Direct bioresorbable vascular scaffold implantation: Feasibility and midterm results.
OBJECTIVE
To analyze the feasibility and safety of direct bioresorbable vascular scaffold (BVS) implantation without previous balloon dilation.


BACKGROUND
Lesion preparation through predilation is recommended before BVS implantation. There is no information on the routine use of direct BVS implantation.


RESULTS
One hundred fifty-three patients with a total of 200 coronary lesions, were treated with BVS. A baseline intravascular ultrasound study (IVUS) was performed in 171 lesions (86%), and after BVS implantation, the quality of scaffolding was assessed with an additional IVUS (83, 41%) or optical coherence tomography (77, 38%). Elective predilation was conducted in 50 lesions. In 150 lesions, direct BVS implantation was attempted. In 129 lesions (86%), the BVS was implanted successfully, and in the remaining 21 (14%), direct implantation failed. In these cases, the scaffolds were retrieved and successfully implanted after balloon angioplasty. Longer and C-type lesions, and a larger plaque burden, were associated with failure to directly cross the lesion. Balloon postdilation was needed in 34% of the lesions. Ten patients (6.6%) had a periprocedural myocardial infarction. One patient (0.6%) died 60 days after BVS implantation due to thrombosis of the scaffold. At follow-up, target lesion revascularisation was needed in eight patients (5%). After 12 ± 3 months, the remaining patients were symptom-free.


CONCLUSIONS
Direct BVS implantation is safe and feasible in most soft coronary plaques.
Department of Cardiology, Reina Sofia Hospital, University of Córdoba (IMIBIC), Spain.
Javier
J
Suárez de Lezo
Department of Cardiology, Dr. Negrin Hospital, University of Las Palmas, Las Palmas De Gran Canaria, Spain.
Pedro
P
Martín
Department of Cardiology, Reina Sofia Hospital, University of Córdoba (IMIBIC), Spain.
Francisco
F
Mazuelos
Department of Cardiology, Dr. Negrin Hospital, University of Las Palmas, Las Palmas De Gran Canaria, Spain.
José
J
Nóvoa
Department of Cardiology, Reina Sofia Hospital, University of Córdoba (IMIBIC), Spain.
Soledad
S
Ojeda
Department of Cardiology, Reina Sofia Hospital, University of Córdoba (IMIBIC), Spain.
Manuel
M
Pan
Department of Cardiology, Reina Sofia Hospital, University of Córdoba (IMIBIC), Spain.
José
J
Segura
Department of Cardiology, Reina Sofia Hospital, University of Córdoba (IMIBIC), Spain.
Enrique
E
Hernández
Department of Cardiology, Reina Sofia Hospital, University of Córdoba (IMIBIC), Spain.
Miguel
M
Romero
Department of Cardiology, Dr. Negrin Hospital, University of Las Palmas, Las Palmas De Gran Canaria, Spain.
Francisco
F
Melián
Department of Cardiology, Dr. Negrin Hospital, University of Las Palmas, Las Palmas De Gran Canaria, Spain.
Alfonso
A
Medina
Department of Cardiology, Reina Sofia Hospital, University of Córdoba (IMIBIC), Spain.
José
J
Suárez de Lezo
D020341:Absorbable Implants; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D062906:Cardiac Catheters; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D003328:Coronary Thrombosis / Q000209:etiology; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D018572:Disease-Free Survival; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D013030:Spain; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
bioresorbable vascular scaffold; direct stent; mid-term outcom