Safety and Efficacy Outcomes of Bioresorbable Scaffolds in Long Segment Coronary Lesions

Yıl 2018, Cilt: 21 Sayı: 1, 53 - 60, 01.04.2018

Hacı Murat Güneş , Tayyar Gökdeniz İbrahim Oğuz Karaca Gültekin Günhan Demir Filiz Kızılırmak Ekrem Güler Gamze Babür Güler Mehmet Onur Omaygenç Umeyir Savur Ersin İbişoğlu Bilal Boztosun

Öz

Introduction:
There
is limited knowledge about the use of bioresorbable scaffolds (BRSs) in long
segment coronary artery lesions. We aimed to evaluate the clinical outcomes of
BRS-BRS and drug eluting stents (DESs)-BRS overlapping applications.

Patients
and Methods: Cross-sectional, single-center study between 2013 and
2016 enrolled 97 patients and 100 lesions scheduled for BRS placement in long
segment lesions (> 28 mm). BRS-BRS overlap was performed in 30 patients and
30 lesions, DES-BRS overlap was performed in 67 patients and 70 lesions. Acute
procedural success and major adverse cardiac events (MACE) (death, stent thrombosis,
and target lesion reintervention) were assessed.

Results: Acute
procedural success was 97.1% in the overall group. MACE was observed in 6
patients (6.2%) in the entire group, 4 (5.9%) in the DES-BRS group, and 2
(6.6%) in the BRS-BRS group.

Conclusion: BRS use might be a safe
and effective option for the treatment of long segment lesions. Both BRS-BRS
overlap and BRS-DES overlap may be performed with short overlap segment.

Anahtar Kelimeler

Bioresorbable scaffolds, overlapping, hybrid strategy

Uzun Segment Koroner Lezyonlarda Biyoeriyebilen Stentlerin Güvenlik ve Etkinlik Sonlanımları

Öz

Giriş: Uzun segment lezyonlarda biyoeriyebilen stentlerin (BRS) kullanımı ile
ilgili sınırlı bilgimiz olduğundan hem BRS-BRS hem de İlaç salınımlı metal
stent (DES)-BRS overlap uygulanan hastaların klinik sonuçlarını değerlendirmeyi
planladık.

Hastalar ve
Yöntem: Tek merkezli, kesitsel planlanan; Ocak 2013-Haziran 2016
tarihleri arasında uzun segment lezyonlara (> 28 mm) BRS yerleştirilmesi
planlanan 97 hasta ve 100 lezyon çalışmaya alındı. Otuz hasta ve 30 lezyonda
BRS-BRS overlap uygulanırken , 67 hasta 70 lezyona DES-BRS overlap uygulandı.
Akut işlem başarısı ve MACE (ölüm, stent trombozu, hedef damara yeniden girişim)
değerlendirildi.

Bulgular: Akut işlem başarısı %97.1 idi. Tüm hasta grubunda toplam MACE 6 (%6.2)
hastada gelişirken, DES-BRS grubunda 4 (%5.9), BRS-BRS grubunda 2 (%6.6)
hastada MACE gerçekleşti.

Sonuç: Uzun segment lezyonlarda
BRS kullanımı seçenek olarak değerlendirilebilinir. BRS-BRS veya BRS-DES
overlap yapacak şekilde yerleştiriken kısa segment overlap olacak şekilde
gerçekleştirilmelidir.

Anahtar Kelimeler

Biyoeriyebilen stentler, overlap, hibrit tekniği

Kaynakça

• 1. Ormiston JA, Serruys PWS. Bioabsorbable coronary stents. Circ Cardiovasc Interv 2009;2:255-60.
• 2. Serruys PW, Garcia-Garcia HM, Onuma Y. From metallic cages to transient bioresorbable caffolds: change in paradigm of coronary revascularization in the upcoming decade? Eur Heart J 2012;33:16-25.
• 3. Onuma Y, Dudek D, Thuesen L, Webster M, Nieman K, Garcia-Garcia HM, et al. Five-year clinical and functional multislice computed tomography angiographic results after coronary implantation of the fully resorbable polymeric everolimus-eluting scaffold in patients with de novo coronary artery disease: the ABSORB cohort A trial. JACC Cardiovasc Interv 2013;6:999-1009.
• 4. Räber L, Jüni P, Löffel L, Wandel S, Cook S, Wenaweser P, et al. Impact of stent overlap on angiographic and long-term clinical outcome in patients undergoing drug-eluting stent implantation. J Am Coll Cardiol 2010;55:1178-88.
• 5. Finn AV, Kolodgie FD, Harnek J, Guerrero LJ, Acampado E, Tefera K, et al. Differential response of delayed healing and persistent inflammation at sites of overlapping sirolimus- or paclitaxel-eluting stents. Circulation 2005;112:270-8.
• 6. Kitabata H, Loh JP, Pendyala LK, Badr S, Dvir D, Barbash IM, et al. Safety and efficacy outcomes of overlapping second-generation everolimus-eluting stents versus first-generation drug-eluting stents. Am J Cardiol 2013;112:1093-8.
• 7. Biscaglia S, Ugo F, Ielasi A, Secco GG, Durante A, D’Ascenzo F, et al. Bioresorbable scaffold vs. second generation drug eluting stent in long coronary lesions requiring overlap: a propensity-matched comparison (the UNDERDOGS study). Int J Cardiol 2016;208:40-5.
• 8. Ho HH, Jafary FH, Loh KK, Tan JK, Ooi YW, Ong PJ. Deliverability of integrity coronary stents in severely tortuous coronary arteries: a preliminary experience. J Invasive Cardiol 2012;24:650-4.
• 9. Mintz GS, Popma JJ, Pichard AD, Kent KM, Satler LF, Chuang YC, et al. Patterns of intravascular ultrasound and coronary angiography in 1155 lesions. Circulation 1995;91:1959-65.
• 10. Wiebe J, Liebetrau C, Dörr O, Most A, Weipert K, Rixe J, et al. Feasibility of everolimus- eluting bioresorbable vasculars caffolds in patients with chronic total occlusion. Int J Cardiol 2015;179:90-4.
• 11. Džavík V, Colombo A. The absorb bioresorbable vascular scaffold in coronary bifurcations: insights from bench testing. JACC Cardiovasc Interv 2014;7:81-8.
• 12. Gori T, Schulz E, Hink U, Wenzel P, Post F, Jabs A, et al. Early outcome after implantation of absorb bioresorbable drug-eluting scaffolds in patients with acute coronary syndromes. Euro Intervention 2014;9:1036-41.
• 13. Kolandaivelu K, Swaminathan R, Gibson WJ, Kolachalama VB, Nguyen-Ehrenreich KL, Giddings VL, et al. Stent thrombogenicity early in high-risk interventional settings is driven by stent design and deployment and protected by polymer-drug coatings. Circulation 2011;123:1400-9.
• 14. Murasato Y, Hikichi Y, Nakamura S, Kajiya F, Iwasaki K, Kinoshita Y, et al. Recent perspective on coronary bifurcation intervention: statement of the “Bifurcation Club in KOKURA”. J Interv Cardiol 2010;23:295-304.
• 15. Rikhtegar F, Wyss C, Stok KS, Poulikakos D, Müller R, Kurtcuoglu V, et al. Hemodynamics incoronary arteries with overlapping stents. Journal of Biomechanics 2014;47:505-11.
• 16. Farooq V, Serruys PW, Heo JHW, et al. Intracoronary optical coherence tomography and histology of overlapping everolimus-eluting bioresorbable vascular scaffolds in a porcine coronary artery model: the potential implications for clinical practice. JACC Cardiovasc Interv 2013;6:523-2.
• 17. Farooq V, Onuma Y, Radu M, Okamura T, Gomez-Lara J, Brugaletta S, et al. Optical coherence tomography (OCT) of overlapping bioresorbable scaffolds: from bench work to clinical application. Euro Intervention 2011;7:386-99.
• 18. Gil RJ, Bil J, Pawłowski T, Yuldashev N, Kołakowski L, Jańczak J, et al. The use of bioresorbable vascular scaffold Absorb BVS® in patients with stable coronary artery disease: one-year results with special focus on the hybrid bioresorbable vascular scaffolds and drug eluting stents treatment. Kardiol Pol 2016;74:627-33.
• 19. Yew KL. Overlapping technique for hybrid percutaneous coronary intervention strategy utilising drug eluting stent and ABSORB bioresorbable vascular scaffold. Int J Cardiol 2015;178:e8-e10.
• 20. Serruys PW, Chevalier B, Sotomi Y, Cequier A, Carrié D, Piek JJ, et al. Comparison of an everolimus-eluting bioresorbable scaf oldwith an everolimus-eluting metallic stent for the treatmentof coronary artery stenosis (ABSORB II): a 3 year, randomised,controlled, single-blind, multicentre clinical trial. Lancet 2016;388:2479-91.
• 21. Polimeni A, Anadol R, Münzel T, Indolfi C, De Rosa S, Gori T. Long-term outcome of bioresorbable vascular scaffolds for the treatment of coronary artery disease: a meta-analysis of RCTs. BMC Cardiovasc Disord 2017;17:147.