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Review
. 2017 Aug;9(Suppl 9):S914-S922.
doi: 10.21037/jtd.2017.06.35.

BRS implantation in long lesions requiring device overlapping: myth or reality?

Simone Biscaglia  1 , Andrea Erriquez  1 , Davide Bernucci  1 , Giulia Bugani  1 , Enrico Favaretto  2 , Gianluca Campo  1   3   4
Affiliations
Review

BRS implantation in long lesions requiring device overlapping: myth or reality?

Simone Biscaglia et al. J Thorac Dis. 2017 Aug.

Abstract

Dealing with bioresorbable vascular scaffolds (BVS) implantation in long lesions requiring device overlapping in this particular moment might seem a little provocative for several reasons. First, most studies testing BVS have focused on their safety and efficacy profile in simple patients with simple lesions. Second, ABSORB II did not meet its primary endpoint, while ABSORB III showed a higher rate of target vessel-myocardial infarction (TV-MI) at 2 years. Third, data on porcine model showed that overlapping zone has delayed but greater neointimal proliferation with consequent higher risk for scaffold thrombosis in the short-term and of in-scaffold restenosis in the long-term. Fourth, recently published data showed higher risk of TVF in patients treated with ≥60 mm BVS. Given all these premises, it may seem right to put aside this technology, while it may seem inappropriate to hypothesize the use of BVS in long lesions. The aim of the present review is precisely to critically review the available evidences regarding BVS with particular regard to overlapping BVS in order to understand whether this technology has a future per se and especially in long coronary lesions requiring overlap.

Keywords: Bioresorbable vascular scaffold (BVS); overlap; scaffold thrombosis.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Example of ‘marker over marker’ configuration. (A) enhanced stent visualization image of ‘marker over marker’ configuration; (B) OCT 3-D reconstruction with evidence of ‘marker over marker’ configuration (white arrows); (C) OCT long run showing a 2.1 mm overlap (white bars); (D-G) OCT short axis sections of the overlap zone. OCT, optical coherence tomography.
Figure 2
Figure 2
Example of ‘marker to marker’ configuration. (A) Enhanced stent visualization image of ‘marker to marker’ configuration; (B) OCT 3-D reconstruction with evidence of ‘marker to marker’ configuration (white arrows); (C) OCT long run showing a 1.2 mm overlap (white bars); (D-G) OCT short axis sections of the overlap zone.
Figure 3
Figure 3
Schematic presentation of all possible overlap configurations.
See this image and copyright information in PMC

References

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