Brown Adam J, McCormick Liam M, Braganza Denise M, Bennett Martin R, Hoole Stephen P, West Nick E J
Department of Interventional Cardiology, Papworth Hospital NHS Trust, United Kingdom; Department of Cardiovascular Medicine, University of Cambridge, United Kingdom.
Catheter Cardiovasc Interv. 2014 Jul 1;84(1):37-45. doi: 10.1002/ccd.25378. Epub 2014 Jan 31.
This study sought to investigate the postdeployment expansion and malapposition characteristics of the bioresorbable vascular scaffold (BVS) in real-world practice.
The material construct of the BVS precludes overexpansion, with consequent potential for scaffold underexpansion and malapposition. In metallic stents, these features are associated with an increased risk of adverse events, including stent thrombosis. The postdeployment characteristics of the BVS are yet to be described outside clinical trials, where implantation occurred in straightforward lesion subsets.
Data from 25 patients undergoing BVS implantation were analyzed. Optical coherence tomography (OCT) was performed both before and after intervention to assess plaque composition, scaffold expansion and strut apposition. Manufacturer's compliance charts were used to predict expected minimal scaffold diameter and area.
OCT pullback (522.2 mm) was analyzed. Overall, BVS achieved 82.5 ± 8.7 and 79.8 ± 12.3% of predicted minimal stent diameter and cross-sectional area (SCA), respectively, with expansion reduced in middle third of the scaffold (central SCA 76.7 ± 10.9% vs. noncentral SCA 81.5 ± 12.7%, P < 0.0001). Improved measures of SCA were observed with 1:1 balloon:vessel predilatation (1:1 PreD 82.8 ± 9.5% vs. No 1:1 PredD 78.6 ± 13.0%, P < 0.0001). Seven thousand six hundred scaffold struts were identified, of which 470 (6.18%) were malapposed. In fibrocalcific (FCa) plaques, malapposition was observed more frequently (FCa 44.4% vs. Other plaques 7.5%, P < 0.001) and at a greater distance from the vessel wall (FCa 0.17 ± 0.10 mm vs. Other plaques 0.14 ± 0.08 mm, P = 0.002).
In this study, BVS expansion was significantly improved by 1:1 PreD, while increased rates of malapposition was associated with FCa plaques.
本研究旨在调查生物可吸收血管支架（BVS）在实际应用中植入后扩张及贴壁不良的特征。
BVS的材料结构限制了过度扩张，因此存在支架扩张不足及贴壁不良的可能性。在金属支架中，这些特征与不良事件风险增加相关，包括支架血栓形成。BVS植入后的特征在临床试验之外尚未得到描述，临床试验中的植入发生在简单的病变亚组中。
分析了25例行BVS植入患者的数据。在干预前后均进行光学相干断层扫描（OCT），以评估斑块成分、支架扩张及支柱贴壁情况。使用制造商的顺应性图表预测预期的最小支架直径和面积。
分析了OCT回撤（522.2毫米）情况。总体而言，BVS分别达到预测最小支架直径和横截面积（SCA）的82.5±8.7%和79.8±12.3%，支架中部三分之一处的扩张减少（中央SCA为76.7±10.9%，而非中央SCA为81.5±12.7%，P<0.0001）。在1:1球囊:血管预扩张时观察到SCA测量值有所改善（1:1预扩张时为82.8±9.5%，未进行1:1预扩张时为78.6±13.0%，P<0.0001）。识别出7600个支架支柱，其中470个（6.18%）贴壁不良。在纤维钙化（FCa）斑块中，贴壁不良更常见（FCa为44.4%，其他斑块为7.5%，P<0.001），且距血管壁更远（FCa为0.17±0.10毫米，其他斑块为0.14±0.08毫米，P=0.002）。
在本研究中，1:1预扩张显著改善了BVS的扩张，而贴壁不良发生率增加与FCa斑块相关。
