - de Prado, Armando Pérez
AU - Carrillo, Xavier
AU - Fernández-Nofrerias, Eduard
AU - Vilalta, Victoria
AU - Rodríguez-Leor, Oriol
AU - Llibre, Cinta
AU - Fadeuilhe, Edgar
AU - Trujillo, Aaron
AU - Mauri, Josepa
AU - de la Torre Hernández, Jose M.
AU - Bayes-Genís, Antoni
AU - Puri, Rishi
N1 - Funding Information:
The authors would like to thank Roman Poliszczuk, MD, of the Angio/IVUS Core Laboratory of the Cleveland Clinic Coordinating Center for Clinical Research (C5R) for his contribution toward imaging analysis and Eduardo Núñez, MD, of MedStats Consulting & Reading (Pennsylvania) for assisting in the statistical analysis.
Publisher Copyright:
© 2022 Elsevier Inc.
PY - 2022/4/1
Y1 - 2022/4/1
N2 - We systematically categorized the longer-term (≥3 years) structural and functional characteristics of the ABSORB bioresorbable vascular scaffold (BVS) using optical coherence tomography imaging and coronary vasomotor reactivity testing and further compared the functional characteristics of BVS stented versus remote coronary segments. A total of 92 patients (mean age 56.4 ± 9.7 years, 22.8% women) who underwent percutaneous coronary intervention (76% with acute coronary syndrome) using the ABSORB BVS (112 lesions) were included. Optical coherence tomography analysis (38,790 visible struts) comprised in-segment quantitative lumen/plaque and semiquantitative plaque composition analysis of the neointimal pattern. Epicardial endothelium-dependent and-independent vasomotion was defined as any vasodilatation at low/intermediate intracoronary dose of acetylcholine (ACh) and nitroglycerine, assessed using quantitative coronary angiography. At a median time of 3.2 years follow-up, 79.8% of BVS segments still demonstrated visible struts with a predominant neointimal fibrotic healing pattern in 84% of BVS segments, with 99.5% of struts demonstrating coverage with apposition. Compared with remote segments, BVS segments demonstrated less endothelium-dependent vasodilatation at low (p = 0.06) and intermediate ACh doses (p = 0.04). Hypertension, longer time interval from index percutaneous coronary intervention, and the degree of in-BVS segment neointimal volume (p <0.03 for all) were each independently associated with abnormal BVS endothelium-dependent vasomotor function. Endothelium-independent function was more likely preserved in non-BVS (remote) segments compared with BVS segments (p = 0.06). In conclusion, at 3+ years post-ABSORB BVS insertion, the rate of complete scaffold resorption was low and residual strut presence was high, with a dominant fibrous healing response contributing toward neointimal hyperplasia and endothelium-dependent and-independent vasomotor dysfunction.
AB - We systematically categorized the longer-term (≥3 years) structural and functional characteristics of the ABSORB bioresorbable vascular scaffold (BVS) using optical coherence tomography imaging and coronary vasomotor reactivity testing and further compared the functional characteristics of BVS stented versus remote coronary segments. A total of 92 patients (mean age 56.4 ± 9.7 years, 22.8% women) who underwent percutaneous coronary intervention (76% with acute coronary syndrome) using the ABSORB BVS (112 lesions) were included. Optical coherence tomography analysis (38,790 visible struts) comprised in-segment quantitative lumen/plaque and semiquantitative plaque composition analysis of the neointimal pattern. Epicardial endothelium-dependent and-independent vasomotion was defined as any vasodilatation at low/intermediate intracoronary dose of acetylcholine (ACh) and nitroglycerine, assessed using quantitative coronary angiography. At a median time of 3.2 years follow-up, 79.8% of BVS segments still demonstrated visible struts with a predominant neointimal fibrotic healing pattern in 84% of BVS segments, with 99.5% of struts demonstrating coverage with apposition. Compared with remote segments, BVS segments demonstrated less endothelium-dependent vasodilatation at low (p = 0.06) and intermediate ACh doses (p = 0.04). Hypertension, longer time interval from index percutaneous coronary intervention, and the degree of in-BVS segment neointimal volume (p <0.03 for all) were each independently associated with abnormal BVS endothelium-dependent vasomotor function. Endothelium-independent function was more likely preserved in non-BVS (remote) segments compared with BVS segments (p = 0.06). In conclusion, at 3+ years post-ABSORB BVS insertion, the rate of complete scaffold resorption was low and residual strut presence was high, with a dominant fibrous healing response contributing toward neointimal hyperplasia and endothelium-dependent and-independent vasomotor dysfunction.
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U2 - 10.1016/j.amjcard.2021.12.037
DO - 10.1016/j.amjcard.2021.12.037
M3 - Article
C2 - 35058053
AN - SCOPUS:85123016994
SN - 0002-9149
VL - 168
SP - 55
EP - 63
JO - American Journal of Cardiology
JF - American Journal of Cardiology
ER -