Bioresorbable vascular scaffolds for complex chronic total occlusions.

Area of Science:

• Cardiovascular Interventions
• Biomaterials Science
• Interventional Cardiology

Background:

• Drug-eluting stents (DES) are standard for treating coronary artery disease.
• Permanent metallic stents can lead to long-term complications, termed 'full metal jackets'.
• Bioresorbable vascular scaffolds (BVS) offer a potential alternative to permanent implants.

Purpose of the Study:

• To evaluate the feasibility and outcomes of using BVS for complex chronic total occlusions (CTOs).
• To assess the potential of BVS to avoid the need for permanent metallic stents in CTO treatment.

Main Methods:

• Analysis of a consecutive series of 52 patients treated with BVS for complex CTOs.
• A subgroup of 17 patients received a hybrid approach combining BVS and DES for severe calcification.
• Follow-up included clinical assessment, angiography, and MSCT at 12 months.

Main Results:

• Successful BVS implantation in 69 of 70 patients, with an average of 3.17 scaffolds per lesion.
• High complexity lesions (J-CTO ≥ 2) and retrograde approach were common.
• At 12 months, no deaths or acute myocardial infarctions occurred; target revascularization was 7%.

Conclusions:

• BVS implantation for complex CTOs is feasible, even with multiple scaffolds, and shows no early stent thrombosis.
• While mechanical limitations may necessitate reintervention, BVS can avoid the long-term burden of permanent metallic stents.