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GHOST-CTO: Bioresorbable Scaffolds Yield Lower Success Rates than DES for CTO PCI
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For percutaneous treatment of chronic total occlusions, bioresorbable scaffolds were associated with higher rates of technical and procedural failure compared with second-generation drug-eluting stents, according to findings from the GHOST-CTO registry.
In the prospective, observational study, researchers evaluated 32 consecutive patients who underwent CTO PCI with a bioresorbable scaffold (Absorb, Abbott Vascular) at Ferrarotto Hospital in Catania, Italy, between May 2013 and May 2014. Patients were considered eligible for bioresorbable scaffolds if they had a minimum of one chronic totally occluded vessel with signs of significant myocardial anemia. The researchers compared these patients with a historical control group of patients (n = 54) who had undergone CTO PCI in the 2 previous years with second-generation DES.
The primary outcomes of interest were technical success and procedural success. Technical success was defined as successful scaffold/stent delivery and placement at the target lesion after CTO recanalization, achieving a final residual stenosis of less than 30% within the treated segment and re-establishment of TIMI grade 3 flow in the target vessel. Procedural success was defined as technical success free of MACE (composite of death, MI and target lesion revascularization) during hospitalization.
Baseline characteristics between the groups were comparable, except for a larger mean vessel diameter in the bioresorbable scaffold group (2.92 ± 0.34 mm vs. 2.5 ± 0.68 mm; P < .001).
The rate of technical success in the bioresorbable scaffold group was 78.1% vs. 96.3% in the DES group (P = .012). Technical failure in the bioresorbable scaffold group was attributable to maximal residual stenosis greater than 30% in six patients and delivery failure at the target lesion site in one patient. Procedural success was 78.1% in the bioresorbable scaffold group vs. 94.4% in the DES group (P = .035). Patients in the bioresorbable scaffold group were free of events throughout their stay in the hospital, whereas the DES group had one case of death. There was no significant difference between the groups in the occurrence of periprocedural MI, side branch occlusion or contrast-related acute kidney injury. Frequency domain OCT analysis revealed 14 (22%) cases of scaffold underexpansion. Significant edge dissections occurred in two (3%) cases and bioresorbable scaffold fractures were seen in two (3%) cases.
“In this single-center series, [bioresorbable scaffold] use for CTOs recanalization was affected by higher technical and procedural failure compared to second-generation DES, mostly related to suboptimal scaffold expansion,” the researchers wrote. “Aggressive lesion preparation together with device ameliorations will be a key to enable routine use of [bioresorbable scaffold] in the CTO setting.” – by Jennifer Byrne
Disclosure: Two researchers report receiving speaker’s honoraria from Abbott Vascular.
Perspective
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Emmanouil S. Brilakis, MD
The study results are concerning, as a 78% technical success rate after successful guidewire crossing is unacceptable. The main question is whether optimal techniques for sizing and deploying BRS were followed. The study was performed in 2013 to 2014 before widespread appreciation of the importance of excellent vessel preparation and high-pressure inflations for optimal BRS deployment. Although postdilation was performed, the actual pressure used is unclear. It is also unclear whether BRS sizing was accurate, with the added caveat that CTO vessel size increases following recanalization. Given that the radial strength of BRS is similar to that of metallic stents, the study results are somewhat surprising. Since CTO PCI often involves implantation of multiple stents (and full metal jacket), use of BRS could prove beneficial in the long-term if adequate acute results can be obtained. A contemporary study utilizing state-of-the-art BRS deployment and optimization techniques in CTO PCI is urgently needed to confirm or disprove the GHOST-CTO findings.
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