Bioresorbable Polymeric Vascular Scaffolds
A Cautionary Tale
- coronary artery disease
- intravascular ultrasound
- optical coherence tomography
- Bioresorbable scaffold
The everolimus-eluting bioresorbable vascular scaffold (BVS, Abbott Vascular, Santa Clara, CA) is an exciting advance in percutaneous coronary intervention (PCI), providing a temporary coronary scaffold for at least 3 months and being resorbed by about 2 years.1–3 Along with patient preference, potential advantages over metallic stents include restored vasomotion, reduced late thrombosis, and unimpaired imaging with computed tomography and magnetic resonance. However, advances in interventional devices may bring new challenges in the early days of the technology.
A 78-year-old man with recent-onset angina was enrolled in the ABSORB Trial Cohort B Group 1.3 An obtuse marginal coronary artery branch measuring by quantitative angiography 3.5 mm upstream and 3.0 mm downstream from a stenosis was predilated with a 2.5-mm balloon. A 3.0×18 mm Revision 1.1 ABSORB BVS (Figure 1) was deployed at 16 atm, and the scaffold was postdilated with a 3.25-mm noncompliant balloon at 24 atm (expected diameter, 3.5 mm). Although the angiographic appearances were good, there was malapposition of the proximal half of the scaffold shown by intravascular ultrasound (IVUS), and more clearly seen with optical coherence tomography (OCT) (Figure 1). After further inflations with a compliant 3.5-mm balloon to 16 atm (expected diameter, 4.0 mm), the angiographic appearances remained satisfactory. However, repeat IVUS and OCT showed persisting strut malapposition, including sections where the struts lay …