Jiang Ming Fam

Initial experience with everolimus-eluting bioresorbable vascular scaffolds for treatment of patients presenting with acute myocardial infarction: a propensity-matched comparison to metallic drug eluting stents 18-month follow-up of the BVS STEMI first study.

AIMS Limited data are currently available on midterm outcomes after implantation of everolimus-eluting bioresorbable vascular scaffolds (BVS) for treatment of acute ST-elevation myocardial infarction (STEMI). METHODS AND RESULTS Patients presenting with STEMI and undergoing primary percutaneous coronary intervention in the initial experience with BVS were evaluated and compared with patients treated with everolimus-eluting metal stents (EES) by applying propensity matching. Quantitative coronary angiography analysis, and 18-month clinical follow-up were reported. A total of 302 patients were analysed, 151 with BVS and 151 with EES. Baseline clinical characteristics were similar between groups. Final TIMI 3 flow was 87.4% vs. 86.1%, p=0.296. At 18-month follow-up, all-cause mortality was 2.8% vs. 3.0% in the BVS and EES groups respectively, p=0.99; the MACE rate was higher in the BVS group (9.8% vs. 3.6%, p=0.02); target lesion revascularisation was 5.7% vs. 1.3%, p=0.05. The 30-day MACE rate in BVS patients without post-dilatation was 6.8%, while in patients with post-dilatation it was 3.6%. Scaffold thrombosis (ST) occurred primarily in the acute phase (acute ST 2.1% vs. 0.7%, p=0.29; subacute 0.7% vs. 0.7%, p=0.99; late 0.0% vs. 0.0%; very late 1.5% vs. 0.0%, p=0.18). All three BVS cases with acute ST had no post-dilatation at the index procedure. CONCLUSIONS STEMI patients treated during the early experience with BVS had similar acute angiographic results as compared with the EES group. Clinical midterm follow-up data showed a higher clinical events rate compared with metal stents. The majority of clinical events occurred in the early phase after implantation and mainly in cases without post-dilatation. Optimisation of the implantation technique in the acute clinical setting is of paramount importance for optimal short and mid-term outcomes.

Safety of optical coherence tomography in daily practice: A comparison with intravascular ultrasound

Aims Previous studies have reported the safety and feasibility of both time-domain optical coherence tomography (TD-OCT) and Fourier-domain OCT (FD-OCT) in highly selected patients and clinical settings. However, the generalizability of these data is limited, and data in unselected patient populations reflecting a routine cathlab practice are lacking. We compared safety of intracoronary FD-OCT imaging to intravascular ultrasound (IVUS) imaging in a large real-world series of consecutive patients who underwent invasive imaging during coronary catheterization in our centre. Methods and results This is a prospective, single-centre registry of patients scheduled for coronary angiography or intervention undergoing intracoronary imaging with FD-OCT or IVUS between April 2008 and December 2013. Intra-procedural and major in-hospital adverse events that could be possibly related to invasive imaging were registered routinely by the operator as part of our clinical report and prospectively recorded in our database. These events were retrospectively individually adjudicated by an independent safety committee. Between April 2008 and December 2013, 13 418 diagnostic or interventional coronary catheterization procedures were performed. Of these, 1142 procedures used OCT and 2476 procedures used IVUS. Invasive imaging-related complications were rare, did not differ between the two imaging methods (OCT: n = 7, 0.6%; IVUS: n = 12, 0.5%; P = 0.6), and were self-limiting after retrieval of the imaging catheter or easily treatable in the catheterization laboratory. No major adverse events, prolongation of hospital stay, or permanent patient harm was observed. Conclusion FD-OCT is safe in an unselected and heterogeneous group of patients with varying clinical settings.

Comparison of acute expansion of bioresorbable vascular scaffolds versus metallic drug-eluting stents in different degrees of calcification: An optical coherence tomography study: BRS and DES, Expansion in Calcified Lesions on OCT

The acute expansion of bioresorbable vascular scaffolds (BRS) and drug‐eluting stents (DES) in lesions with different extent of calcification was compared by Optical Coherence Tomography (OCT).

Expanded clinical use of everolimus eluting bioresorbable vascular scaffolds for treatment of coronary artery disease

Limited data are currently available on the performance of everolimus eluting bioresorbable vascular scaffold (BVS) for treatment of complex coronary lesions representative of daily practice.

Optical coherence tomography in grafts

Coronary artery bypass graft (CABG) is a commonly used surgery to treat patients with complex artery disease. Long-term outcome of specifically saphenous vein grafts (SVG) is considered unfavorable, while it is the most commonly used conduit. The SVG is prone to occlude and half of the patients will develop vein graft failure (VGF) within 10 years. VGF is the result of the accelerated atherosclerosis that differs from what is seen in native coronaries. Revascularization of SVGs is considered challenging, due to their challenging anatomy and embolic nature. Optical coherence tomography (OCT) imaging is an invasive imaging technique that can be used to get a visual assessment of the development of this process. It is able to generate high-resolution cross-sectional images of the vessel. Ultimately, this could lead to a better understanding of VGF and possibly a better way of anticipating and treating complications. This chapter will discuss the challenges of OCT in SVG and the feasibility, findings, and potential clinical applications of OCT in saphenous vein grafts.

TCT-440 Impact of optimal implantation technique on bioresorbable scaffold expansion and one-year clinical outcomes in patients presenting with acute coronary syndromes and calcified lesions. A pooled analysis of BVS STEMI First and BVS Expand Studies

TCT-439 Increased incidence of revascularization in diabetic patients treated with the ABSORB everolimus-eluting bioresorbable scaffold: 24-months clinical results Robin Kraak, Joelle Elias, Deborah Kalkman, Karel Koch, Jose Henriques, Jan Piek, Jan Baan, Marije Vis, Jan Tijssen, Robert de Winter, Joanna Wykrzykowska AMC Heartcentre, Academic Medical Centre Un, Amsterdam, Netherlands; Academic Medical Centre (AMC) University of Amsterdam, Amsterdam, Netherlands; Academic Medical Center, Amsterdam, Netherlands; Academic Medical Center University of Amsterdam, Amsterdam, Netherlands; Academic Medical Center University of Amsterdam, Amsterdam, Netherlands; University of Amsterdam, Amsterdam, Netherlands; AMC, Amsterdam, Netherlands; AMC Amsterdam, Amsterdam, Netherlands; AMC-UVA, Naarden, Netherlands; Academisch Medisch Centrum, Amsterdam, Netherlands; Academic Medical Center Amsterdam, Amsterdam, Netherlands

TCT-398 Impact of scaffold oversizing, underexpansion and postdilatation on acute angiographic and one year clinical outcomes in patients with ACS treated with bioresorbable vascular scaffolds. A pooled analysis from BVS STEMI First and BVS EXPAND studies

Implantation of bioresorbable vascular scaffold (BVS) in acute coronary syndromes (ACS), with the presence of vasoconstriction and thrombotic material, might be associated with device undersizing and malapposition after thrombus dissolution. On the other hand, the implantation of oversized BVS has

Everolimus-eluting bioresorbable vascular scaffolds implanted in coronary bifurcation lesions: Impact of polymeric wide struts on side-branch impairment.

BACKGROUND Limited data are available on bioresorbable vascular scaffolds (BVS) performance in bifurcations lesions and on the impact of BVS wider struts on side-branch impairment. METHODS Patients with at least one coronary bifurcation lesion involving a side-branch ≥2mm in diameter and treated with at least one BVS were examined. Procedural and angiographic data were collected and a dedicated methodology for off-line quantitative coronary angiography (QCA) in bifurcation was applied (eleven-segment model), to assess side-branch impairment occurring any time during the procedure. Two- and three-dimensional QCA were used. Optical coherence tomography (OCT) analysis was performed in a subgroup of patients and long-term clinical outcomes reported. RESULTS A total of 102 patients with 107 lesions, were evaluated. Device- and procedural-successes were 99.1% and 94.3%, respectively. Side-branch impairment occurring any time during the procedure was reported in 13 bifurcations (12.1%) and at the end of the procedure in 6.5%. Side-branch minimal lumen diameter (Pre: 1.45±0.41mm vs Final: 1.48±0.42mm, p=0.587) %diameter-stenosis (Pre: 26.93±16.89% vs Final: 27.80±15.57%, p=0.904) and minimal lumen area (Pre: 1.97±0.89mm(2) vs Final: 2.17±1.09mm(2), p=0.334), were not significantly affected by BVS implantation. Mean malapposed struts at the bifurcation polygon-of-confluence were 0.63±1.11. CONCLUSIONS The results of the present investigation suggest feasibility and relative safety of BVS implantation in coronary bifurcations. BVS wide struts have a low impact on side-branch impairment when considering bifurcations with side-branch diameter≥2mm.

Comparison of acute expansion of bioresorbable vascular scaffolds versus metallic drug‐eluting stents in different degrees of calcification

The acute expansion of bioresorbable vascular scaffolds (BRS) and drug‐eluting stents (DES) in lesions with different extent of calcification was compared by Optical Coherence Tomography (OCT).

Bioresorbable vascular scaffold for ST elevation myocardial infarction: optical coherence tomography observations at the 2-year follow-up.

Received 13 March 2015 Revised 27 March 2015 Accepted 31 March 2015 Case description A 51-year-old man was treated at our institution in March 2013 for inferior ST elevation myocardial infarction (STEMI). His cardiovascular risk factors included smoking, hyperlipidaemia and hypertension. A primary percutaneous coronary intervention was performed with two nonoverlapping bioresorbable vascular scaffolds (BRS; Absorb BVS 3.5×18 mm and 3.0×18 mm; Abbott Vascular, Santa Clara, California, USA) deployed in the proximal and the mid right coronary artery, respectively (Fig. 1) (Video 1, Supplemental digital content 1, http://links.lww.com/MCA/A44).