Cardio-Thoracic-Vascular Department, Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy.
Harrington Heart and Vascular Institute, University Hospitals, Cleveland Medical Center, 11100 Euclid Avenue Lakeside, 3113 Cleveland, OH, United States.
Int J Cardiol. 2018 Feb 15;253:45-49. doi: 10.1016/j.ijcard.2017.10.107. Epub 2017 Nov 8.
Bioresorbable vascular scaffolds (BVS) have been heralded with potential benefits that are especially desired in long lesions, including chronic total occlusions (CTOs). Procedural feasibility and mid-term outcomes of BVS in CTOs have been reported. However, there is still a paucity of data regarding the vascular and healing response to BVS in CTOs evaluated by optical coherence tomography (OCT).
This study included prospectively 21 patients who had a CTO lesion treated with a BVS. Angiography and OCT scan were recorded at either post-implantation and 1-year follow-up. Quantitative coronary angiography and OCT analyses were performed by an independent core laboratory.
The angiographic analysis showed a significant increase in the percentage of in-segment diameter stenosis at 1year (11.89±9.5% vs. 21.84±11.7%; p=0.002). The OCT analysis showed a trend (p=0.07) towards increased mean scaffold area and significant reductions in mean lumen diameter (3.1±0.36mm vs. 2.85±0.47mm; p=0.0046), mean lumen area (7.8±1.73mm vs. 6.76±2mm; p=0.0082) and minimal lumen area (5.26±1.86mm vs. 3.56±1.52mm; p<0.0001). Malapposition area and volume decreased from 0.26±0.17mm to 0.08±0.1mm (p=0.0003) and from 14.17±12.92mm to 3.99±4.46mm (p=0.0014), respectively. The rate of uncovered or malapposed struts, measured at the frame level, was 5.29±6.48% at 1year.
In a small series of CTO patients treated with BVS implantation, OCT outcomes at 1year displayed an overall favorable vascular response and healing profile.
生物可吸收血管支架（BVS）具有潜在的益处，在长病变中尤其受到青睐，包括慢性完全闭塞（CTO）。已经报道了 BVS 在 CTO 中的手术可行性和中期结果。然而，关于 CTO 中 BVS 的血管和愈合反应，通过光学相干断层扫描（OCT）评估的数据仍然很少。
本研究前瞻性纳入 21 例接受 BVS 治疗的 CTO 病变患者。在植入后和 1 年随访时记录血管造影和 OCT 扫描。定量冠状动脉造影和 OCT 分析由独立的核心实验室进行。
血管造影分析显示，1 年后节段内直径狭窄百分比显著增加（11.89±9.5%比 21.84±11.7%；p=0.002）。OCT 分析显示，支架面积均值呈增加趋势（p=0.07），管腔直径均值显著减小（3.1±0.36mm 比 2.85±0.47mm；p=0.0046），管腔面积均值（7.8±1.73mm 比 6.76±2mm；p=0.0082）和最小管腔面积均值（5.26±1.86mm 比 3.56±1.52mm；p<0.0001）。贴壁不良面积和体积分别从 0.26±0.17mm 减少到 0.08±0.1mm（p=0.0003）和从 14.17±12.92mm 减少到 3.99±4.46mm（p=0.0014）。在 1 年时，以帧为单位测量的未覆盖或贴壁不良支架的比例为 5.29±6.48%。
在接受 BVS 植入治疗的 CTO 患者小系列中，1 年时的 OCT 结果显示出整体良好的血管反应和愈合情况。
