In-Vivo Vascular Healing Following Bifurcation Interventions with the Absorb Bioresorbable Vascular Scaffold.
Bioresorbable scaffolds
Coronary bifurcation
Histology
Optical coherence tomography
Vascular healing
Journal
Cardiovascular revascularization medicine : including molecular interventions
ISSN: 1878-0938
Titre abrégé: Cardiovasc Revasc Med
Pays: United States
ID NLM: 101238551
Informations de publication
Date de publication:
01 2020
01 2020
Historique:
received:
25
01
2019
revised:
19
02
2019
accepted:
11
03
2019
pubmed:
20
4
2019
medline:
26
8
2020
entrez:
20
4
2019
Statut:
ppublish
Résumé
Long-term vascular healing, evaluated by optical coherence tomography (OCT) and histology, following complex bifurcation interventions with polymeric Absorb Bioresorbable Vascular Scaffold (BVS, Abbott Vascular, Santa Clara, CA) has not been previously described. Fifteen New-Zealand-White rabbits (4.0 ± 0.3 kg) underwent stenting of non-diseased aorto-iliac bifurcations with BVS using provisional stenting (PS, n = 2), culotte stenting (n = 7) and modified-T (n = 6) stenting techniques. At 18 months angiography, optical coherence tomography (OCT) and histology were performed. The acute angiographic results were excellent. Three rabbits succumbed acutely due to anaesthetic and renal complications, whilst one was euthanized electively at 4 months for a skin infection. At 18 months, 11 rabbits (PS (2), modified-T (4) and culotte (5)) underwent angiography, revealing excellent results, followed by OCT and histological evaluation. No acute scaffold thrombosis occurred. All non-bifurcation segments revealed complete endothelialisation with excellent healing characteristics on OCT and histology. Following one PS and all 2-stent techniques, uncovered, deformed and malapposed struts were present at the neocarina with adherent fibrin and chronic thrombus in 10/11 cases, extending as long fibrin strands (mean length 11.0 ± 8.3 mm) in 3 culotte and 1 modified-T cases. Late intraluminal scaffold discontinuity was present following five 2-stent cases. Pathological vascular healing with uncovered, distorted and malapposed neocarinal struts with adherent strands of chronic thrombus, suggest that exposed polymeric breakdown products may be thrombogenic and caution against the use of polymeric BVS in interventions when there is a chance of suboptimal results with strut malapposition or compromise of scaffold integrity.
Sections du résumé
BACKGROUND
Long-term vascular healing, evaluated by optical coherence tomography (OCT) and histology, following complex bifurcation interventions with polymeric Absorb Bioresorbable Vascular Scaffold (BVS, Abbott Vascular, Santa Clara, CA) has not been previously described.
METHODS
Fifteen New-Zealand-White rabbits (4.0 ± 0.3 kg) underwent stenting of non-diseased aorto-iliac bifurcations with BVS using provisional stenting (PS, n = 2), culotte stenting (n = 7) and modified-T (n = 6) stenting techniques. At 18 months angiography, optical coherence tomography (OCT) and histology were performed.
RESULTS
The acute angiographic results were excellent. Three rabbits succumbed acutely due to anaesthetic and renal complications, whilst one was euthanized electively at 4 months for a skin infection. At 18 months, 11 rabbits (PS (2), modified-T (4) and culotte (5)) underwent angiography, revealing excellent results, followed by OCT and histological evaluation. No acute scaffold thrombosis occurred. All non-bifurcation segments revealed complete endothelialisation with excellent healing characteristics on OCT and histology. Following one PS and all 2-stent techniques, uncovered, deformed and malapposed struts were present at the neocarina with adherent fibrin and chronic thrombus in 10/11 cases, extending as long fibrin strands (mean length 11.0 ± 8.3 mm) in 3 culotte and 1 modified-T cases. Late intraluminal scaffold discontinuity was present following five 2-stent cases.
CONCLUSIONS
Pathological vascular healing with uncovered, distorted and malapposed neocarinal struts with adherent strands of chronic thrombus, suggest that exposed polymeric breakdown products may be thrombogenic and caution against the use of polymeric BVS in interventions when there is a chance of suboptimal results with strut malapposition or compromise of scaffold integrity.
Identifiants
pubmed: 31000433
pii: S1553-8389(19)30168-X
doi: 10.1016/j.carrev.2019.03.006
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
70-77Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.