Bioresorbable scaffolds deliver more intense expansive remodeling than metallic stents
Implantation of a bioresorbable vascular scaffold (BVS), compared with metallic drug-eluting stent (DES), leads to more frequent and intense expansive vessel wall remodeling, which can be determined by patient baseline characteristics and periprocedural factors, a recent study has found.
Researchers compared vessel remodeling pattern following either Absorb BVS or Xience metallic DES implantation and determined the independent predictors or remodeling. They investigated 383 lesions (n=359) by ultrasound in the ABSORB II randomized trial, both postprocedure and at 3-year follow-up.
The authors categorized nine patterns of vessel remodeling that were beyond the reproducibility of lumen and vessel area measurements based on changes in vessel and lumen area over 3 years.
BVS had significantly greater relative change in mean vessel area vs DES (6.7±12.6 vs 2.9±11.5 percent; p=0.003); the two arms had significantly different relative change in mean lumen area (1.4±19.1 vs ‒1.9±10.5 percent, respectively; p=0.031).
In multivariate analysis, the independent predictors of expansive remodeling were BVS use, female sex, balloon-artery ratio >1.25, expansion index ≥0.8, previous percutaneous coronary intervention and higher level of low-density lipoprotein cholesterol. In addition, necrotic core preprocedure was an independent determinant of expansive remodeling in the BVS group.
“The clinical effect of the observed lumen and vessel remodeling must be investigated in further large clinical studies to optimize the clinical outcome of patients and lesions treated by bioresorbable scaffolds,” researchers said.
Previous observational studies have documented late luminal enlargement and expansive remodeling after BVS implantation, but no comparison with metallic stents has been performed in a randomized fashion, they added.