Current Techniques of Intravascular Imaging and Implantation of Bioresorbable Coronary Vascular Scaffolds (Stents)

Introduction. The use of intravascular imaging techniques, in particular intravascular ultrasound, makes it possible to reduce the number of subsequent revascularisations. The method of optical coherence tomography (ОСТ), due to its high resolution accuracy, makes it possible to establish and assess the edge dissection, stent thrombosis, tissue prolapse, and strut fracture and malposition. This paper aims to assess the impact of routine use of OCT on long term outcomes in patients with scaffolds implanted.

Materials and methods. 32 stenting procedures with the use of bioresorbable coronary intravascular scaffolds (Absorb, Abbot Vascular) were performed in 2014-2015 with subsequent visualisation and assessment with optical coherence tomography. In the control group (n=16) scaffolds were implanted without the use of OCT under traditional contrast enhanced X-ray imaging. The analysis of the combination of outcomes that included subsequent emergency revascularisation in the target artery, cardiac death, myocardial infarction and 12 months post-op OCT imaging data, served as the end.

Results. The total of 55 BVS were implanted, 22 in the OCT group and 23 in control. Suboptimal results were registered in eight cases out of 16 in the OCT group (50%). These included: one dissection and atherosclerotic plaque prolapse — implantation of a second BVS and postdilatation, one eccentric stent expansion — a model for acute thrombosis, resolved with postdilatation, and stent underexpansion in the remaining six. Once the OCT revealed the intima dissection following predilatation; this was stabilised with the implantation of a second scaffold. The examination results at 12 months follow up established that there were 3.215 more scaffold restenoses in the control group.

Conclusion. The cutting edge technique of intravascular revascularisation with bioresorbable coronary scaffolds requires careful preparation and intraoperative control. The results of our study support the use of intravascular imaging techniques as methods of choice for the assessment of the expansion, areas of dissection, thrombosis and scaffold eccentricity.

1. Serruys P.W., Garcia-Garcia H.M., Onuma Y. From metallic cages to transient bioresorbable scaffolds: change in paradigm of coronary revascularization in the upcoming decade? Eur Heart J. 2012 Jan;33(1):16–25b. DOI: 10.1093/eurheartj/ehr384

2. Plechev V.V., Ishmetov V.S., Abdrakhmanov R.E., Blagodarov S.I., Ziyazetdinov R.N., Utenskaya I.D. Experience of absorb scaffolds application in the department of roentgen-endovascular diagnostics and treatment of Bashkortostan state medical university clinic. Creative surgery and oncology. 2014;(1–2):25–7 (In Russ.). DOI: 10.24060/2076-3093-2014-0-1-2-25-27

3. Ruiz-Salmeron R.J., Pereira S., de Araujo D. Bioresorbable vascular scaffold collapse causes subacute thrombosis. J Invasive Cardiol. 2014;26(7):E98–9. PMID: 24993999

4. Grundeken M.J., Garcia-Garcia H.M., Kumsars I., Lesiak M., Kayaert P., Dens J., et al. Segmental comparison between a dedicated bifurcation stent and balloon angioplasty using intravascular ultrasound and three-dimensional quantitative coronary angiography: A subgroup analysis of the Tryton IDE randomized trial. Catheter Cardiovasc Interv. 2017;89(2):E53–63. DOI: 10.1002/ccd.26527

5. Shin D.H., Hong S.J., Mintz G.S., Kim J.S., Kim B.K., Ko Y.G., et al. Effects of intravascular ultrasound-guided versus angiography-guided new-generation drug-eluting stent implantation: meta-analysis with individual patient-level data from 2,345 randomized patients. JACC Cardiovasc Interv. 2016;9(21):2232–9. DOI: 10.1016/j.jcin.2016.07.021

6. Maehara A., Ben-Yehuda O., Ali Z., Wijns W., Bezerra H.G., Shite J., et al. Comparison of stent expansion guided by optical coherence tomography versus intravascular ultrasound: The ILUMIEN II study (Observational Study of Optical Coherence Tomography [OCT] in patients undergoing fractional flow reserve [FFR] and percutaneous coronary intervention). JACC Cardiovasc Interv. 2015;8(13):1704–14. DOI: 10.1016/j.jcin.2015.07.024

7. Kim J.S., Kang T.S., Mintz G.S., Park B.E., Shin D.H., Kim B.K., et al. Randomized comparison of clinical outcomes between intravascular ultrasound and angiography-guided drug-eluting stent implantation for long coronary artery stenoses. JACC Cardiovasc Interv. 2013;6(4):369–76. DOI: 10.1016/j.jcin.2012.11.009

8. Prati F., Romagnoli E., Burzotta F., Limbruno U., Gatto L., La Manna A., et al. Clinical Impact of OCT Findings During PCI: The CLI-OPCI II Study. JACC Cardiovasc Imaging. 2015 Nov;8(11):1297– 305. DOI: 10.1016/j.jcmg.2015.08.013

9. Fujino Y., Bezerra H.G., Attizzani G.F., Wang W., Yamamoto H., Chamié D., et al. Frequency-domain optical coherence tomography assessment of unprotected left main coronary artery disease-a comparison with intravascular ultrasound. Catheter Cardiovasc Interv. 2013;82(3):E173–83. DOI: 10.1002/ccd.24843

10. Fujino Y., Attizzani G.F., Bezerra H.G., Wang W., Tahara S., Yamamoto H., et al. Serial assessment of vessel interactions after drug-eluting stent implantation in unprotected distal left main coronary artery disease using frequency-domain optical coherence tomography. JACC Cardiovasc Interv. 2013;6(10):1035–45. DOI: 10.1016/j.jcin.2013.05.015

11. Chin Yong A., Wei Chieh J.T. Coronary perforation complicating percutaneous coronary intervention — a case illustration and review. ASEAN Heart J. 2013;21(2):3. DOI: 10.7603/s40602-013-0002-9

12. Takarada S., Imanishi T., Liu Y., Ikejima H., Tsujioka H., Kuroi A., et al. Advantage of next-generation frequency-domain optical coherence tomography compared with conventional time-domain system in the assessment of coronary lesion. Catheter Cardiovasc Interv. 2010;75(2):202–6. DOI: 10.1002/ccd.22273

13. Allahwala U.K., Cockburn J.A., Shaw E., Figtree G.A., Hansen P.S., Bhindi R. Clinical utility of optical coherence tomography (OCT) in the optimisation of Absorb bioresorbable vascular scaffold deployment during percutaneous coronary intervention. EuroIntervention. 2015;10(10):1154–9. DOI: 10.4244/EIJV10I10A190

14. Brown A.J., McCormick L.M., Hoole S.P., West N.E. Coregistered intravascular ultrasound and optical coherence tomography imaging during implantation of a bioresorbable vascular scaffold. JACC Cardiovasc Interv. 2013;6(7):e41–2. DOI: 10.1016/j.jcin.2013.03.018