Clinical and Intravascular Imaging Outcomes at 1 and 2 Years After Implantation of Absorb Everolimus Eluting Bioresorbable Vascular Scaffolds in Small Vessels. Late Lumen Enlargement: Does Bioresorption Matter With Small Vessel Size? Insight From the ABSORB Cohort B Trial

Study Questions:

What is the long-term outcome of second-generation everolimus-eluting bioresorbable vascular scaffold (Absorb BVS) placement in small vessels?

Methods:

The authors reported a post-hoc analysis of the ABSORB Cohort B trial. In this study, out of the total study population of 101 patients, 45 patients were assigned to undergo 6-month and 2-year angiographic follow-up, and 56 patients were assigned to have angiographic follow-up at 1 year. The reference vessel diameter (RVD) was <2.5 mm (small-vessel group) in 41 patients (41 lesions) and ≥2.5 mm (large-vessel group) in 60 patients (61 lesions).

Results:

At 2-year angiographic follow-up, there was no difference in late lumen loss (0.29 ± 0.16 mm vs. 0.25 ± 0.22 mm, p = 0.44), or in-segment binary restenosis (5.3% vs. 5.3%, p = 1.0000). In the small-vessel group, there was a significant increase in vessel area (12.25 ± 3.47 mm2 vs. 13.09 ± 3.38 mm2, p = 0.0015), scaffold area (5.76 mm2 vs. 6.41 mm2, p = 0.0008), and lumen area (5.71 mm2 vs. 6.20 mm2, p = 0.016) on intravascular ultrasound between 6-month and 2-year follow-up. At 2-year clinical follow-up, there were no differences in major adverse cardiac events (7.3% vs. 10.2%, p = 0.73), myocardial infarction (4.9% vs. 1.7%, p = 0.56), or ischemia-driven target lesion revascularization (2.4% vs. 8.5%, p = 0.396) between small and large vessels. No deaths or scaffold thrombosis were observed.

Conclusions:

The authors concluded that the Absorb BVS was associated with similar clinical and angiographic outcomes at 2-year follow-up in small- and large-vessel groups.

Perspective:

This small study demonstrates the remarkable efficacy of the Absorb BVS in small vessels. A biodegradable stent that has a low risk of restenosis would be a paradigm shift in interventional cardiology, and the results of this study bring us one step closer to that goal.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Stable Ischemic Heart Disease, Interventions and Imaging, Angiography, Nuclear Imaging, Chronic Angina

Keywords: Myocardial Infarction, Follow-Up Studies, Coronary Restenosis, Coronary Angiography, Thrombosis, Immunosuppressive Agents, Cardiovascular Diseases, Sirolimus, Angioplasty, Balloon, Coronary, Stents


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