Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy.
EuroIntervention. 2017 Feb 20;12(14):1730-1737. doi: 10.4244/EIJ-D-16-00247.
It has become apparent that, in comparison to metallic stents, bioresorbable vascular scaffolds (BVS) require specific implantation techniques. The aim of this study was to investigate outcomes following BVS implantation using a dedicated strategy for optimal deployment.
Four hundred consecutive lesions (264 patients) treated with the Absorb BVS were analysed. All procedures were performed based on the following principles: 1) aggressive lesion preparation; 2) high-pressure post-dilation; and 3) a low threshold for intravascular imaging. The majority of target lesions (74.8%) were type B2 or C lesions. Predilation (97.3%) and post-dilation (99.8%) were performed in almost all cases. The mean post-dilation pressure was 21±5 atm, and the total scaffold length per patient was 53.2±32.5 mm. Intravascular imaging was performed in the majority of cases (85.8%) and, when utilised after post-dilatation, a further intervention was required in 24.5% of lesions. The cumulative target lesion failure rates were 7.9% at one year and 11.6% at two years. Definite/probable scaffold thrombosis occurred in three patients (1.2% at one and two years).
Clinical outcomes following implantation of current-generation BVS, in a real-world population with a high prevalence of complex lesions, were acceptable when utilising our optimised implantation strategy.
与金属支架相比，生物可吸收血管支架（BVS）需要特定的植入技术，这一点已经很明显。本研究旨在探讨采用专用策略优化植入以获得更好的效果。
对 264 例患者的 400 个病变部位采用 Absorb BVS 进行分析。所有手术均基于以下原则进行：1）积极的病变准备；2）高压后扩张；3）对血管内成像的要求较低。大多数目标病变（74.8%）为 B2 或 C 型病变。几乎所有病例均进行预扩张（97.3%）和后扩张（99.8%）。后扩张平均压力为 21±5 个大气压，每位患者的支架总长度为 53.2±32.5mm。大多数病例都进行了血管内成像（85.8%），在进行后扩张后，24.5%的病变需要进一步干预。一年和两年的累积靶病变失败率分别为 7.9%和 11.6%。有 3 例患者（1.2%在 1 年和 2 年）发生明确/可能的支架血栓形成。
在复杂病变患病率较高的真实世界人群中，采用我们优化的植入策略，植入新一代 BVS 的临床结果是可以接受的。
