CIBERCV, Hospital Clínico Universitario, Valladolid, Spain; Complejo Asistencial Universitario de León (CAULE), León, Spain.
CIBERCV, Hospital Clínico Universitario, Valladolid, Spain.
Am J Cardiol. 2022 Nov 1;182:1-7. doi: 10.1016/j.amjcard.2022.07.038. Epub 2022 Sep 6.
Although complete bioresorbable vascular scaffold (BVS) resorption has been demonstrated at 5-year follow-up, whether corresponding vasomotor function restoration occurs remains unknown. The objective was to simultaneously assess the structural healing response along with vasomotor responses at 5-year follow-up of BVS implantation. We studied consecutive patients treated with ABSORB-BVS at 5-year follow-up (n = 31), who were recruited from a multicenter registry and were contacted to undergo a research protocol-driven repeat coronary angiogram involving intracoronary optical coherence tomography (OCT) and invasive coronary endothelial function testing. Epicardial endothelium-dependent vasomotion was defined as any vasodilatation after intracoronary acetylcholine (ACh), whereas endothelium-independent vasomotion was defined as any vasodilatation after intracoronary nitroglycerine (NTG), using quantitative coronary angiography. The mean implantation time point was 60.5 ± 4.6 months. OCT imaging demonstrated complete scaffold resorption in all patients. New coronary lesions (stenosis >50%) were found in 5 patients (16.1%), 3 of them underwent ad hoc percutaneous revascularization (9.7%). Intracoronary ACh (27 patients) and NTG testing (30 patients) was performed. Quantitative coronary angiography analysis demonstrated vasoconstriction after ACh administration and lack of response to NTG in BVS segments (mean lumen diameter = 2.00 ± 0.61 mm at baseline vs 1.74 ± 0.70 mm post-ACh, p <0.001; 2.05 ± 0.54 mm at baseline vs 2.03 ± 0.50 mm post-NTG, p = 0.69). OCT lumen analysis demonstrated similar vasoconstrictive responses to ACh (mean lumen area = 5.31 ± 2.26 mm at baseline vs 5.12 ± 2.55 mm post-ACh, p = 0.007) but had a vasodilatory response to NTG (5.96 ± 2.35 mm at baseline vs 6.17 ± 2.55 mm post-NTG, p<0.001). In conclusion, complete ABSORB-BVS resorption was demonstrated at 5-year follow-up. However, this healing response was associated with endothelium-dependent vasomotor dysfunction within the BVS segment.
虽然在 5 年随访时已经证明了完全可生物吸收血管支架（BVS）的吸收，但相应的血管舒缩功能恢复情况仍不清楚。目的是同时评估 BVS 植入后 5 年时的结构愈合反应和血管舒缩反应。我们研究了连续 31 例在 5 年随访时接受 ABSORB-BVS 治疗的患者，这些患者是从一个多中心登记处招募的，并联系他们进行研究方案驱动的重复冠状动脉造影，包括冠状动脉内光学相干断层扫描（OCT）和侵入性冠状动脉内皮功能测试。心外膜内皮依赖性血管舒张定义为冠状动脉内乙酰胆碱（ACh）后任何血管扩张，而内皮非依赖性血管舒张定义为冠状动脉内硝酸甘油（NTG）后任何血管扩张，使用定量冠状动脉造影。平均植入时间点为 60.5±4.6 个月。OCT 成像显示所有患者均完全吸收支架。5 名患者（16.1%）发现新的冠状动脉病变（狭窄>50%），其中 3 名患者接受了择期经皮血运重建（9.7%）。进行了冠状动脉内 ACh（27 例）和 NTG 检测（30 例）。定量冠状动脉造影分析显示，ACh 给药后血管收缩，BVS 段对 NTG 无反应（基线时平均管腔直径为 2.00±0.61mm，ACh 后为 1.74±0.70mm，p<0.001；基线时为 2.05±0.54mm，ACh 后为 2.03±0.50mm，p=0.69）。OCT 管腔分析显示，ACh 也有类似的血管收缩反应（基线时平均管腔面积为 5.31±2.26mm，ACh 后为 5.12±2.55mm，p=0.007），但对 NTG 有血管扩张反应（基线时为 5.96±2.35mm，ACh 后为 6.17±2.55mm，p<0.001）。总之，在 5 年随访时已经证明了完全吸收的 ABSORB-BVS 的吸收。然而，这种愈合反应与 BVS 节段内的内皮依赖性血管舒缩功能障碍有关。
