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Optical coherence tomography evaluation of the absorb bioresorbable scaffold performance for overlap versus non-overlap segments in patients with coronary chronic total occlusion: insight from the GHOST-CTO registry

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Abstract

The Absorb bioresorbable vascular scaffold (BVS) promised to avoid some of the disadvantages of its metal predecessors. Even though it has been taken off the market, limited data is available about its use in coronary chronic total occlusion (CTO) and its performance in overlap segments, which would be of special research interest due to its large thickness. This data is still pertinent since the platform of bioresorbable devices has not been abandoned, with several companies working on it. We aimed to compare healing and performance between overlap (OL) and non-overlap regions (NOL) of CTO lesions treated with BVS, using optical coherence tomography (OCT). Fourteen patients with overlapping BVS were included from the GHOST-CTO registry, resulting in 25 OL and 38 NOL regions. OCT based parameters were compared between OL and NOL groups at baseline (post-implantation) and 12-month follow-up. The mean age was 61.7 ± 7.2 years and 12 (86%) were males. Twelve (86%) patients underwent PCI for stable coronary artery disease and 2 (14%) had unstable angina. At 12-month follow-up, mean lumen area decreased in both NOL and OL regions, but the decrease was significantly larger in the OL region (NOL − 0.7 ± 1.33 vs. OL − 2.4 ± 1.54 mm2; p = 0.002). Mean scaffold area increased in both regions, but increased significantly more in NOL ( + 1.1 ± 1.54 vs. + 0.4 ± 1.16 mm2; p = 0.016). The percent of uncovered struts was lower in the OL group (5.0 ± 6.6% vs. 3.75 ± 8.7%, p = 0.043), whereas the percentage of malapposed struts was similar (0.3 ± 0.5% vs. 0.7 ± 2.3%, p = 0.441). Neointimal hyperplasia (NIH) was more pronounced in the OL region (0.13 ± 0.04 vs. 0.24 ± 0.10 mm2, p = 0.001). The OL and NOL segments showed comparable healing in terms of coverage and malapposition. However, NIH was more prominent in OL region. The long-term clinical implications of these findings needs further evaluation. The present study provides important insights for future development of BVS technology.

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Authors and Affiliations

  1. Case Western Reserve University and Harrington Heart and Vascular Institute, University Hospitals, Cleveland Medical Center, Cleveland, USA

    Gabriel T. R. Pereira, Yasuhiro Ichibori, Armando Vergara-Martel, Abdul Jawwad Samdani & Guilherme F. Attizzani

  2. Cardio-Thoracic-Vascular Department, Azienda Ospedaliero-Universitaria “Policlinico-Vittorio Emanuele”, University of Catania, Catania, Italy

    Alessio La Manna, Davide Capodanno, Guido D’Agosta, Giacomo Gravina, Giuseppe Venuti & Corrado Tamburino

  3. Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil

    Bruno Ramos Nascimento

  4. Cardiovascular Imaging Core Laboratory, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Lakeside building, Room 3113, Mailstop Lakeside 5038, Cleveland, OH, 44106, USA

    Gabriel T. R. Pereira & Guilherme F. Attizzani

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Guilherme F. Attizzani - Speaker for Abbott, Alessio La Manna - Consultant for Abbott. The other authors have no conflicts of interest to disclose.

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Pereira, G.T.R., La Manna, A., Ichibori, Y. et al. Optical coherence tomography evaluation of the absorb bioresorbable scaffold performance for overlap versus non-overlap segments in patients with coronary chronic total occlusion: insight from the GHOST-CTO registry. Int J Cardiovasc Imaging 35, 1767–1776 (2019). https://doi.org/10.1007/s10554-019-01636-3

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