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Treating CTO with BVS safe, effective if proper procedures followed
In patients with chronic total occlusion lesions, treatment with a bioresorbable vascular scaffold appears to be feasible and safe, according to recent findings.
In the study, researchers retrospectively assessed 65 consecutive patients with a CTO (mean age, 61 years; 89% men; 40% with diabetes) who were treated with a BVS (Absorb, Abbott Vascular) as part of a multicenter registry between September 2012 and November 2015. The researchers designated target lesion failure as the study’s primary endpoint. TLF was defined as a composite of cardiac death, target vessel MI and clinically driven target lesion revascularization. The patient population had a mean ejection fraction of 57.7 ± 10.8%, a mean reference vessel diameter of 3 ± 0.4 mm and a mean CTO lesion length of 20.2 ± 3 mm.
The researchers found that, for each patient, a mean of 1.8 ± 0.7 BVS were utilized. The mean diameter of the BVS was 3 ± 0.4 mm and the total length was 47.6 ± 19.9 mm. In all cases, postdilation with noncompliant balloons (mean diameter, 3.3 ± 0.3 mm) was performed at high pressures (18.6 ± 5.3 atmospheres). All patients were assessed with either IVUS (n = 34) or OCT (n = 31). The median follow-up was 453 days, and in 22 patients (33.8%), follow-up angiography was performed.
No in-hospital adverse events were recorded. During follow-up, no cases of TLF occurred. There were four cases of target vessel revascularization during follow-up. No cases of significant intra-scaffold restenosis requiring revascularization were reported, either clinically or on angiography. No cases of definite/probable stent thrombosis occurred. Premature discontinuation of dual antiplatelet therapy occurred in one patient within 12 months, and this discontinuation was due to a gastric ulcer.
“There were no occurrences of [TLF], defined as a composite of cardiac death, target vessel [MI], clinically driven [TLR], and scaffold thrombosis after BVS implantation for [CTOs],” the researchers wrote. “Intravascular imaging-guided lesion preparation and postdilatation are recommended to obtain the best possible final result in BVS implantation for [CTOs].” – by Jennifer Byrne
Disclosure: The researchers report no relevant financial disclosures.