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Objectives: This study aimed to investigate clinical outcomes following bioresorbable scaffold (BRS) optimized with intravascular ultrasound (IVUS), and furthermore expansion of BRS in calcific lesions., Background: Although IVUS use has contributed to improved clinical outcomes with metallic stent implantation, it is unclear if this is also true with regards to BRS, especially in calcified lesions., Methods: Between May 2012 and April 2015, 291 lesions in 198 patients were treated with BRS with IVUS use. We evaluated overall clinical outcomes at 1-year and investigated the expansion and eccentricity index of BRS amongst quadrants categorized by calcium arc (CA) every 90-degrees., Results: The rates of major adverse cardiac events were 5.4% (at 6 months) and 10.7% (at 12 months). TLR was observed in 3.1% at 6-month and 7.5% at 12-month follow up. Although there was a significant difference among quadrants regarding to eccentricity of calcium (0°≦CA < 90°: 0.82 ± 0.09, 90°≦CA < 180°: 0.75 ± 0.12, 180°≦CA < 270°: 0.78 ± 0.11, and 270°≦CA≦360°: 0.79 ± 0.09, ANOVA P = 0.002), the BRS expansion index [minimal scaffold area (MSA) divided by BRS area expanded at a nominal pressure] was comparable between quadrants., Conclusions: The use of IVUS to optimize BRS implantation results in favorable clinical outcomes even for complex lesions. Although eccentric calcium distribution resulted in asymmetric expansion of BRS, the final MSA was comparable irrespective of calcium distribution. © 2016 Wiley Periodicals, Inc., (© 2016 Wiley Periodicals, Inc.)

Introduction and Objectives: There is limited evidence on procedural and clinical outcomes in patients treated with overlapping bioresorbable scaffolds vs overlapping everolimus-eluting stents. We evaluated the outcomes of propensity-matched patients treated with overlapping scaffolds vs everolimus-eluting stents., Methods: After propensity matching, 70 consecutive stable angina patients treated with overlapping bioresorbable scaffolds and 70 patients treated with overlapping new generation everolimus stents were included in this study. The primary outcome was the 1-year rate of major adverse cardiovascular events, defined as the composite of all-cause mortality, nonprocedural myocardial infarction, and target-vessel revascularization., Results: Patients in the 2 groups had similar age (scaffold vs stent: 64.5 ± 10.3 vs 66 ± 9.7 years; P=.381), sex, diabetes, previous cardiovascular history, and SYNTAX score (scaffold vs stent: 18.6 ± 9.2 vs 19.4 ± 10.4; P=.635). Postprocedural acute gain was significantly lower in patients treated with scaffolds (1.82±0.66 vs 2.03±0.68mm; P=.033). At 1-year follow up, the estimated major adverse cardiovascular event rate was not significantly different between the 2 groups (scaffold vs stent: 14.5% vs 14.6%; P log-rank =.661). Similarly, no significant differences were seen in 1-year rates of target vessel (scaffold vs stent: 14.5% vs 10%; P log-rank =.816) or target lesion revascularization (scaffold vs stent: 9.7% vs 8.3%; P log-rank =.815)., Conclusions: Treating long lesions with overlapping scaffolds is feasible with acceptable 1-year outcomes., (Copyright © 2016 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Aims: The bioresorbable vascular scaffold (BVS) (Abbott Vascular) provides temporary scaffolding while eluting everolimus. There are limited data on its use in daily practice, especially in patients with stable angina pectoris referred for elective percutaneous coronary intervention (PCI) of chronic total occlusions (CTOs). The current study aims to investigate the safety and efficacy of BVS implantation in a selected patient cohort with CTO., Methods: A total of 70 consecutive patients, who underwent successful recanalization of CTO with BVS between September 13, 2012 and September 20, 2014 in three cardiac centers (Department of Cardiology, Bezmialem Vakif University, Istanbul, Turkey; Department of Interventional Cardiology, San Raffaele Hospital, Milan, Italy; and EMO-GVM Centro Cuore Columbus, Milan, Italy) were included in this CTO registry. Endpoints analyzed included: (1) the composite of all-cause death and non-fatal myocardial infarction (MI); and (2) the composite safety endpoint of major adverse cardiovascular events (MACEs), including death, MI and symptom-driven target lesion revascularization (TLR)., Results: Clinical data were obtained for 70 patients (mean age, 56.9 ± 9.4 years; 90.0% male) with a total number of 76 CTOs. At a median follow-up of 11.0 months (interquartile range, 7-18 months), both MACE and TLR rates were 4.3%. Two patients suffered from ischemia-driven TLR (1 patient at 6 months and 1 patient at 9 months after implantation). No death, MI, or stent thrombosis was observed during the follow-up period., Conclusion: Treatment of CTOs with BVS seems to be safe and effective, with a high technical success rate and acceptable MACE at short-term follow-up.

We present a case of a heavily calcified left anterior descending artery lesion successfully treated with bioresorbable vascular scaffold (BVS). Despite a 360° heavy calcification at the site of the culprit lesion and prior implantation of a proximal metal stent, meticulous lesion preparation with scoring balloon and use of a deep-seated child catheter facilitated the successful deployment of two BVSs. This case report demonstrates how optimal lesion preparation, adequate dedicated device support, and careful assessment with the use of intracoronary imaging device can facilitate implantation of BVS in complex lesions.

Background: There is limited experience regarding the feasibility of the bioresorbable vascular scaffold (BVS) in "all-comer" populations. We evaluated the impact of BVS use on procedural factors and clinical outcomes compared with the new-generation drug-eluting stent (DES)., Methods: We analyzed procedural feasibility and outcome data from 292 consecutive patients treated with either a new-generation DES or a BVS between May 2008 and May 2014 using propensity-score (PS) matching., Results: After PS matching, 96 patients treated with BVSs and 96 patients treated with DESs were selected. Lesion characteristics were similar between the 2 groups. Maximum balloon size after dilation was larger and maximum inflation pressure was higher in the BVS group, despite similar quantitative coronary angiography results. Procedure time (114.7 ± 39.2 minutes vs 90.4 ± 38.2 minutes; P < 0.001), amount of contrast medium used (268.3 ± 104.2 mL vs 229.2 ± 122.2 mL; P = 0.02), and fluoroscopy time (42.4 ± 17.9 minutes vs 34.5 ± 19.7 minutes; P < 0.001) were significantly increased in the BVS group compared with the DES group. In multivariable analysis, BVS use was identified as an independent predictor of long (> 120 minutes) procedure time (odds ratio, 7.83; 95% confidence interval, 2.81-25.78; P < 0.001). Procedural success (93.6% BVS vs 95.7% DES; P = 0.51) and 1-year major adverse cardiovascular events (10.2% BVS vs 10.5% DES; P = 0.82) were similar between the groups., Conclusions: In real-world patients with predominantly complex lesions treated with BVSs, procedural success rates and short-term outcomes similar to those seen in patients treated with DESs are observed at the expense of longer procedure and fluoroscopy times., (Copyright © 2015 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)

The current case report demonstrates the interesting finding of incomplete bioresorbable vascular scaffold (BVS) strut coverage at 18 months after implantation for a chronic total occlusion of the left anterior descending coronary artery. In this case, local differences in shear stress could explain the simultaneous presence of well covered and uncovered BVS strut segments in the same optical coherence tomography frame. Even though current standard practice suggests dual antiplatelet therapy for 12 months after BVS implantation, further studies are required to establish optimal duration of dual antiplatelet therapy, particularly when tackling complex lesions., (Copyright © 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)

We present a case of a left anterior descending artery/diagonal branch bifurcation successfully treated with a dedicated 2-stent technique utilizing bioresorbable vascular scaffolds, where the bifurcation angle did not strictly allow a T-stenting approach. We also propose a strategy to avoid or reduce scaffold overlap in the main branch, especially important in view of the bulkier size of these novel devices. [ABSTRACT FROM AUTHOR]