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Neoatherosclerosis observed 5 years after BVS implantation
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Neoatherosclerosis with luminal narrowing was observed 5 years after implantation of an everolimus-eluting bioresorbable vascular scaffold, according to results published in the Journal of American College of Cardiology.
“In the first year after implantation, BVS produces neointima that contributes to the recapping of high-risk plaques without significant lumen loss. In a 5-year analysis, BVS is completely absorbed and creates a low-attenuating, signal-rich layer that covers the underlying, potentially thrombogenic plaque components after scaffold resorption,” Noriaki Moriyama, MD, from the department of cardiology and catheterization laboratories, Shona Kamakura Genera Hospital in Kamakura, Japan, and colleagues wrote in the study background. “Moreover, the vasomotor response to intracoronary nitroglycerin gradually tends to recover over time 5 years. However, different results pertaining to long-term BVS resorption have been reported, including persistence of BVS scaffolds at 5 years.”
The researchers used multi-imaging modalities including OCT to investigate the findings of neoatherosclerosis at 5 years after BVS implantation in patients included in the ABSORB EXTEND trial.
Twenty patients (mean age, 69 years; 25% with diabetes) with 22 lesions from the Shonan Kamakura General Hospital who underwent OCT at baseline, after implantation with the BVS (Absorb, Abbott Vascular) and at 1 and 5 years, were enrolled in the study. Intimal plaque distributions in the in-scaffold and out-scaffold segments were analyzed by Moriyama and colleagues.
Median follow-up was 67 months (interquartile range, 65-69).
A baseline angiogram showed that 46% of lesions were type B2/C lesions.
Between 1 and 5 years, there were increases in the prevalence of the following in-scaffold characteristics: lipid-laden neointima (17% vs. 61%; P = .04), calcification (28% vs. 94%; P < .01), neovascularization (6% vs. 78%; P < .01) and thin-cap fibroatheroma (0% vs. 22%; P = .02), the researchers wrote.
There were no significant differences found in the out-scaffold segments in the plaque prevalence between 1 and 5 years.
“The development of neoatherosclerosis after BVS implantation is a conceptually unanticipated finding with clinical significance,” Stephan Windecker, MD, from the department of cardiology, at Bern University Hospital, University of Bern, in Bern, Switzerland, and colleagues wrote in a related editorial. “Future efforts need to identify biomaterials for PCI that minimize the stimulus for neoatherosclerosis within stented/scaffolded segments in concert with advances in systemic pharmacotherapy to prevent atherosclerosis progression.” − by Dave Quaile
Disclosures: Windecker reports he has received research grants to his institution from Abbott, Amgen, Boston Scientific, Biotronik and St. Jude Medical. The authors and the other editorial writers report no relevant financial disclosures.
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