Bioresorbable Scaffold Stands Ground Next to Current DES

San Francisco, CA—Three presentations at TCT 2013 focused on the ever-growing field of fully bioabsorbable drug-eluting stents (DES), showing comparable clinical and angiographic outcomes with current DES and demonstrating improvements in procedural technique.

The Bioresorbable Vascular Scaffold (BVS; Absorb, Abbott Vascular) has a backbone of poly-L-lactic acid that provides support and a coating of poly-DL-lactic acid that contains and controls the release of everolimus. All components of the BVS, except for two radio-opaque markers, are expected to fully absorb into the human body within 2 years.

Bernard Chevalier, MD, of Institut Hospitalier Jaques Cartier, France, presented results of a propensity score analysis of patients with up to two de novo coronary artery lesions who underwent PCI with the BVS (n=613) or the EES (Xience V, Abbott Vascular; n=905).

Results showed no differences between the stents in terms of lesion characteristics (see Figure).

Clinical outcomes at 1 year were also similar, though hierarchical target vessel failure was higher with Xience V (8.6% vs. 5.5%; P=.04). Additionally, MI trended higher with Absorb (P=.06) and ischemia-driven target lesion revascularization trended higher with Xience V (P=.08). By 2 years, clinical outcomes were all similar regardless of stent type.

Propensity score matched angina rates were 11.9% higher with Xience V at 1 year (27.9% vs. 16%).

Technique gets an upgrade

As the technology expands, procedural techniques continue to be refined and outcomes optimized. Pieter Smits, MD, PhD, of Maasstad Hospital, The Netherlands, offered several procedural considerations for BVS implantations:

 • In preparing the lesion, direct stenting should be performed less than 40% of the time.

 • There should be good guiding support (6F or higher) and support wires.

 • Multiple crossing attempts are possible within 30 minutes.

 • Correct sizing to vessel diameters is crucial to prevent undersizing.

 • Inflation should be slow (1 atm/2 sec).

 • Post dilatation should be done with non-compliant balloons.

 • Different overlapping BVS strategies should be considered.

Continuing the theme, John Ormiston, MB, ChB, of Mercy Hospital, New Zealand, spoke about using the bifurcation technique with the Absorb BVS. He showed examples of distortion and advised against performing dilatation through the side of an Absorb stent. “Distortion is best corrected by mini-[kissing balloon post-dilatation] slowly to 5 atm as this will not cause scaffold fracture,” he said, adding that higher pressures can cause multiple fractures that would likely lead to MACE.

“The best provisional [side branch] strategy if [kissing balloon post-dilatation] is unsuccessful is ‘T’ stenting, probably with a metallic stent,” Ormiston concluded.

Disclosures:

Chevalier received research grants/speaker fees from several device and pharmaceutical manufacturers. He is a minor shareholder/general director of European Cardiovascular Research Corporation.

Smits received grant/research support from Abbott Vascular, St. Jude Medical and Terumo Medical Corporation; and consultant fees/honoraria from Abbott Vascular, St. Jude Medical and The Medicines Company. 

Ormiston received grant/research support and consultant fees/honoraria from Abbott Vascular and Boston Scientific.