OCT Assessment of the Long-Term Vascular Healing Response 5 Years After Everolimus-Eluting Bioresorbable Vascular Scaffold

Abstract Background Although recent observations suggest a favorable initial healing process of the everolimus-eluting bioresorbable vascular scaffold (BVS), little is known regarding long-term healing response. Objectives This study assessed the in vivo vascular healing response using optical coher...

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Published in:	Journal of the American College of Cardiology 2014-12, Vol.64 (22), p.2343-2356
Main Authors:	Karanasos, Antonios, MD, Simsek, Cihan, MD, Gnanadesigan, Muthukarrupan, MSc, van Ditzhuijzen, Nienke S., MSc, Freire, Raphael, MD, Dijkstra, Jouke, PhD, Tu, Shengxian, PhD, Van Mieghem, Nicolas, MD, van Soest, Gijs, PhD, de Jaegere, Peter, MD, PhD, Serruys, Patrick W., MD, PhD, Zijlstra, Felix, MD, PhD, van Geuns, Robert-Jan, MD, PhD, Regar, Evelyn, MD, PhD
Format:	Article
Language:	eng
Subjects:	Absorbable Implants - trends Antibacterial agents Antibiotics. Antiinfectious agents. Antiparasitic agents Biodegradation Biological and medical sciences Cardiology. Vascular system Cardiovascular Cohort Studies Drug-Eluting Stents - trends Everolimus Female Follow-Up Studies Heart Humans Internal Medicine Male Medical imaging Medical sciences Morphology Netherlands Patients percutaneous coronary intervention Pharmacology. Drug treatments plaque Sirolimus - administration & dosage Sirolimus - analogs & derivatives Stents Studies Time Factors Tissue Scaffolds - trends Tomography, Optical Coherence - methods Tomography, Optical Coherence - trends Treatment Outcome Wound Healing - drug effects Wound Healing - physiology
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Summary:	Abstract Background Although recent observations suggest a favorable initial healing process of the everolimus-eluting bioresorbable vascular scaffold (BVS), little is known regarding long-term healing response. Objectives This study assessed the in vivo vascular healing response using optical coherence tomography (OCT) 5 years after elective first-in-man BVS implantation. Methods Of the 14 living patients enrolled in the Thoraxcenter Rotterdam cohort of the ABSORB A study, 8 patients underwent invasive follow-up, including OCT, 5 years after implantation. Advanced OCT image analysis included luminal morphometry, assessment of the adluminal signal-rich layer separating the lumen from other plaque components, visual and quantitative tissue characterization, and assessment of side-branch ostia “jailed” at baseline. Results In all patients, BVS struts were integrated in the vessel and were not discernible. Both minimum and mean luminal area increased from 2 to 5 years, whereas lumen eccentricity decreased over time. In most patients, plaques were covered by a signal-rich, low-attenuating layer. Minimum cap thickness over necrotic core was 155 ± 90 μm. One patient showed plaque progression and discontinuity of this layer. Side-branch ostia were preserved with tissue bridge thinning that had developed in the place of side-branch struts, creating a neo-carina. Conclusions At long-term BVS follow-up, we observed a favorable tissue response, with late luminal enlargement, side-branch patency, and development of a signal-rich, low-attenuating tissue layer that covered thrombogenic plaque components. The small size of the study and the observation of a different tissue response in 1 patient warrant judicious interpretation of our results and confirmation in larger studies.
ISSN:	0735-1097 1558-3597