Jabbour Richard J, Ielasi Alfonso, Tanaka Akihito, Leoncini Massimo, Cortese Bernado, Grigis Giulietta, Mitomo Satoru, Regazzoli Damiano, Di Palma Gaetano, Rapetto Claudio, Tespili Maurizio, Colombo Antonio, Latib Azeem
San Raffaele Hospital, Milan, Italy; EMO GVM Columbus, Milan, Italy.
Bolognini Hospital Seriate, ASST Bergamo Est, Seriate (BG), Italy.
Cardiovasc Revasc Med. 2017 Jul-Aug;18(5S1):S4-S9. doi: 10.1016/j.carrev.2017.03.007. Epub 2017 Mar 8.
Due to the inherent limitations of current generation BVSs, complex coronary artery disease often contains BVS unsuitable segments. Our aim was to assess the feasibility of a hybrid approach using bioresorbable vascular scaffolds (BVSs) and drug-eluting stents (DESs) for the treatment of complex coronary artery lesions not suitable for a scaffolding only approach.
A retrospective multicenter cohort analysis was performed on patients with complex de novo or in-stent restenosis lesions treated with a hybrid BVS (Absorb BVS, Abbott Vascular, Santa Clara, CA) and DES strategy. The primary endpoint was target lesion failure (TLF) defined as a composite of cardiac death, target-vessel myocardial infarction (MI) and target lesion revascularization (TLR).
A total of 98 patients (105 lesions) were treated with the hybrid strategy. Isolated long lesions in which either proximal or distal reference vessel diameters were not suitable for BVS were an indication in 36.2% (n=38) of cases. In contrast, 28% (n=29) of lesions treated with the hybrid strategy were bifurcations in which the side branch was predominantly treated with DES (n=28). DES bailout after BVS implantation was an indication in 21.9% (n=23 lesions). The rates of type B2/C and long lesions (>28mm) were 95.2% and 74.3% respectively. The mean total BVS and DES lengths implanted were 37.5±24.1mm and 25.0±14.7mm respectively. The rate of TLF in the overall cohort of patients (median follow-up 405days [interquartile range 189-658]) was 11.4% at 1-year. This was primarily driven by TLR (9.5%), with rates of cardiac death and target vessel MI of 2.1% and 1.4% respectively. No cases of definite or probable BVS/DES thrombosis occurred.
In conclusion, the use of a hybrid BVS/DES strategy was feasible and associated with acceptable outcomes at 1-year, considering the length and complexity of lesions treated. Further, larger studies with longer follow-up are needed to confirm our findings.
由于当代生物可吸收血管支架（BVS）存在固有限制，复杂冠状动脉疾病常包含不适合使用BVS的节段。我们的目的是评估使用生物可吸收血管支架（BVS）和药物洗脱支架（DES）的混合方法治疗不适合单纯支架置入方法的复杂冠状动脉病变的可行性。
对采用混合BVS（Absorb BVS，雅培血管，加利福尼亚州圣克拉拉）和DES策略治疗的新发或支架内再狭窄复杂病变患者进行回顾性多中心队列分析。主要终点是靶病变失败（TLF），定义为心源性死亡、靶血管心肌梗死（MI）和靶病变血运重建（TLR）的复合终点。
共有98例患者（105处病变）接受了混合策略治疗。36.2%（n = 38）的病例为孤立长病变，其近端或远端参考血管直径不适合使用BVS。相比之下，28%（n = 29）接受混合策略治疗的病变为分叉病变，其中侧支主要采用DES治疗（n = 28）。BVS植入后DES补救治疗占21.9%（n = 23处病变）。B2/C型病变和长病变（>28mm）的发生率分别为95.2%和74.3%。植入的BVS和DES的平均总长度分别为37.5±24.1mm和25.0±14.7mm。在整个患者队列中（中位随访405天[四分位间距189 - 658]），1年时TLF发生率为11.4%。这主要由TLR（9.5%）驱动，心源性死亡和靶血管MI的发生率分别为2.1%和1.4%。未发生明确或可能的BVS/DES血栓形成病例。
总之，考虑到所治疗病变的长度和复杂性，使用混合BVS/DES策略是可行的，且1年时预后可接受。此外，需要进行更大规模、随访时间更长的研究来证实我们的发现。
