Biscaglia Simone, Erriquez Andrea, Bernucci Davide, Bugani Giulia, Favaretto Enrico, Campo Gianluca
Cardiovascular Section, Medical Sciences Department, Azienda Ospedaliero-Universitaria S.Anna, Ferrara, Italy.
Unità di Emodinamica, Ospedale Universitario S.Maria della Misericordia di Udine.
J Thorac Dis. 2017 Aug;9(Suppl 9):S914-S922. doi: 10.21037/jtd.2017.06.35.
Dealing with bioresorbable vascular scaffolds (BVS) implantation in long lesions requiring device overlapping in this particular moment might seem a little provocative for several reasons. First, most studies testing BVS have focused on their safety and efficacy profile in simple patients with simple lesions. Second, ABSORB II did not meet its primary endpoint, while ABSORB III showed a higher rate of target vessel-myocardial infarction (TV-MI) at 2 years. Third, data on porcine model showed that overlapping zone has delayed but greater neointimal proliferation with consequent higher risk for scaffold thrombosis in the short-term and of in-scaffold restenosis in the long-term. Fourth, recently published data showed higher risk of TVF in patients treated with ≥60 mm BVS. Given all these premises, it may seem right to put aside this technology, while it may seem inappropriate to hypothesize the use of BVS in long lesions. The aim of the present review is precisely to critically review the available evidences regarding BVS with particular regard to overlapping BVS in order to understand whether this technology has a future per se and especially in long coronary lesions requiring overlap.
在当前这个特定时期，处理需要器械重叠的长病变中的生物可吸收血管支架（BVS）植入问题，可能因多种原因而显得有些棘手。首先，大多数测试BVS的研究都集中在患有简单病变的简单患者身上，关注其安全性和有效性。其次，ABSORB II未达到其主要终点，而ABSORB III在2年时显示出较高的靶血管心肌梗死（TV-MI）发生率。第三，猪模型数据表明，重叠区域内膜增生延迟但更严重，因此短期内支架血栓形成风险更高，长期内支架内再狭窄风险更高。第四，最近发表的数据显示，接受≥60 mm BVS治疗的患者发生TVF的风险更高。鉴于所有这些前提，搁置这项技术似乎是正确的，而假设在长病变中使用BVS似乎不合适。本综述的目的正是批判性地审视关于BVS的现有证据，特别是关于重叠BVS的证据，以了解这项技术本身是否有未来，尤其是在需要重叠的长冠状动脉病变中。
