Everolimus-eluting Bioresorbable Vascular Scaffold Implantation in Real World and Complex Coronary Disease: Procedural and 30-day Outcomes at Two Australian Centres

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• 作者：Daniel Robaei ; FRACP^a ; ^b ; ^c ; ^{daniel.robaei@unsw.edu.au" class="auth_mail" title="E-mail the corresponding author} ; Liam M. Back ; MBBS^a ; Sze-Yuan M. Ooi ; FRACP^a ; ^c ; Mark R. Pitney ; FRACP^a ; ^b ; ^c ; N. Jepson ; FRACP^a ; ^c
• 关键词：Coronary artery disease ; Percutaneous coronary intervention ; Bioresorbable scaffolds ; Drug-eluting stents
• 刊名：Heart, Lung and Circulation
• 出版年：2015
• 出版时间：September 2015
• 年：2015
• 卷：24
• 期：9
• 页码：854-859
• 全文大小：248 K

文摘

The Absorb BVS is a new generation of coronary stent designed to provide coronary arteries with mechanical support of a temporary nature, following balloon angioplasty. Clinical trials of the device have shown promising results thus far, however concern surrounds the deliverability of the device in real-world and complex coronary disease, and the possible higher incidence of early scaffold thrombosis when compared to conventional metallic drug-eluting stents.

Methods

Implantation of the Absorb BVS was attempted in 152 lesions in 100 patients at two Sydney teaching hospitals, as part of a prospective registry. Lesions treated reflected a wide spectrum of real-world disease. Young patient age, long lesion length and involvement of the mid-portion of the left anterior descending artery were the strongest factors likely to influence the decision to use the Absorb BVS over conventional metallic stents. There were no restrictions on the lesion length, or on the number of lesions or vessels treated. Type C lesions made up 37% of all lesions treated with 64% of these being long lesions (>20mm). The Absorb BVS was successfully implanted in 98.8% of cases. Post-dilatation was performed in 95% of scaffolds. Peri-procedural non-ST elevation myocardial infarction occurred in four cases. Scaffold thrombosis did not occur in any patient at 30 days follow-up. There was no death, or need for target lesion revascularisation in-hospital or at 30 days.

Conclusions

High rates of procedural success were achieved with minimal complications with use of the Absorb BVS in real-world coronary disease, including complex disease. These results suggest that the reduced deliverability of the device can be largely overcome by meticulous lesion preparation, and that early scaffold thrombosis may be minimised through scaffold post-dilatation.