title: Feasibility of second-generation bioresorbable vascular scaffold implantation in complex anatomical and clinical scenarios.
abstract: BACKGROUND
  Bioresorbable vascular scaffolds (BVS) have become an emerging tool to treat coronary artery disease. However, the current use of BVS is still widely restricted to stable patients and non-complex lesions. In real-world practice patients are far more complex than those with simple type A lesions and the extended use of BVS to complex lesions and high-risk patients needs to be evaluated. Therefore, we sought to investigate the feasibility and performance of BVS in a broad spectrum of patients.
  
  
  METHODS
  106 patients underwent in total 193 BVS implantations. We assessed the device-related (cardiac death, target vessel myocardial infarction, ischemia-driven target lesion revascularization) and patient-related (all-cause death, any reinfarction and any revascularization) composite outcomes.
  
  
  RESULTS
  90 % of patients (n = 95) had at least one of the following characteristics: >65 years (35 %), ACS (42 %), tortuous vessels (13 %), calcified (17 %) or thrombotic lesions (12 %), lesions defined as AHA type B2/C (42 %), bifurcations (16 %), chronic total occlusions (9 %) or restenosis (14 %). There was no evidence of significant edge dissection, huge thrombus load or incidence of scaffold dislodgement or scaffold disruption in optical coherence tomography pullbacks. Out of 10,157 struts evaluated within 1,117 cross-sections, 302 were classified as malapposed (2.9 %). During a mean follow-up of 147 ± 119 days the rate of device-related events was 2.0 %, whereas patient-related composite events occurred in 6.1 %.
  
  
  CONCLUSIONS
  Our results strongly suggest that BVS implantation is feasible in a wide spectrum of patients and complex anatomy of coronary lesions. Long-term outcome of BVS should be further investigated in unrestricted settings in randomized controlled trials.
authors.affiliation: University Heart Center, University Hospital Zurich, Raemistr. 100, 8091, Zurich, Switzerland, milosz.jaguszewski@usz.ch.
authors.forename: Milosz
authors.initials: M
authors.lastname: Jaguszewski
authors.forename: Jelena-Rima
authors.initials: JR
authors.lastname: Ghadri
authors.forename: Manuel
authors.initials: M
authors.lastname: Zipponi
authors.forename: Dana Roxana
authors.initials: DR
authors.lastname: Bataiosu
authors.forename: Johanna
authors.initials: J
authors.lastname: Diekmann
authors.forename: Verena
authors.initials: V
authors.lastname: Geyer
authors.forename: Catharina Anna
authors.initials: CA
authors.lastname: Neumann
authors.forename: Mia Aurelia
authors.initials: MA
authors.lastname: Huber
authors.forename: Christian
authors.initials: C
authors.lastname: Hagl
authors.forename: Paul
authors.initials: P
authors.lastname: Erne
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Lüscher
authors.forename: Christian
authors.initials: C
authors.lastname: Templin
mesh_terms: D020341:Absorbable Implants; D000328:Adult; D000368:Aged; D001807:Blood Vessel Prosthesis; D003324:Coronary Artery Disease / Q000473:pathology* / Q000628:therapy*; D054855:Drug-Eluting Stents; D019544:Equipment Failure Analysis; D000068338:Everolimus; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012189:Retrospective Studies; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives*; D013557:Switzerland; D054457:Tissue Scaffolds; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D000068338:Everolimus; D020123:Sirolimus