Impact of Clinical Presentation on Early Vascular Healing After Bioresorbable Vascular Scaffold Implantation

Abstract

Background: Optimal strut coverage and early vascular healing are important factors to reduce the risk of stent thrombosis. Data on early vascular healing with the new bioresorbable vascular scaffolds (BVS) are lacking. Further, healing response after BVS implantation in different clinical presentation has not been fully investigated.

Methods and results: We assessed with optical coherence tomography (OCT) the early vascular response to BVS implantation in 26 consecutive patients presenting with acute coronary syndrome (ACS) or stable angina (SA). Images from 16 BVSs (17,166 struts) in ACS patients and 17 BVSs (23,045 struts) in SA patients were analyzed. The mean implanted BVS diameter and length was 3.1 ± 0.4 mm and 20.4 ± 5.8 mm. At mean 47.6 ± 6.3 days, overall 99% of BVS struts were covered. There were no differences between ACS and SA on the amount of tissue coverage per strut (0.09 ± 0.02 mm vs. 0.09 ± 0.01 mm; P = 0.86, respectively) and lumen area stenosis (24.2 ± 19.3% vs. 22.3 ± 22.0%; P = 0.78, respectively). However, a numerically higher proportion of protruding (ACS 1.2 ± 2.7%; SA 4.2 ± 6.5%; P = 0.11) and malapposed (ACS 0.4 ± 0.5%; SA 2.4 ± 5.8%; P = 0.18) struts were observed in SA compared to ACS, with trendy better healing score in ACS (1.87 ± 1.67 vs. 5.28 ± 7.28, P = 0.08).

Conclusion: Early after BVS implantation almost complete scaffold strut coverage without any thrombi was observed by OCT, independent by the clinical presentation at index coronary intervention. However, BVS in ACS lesions were associated with easier strut penetration and a trendy better healing score compared with SA.

© 2016, Wiley Periodicals, Inc.