Procedural outcomes of patients with calcified lesions treated with bioresorbable vascular scaffolds

Selected in EuroIntervention by S. Brugaletta

References

Authors

Panoulas VF, Miyazaki T, Sato K, Naganuma T, Sticchi A, Kawamoto H, Figini F, Chieffo A, Carlino M, Montorfano M, Latib A, Colombo A

Reference

EuroIntervention. 2016 Mar 20;11(12):1355-62

Published

20 March 2016

Link

Read the abstract

My Comment

What is known

Calcific lesions remain a challenge for the interventional cardiologist despite the advent of low-profile, non-compliant, high-pressure, bladed or scoring balloons. The increased BVS strut thickness (leading to inferior deliverability) and reduced radial force (with time and expansion beyond nominal size) have raised concerns regarding the feasibility, performance and clinical outcomes of BVS in the treatment of calcific lesions. The use of BVS in patients with calcific lesions, however, would be of particular benefit as these patients tend to have more extensive disease requiring longer stents. The present study presents the procedural feasibility and one-year clinical outcomes of patients with calcific lesions treated with BVS, and compares them to those of patients with non-calcific lesions.

Major findings 

  • Of 163 patients who received BVS implantation, 62 (38%) had calcified lesions.
  • The patients with calcific lesions had a higher prevalence of diabetes (35.5% vs. 22.8%, p=0.078) and chronic kidney disease (31.1% vs. 13.9%, p=0.008), and higher SYNTAX scores (18.9±9.7 vs. 15.1±9.0, p=0.017).
  • The calcific lesions required longer procedures (126.4±39.8 vs. 106.9±37.1 min, p=0.015) and a more frequent use of dedicated devices and IVUS.
  • The acute gain (1.83±0.6 vs. 1.86±0.6, p=0.732) and angiographic success were similar (98% non-calcific vs. 95.2% calcific, p=0.369), whereas procedural success was reduced in patients with calcific lesions (94.1% vs. 83.9%, p=0.034) due to higher rates of peri-procedural myocardial infarction (MI) (5% vs. 13.1%, p=0.067).
  • During the median follow-up time of 14 months MACE rates (10.9% non-calcific vs. 12.9% calcific, plog-rank=0.546) were similar.

My comment

The present paper is a first report on the outcomes of BVS in calcific lesions. As we know these lesions represent a challenge for interventional cardiologists and the use of BVS, which require a careful lesion preparation, may add complexity to these lesions. This analysis shows that calcific lesions require indeed longer procedures in BVS implantation. This, together with the high PCI complexity, could be the basis of a higher rate of periprocedural MI. Nevertheless, it is interesting to see that no difference in MACE could be seen at 14-month follow-up. Despite these nice results, it is matter of discussion whether BVS in calcific lesions may represent a benefit in terms of vascular reparative therapy, as calcific plaques, especially if circumferentially calcified and without the use of Rotablator, do not appear to may recovery vasomotion or pulsatility. The only reason behind the use of BVS in this particular scenario may be to avoid using much metal in a long lesion.

What is your opinion on this matter?

2 comments

  • Ramachandra Barik 30 Mar 2016

    Prepare the lesion before scaffold :step1-ROTA(scaling ),Step2:Confirrm by IVUS that ROTA is successful i.e no trace of calcification ,step3:Dilate the lesion well and implant BVS .I am sure it would work same DES with metallic strut for now and then.

  • Salvatore Brugaletta 30 Mar 2016

    thanks for sharing your opinion. I agree with your steps. In particular, I like the step of imaging. I think that in calcified lesions IVUS is an important tool to make decision about stent implantation either for metallic or for bioresorbable devices.