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Procedural microvascular activation in long lesions treated with bioresorbable vascular scaffolds or

Mariano Pellicano1, Giuseppe Di Gioia, Giovanni Ciccarelli

  • 1Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.

Eurointervention : Journal of Europcr in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
|May 16, 2019
PubMed

Insights

Everolimus-eluting bioresorbable vascular scaffolds (BVS) significantly reduce microvascular resistance after treating long coronary lesions compared to everolimus-eluting stents (EES). This improvement in microvascular function was not linked to platelet activation or myonecrosis.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Biomaterials Science

Background:

  • Long stented coronary segments can lead to significant platelet activation, microvascular impairment, and myonecrosis.
  • Bioresorbable vascular scaffolds (BVS) and drug-eluting stents (EES) are used to treat complex coronary lesions.

Purpose of the Study:

  • To compare microvascular impairment after percutaneous coronary intervention (PCI) in long lesions using BVS versus EES.
  • To investigate the relationship between platelet activation, microvascular function, and myonecrosis in these patients.

Main Methods:

  • A randomized trial involving 66 patients with long coronary lesions undergoing PCI with either BVS or EES.
  • Primary endpoint: change in pressure-derived corrected index of microvascular resistance (cIMR) post-PCI.
  • Secondary assessments included high-sensitivity cardiac troponin T (hs-cTnT) for myonecrosis and high-sensitivity adenosine diphosphate (hs-ADP) platelet reactivity.

Main Results:

  • A significant difference in the change of cIMR was observed between the BVS and EES groups (p=0.04).
  • Post-dilatation was more frequent in the BVS group, leading to longer procedure times.
  • Platelet reactivity (hs-ADP) and periprocedural myonecrosis (hs-cTnT) did not differ significantly between the groups.

Conclusions:

  • BVS implantation in long coronary lesions is associated with a significant acute reduction in index of microvascular resistance (IMR) compared to EES.
  • This effect on microvascular function was independent of platelet reactivity and periprocedural myonecrosis.
Abstract

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