Cardiovascular Journal of Africa: Vol 27 No 6 (November/December 2016)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 27, No 6, November/December 2016 AFRICA 345
Procedural and one-year clinical outcomes of
bioresorbable vascular scaffolds for the treatment of
chronic total occlusions: a single-centre experience
Erdem Özel, Ahmet Taştan, Ali Öztürk, Emin Evren Özcan, Baris Kilicaslan, Öner Özdogan
Abstract
Introduction: The bioresorbable vascular scaffold system
(BVS) is the latest fully absorbable vascular therapy system
that is used to treat coronary artery disease. The BVS has
been used in different coronary lesion subsets, such as acute
thrombotic lesions, bifurcation lesions, ostial lesions and
lesions originating from bypass grafts. However, data about
the use of BVS in chronic total occlusions (CTO) are limited.
We report our BVS experience for the treatment of CTOs in
terms of procedural features and one-year clinical follow-up
results.
Methods: An analysis was made of 41 consecutive patients
with CTO lesions who were referred to our clinic between
January 2013 and December 2014. A total of 52 BVS were
implanted. An analysis was made of patient characteris-
tics, procedural features [target vessel, BVS diameter, BVS
length, post-dilatation rate, type of post-dilatation balloon,
procedure time, fluoroscopy time, contrast volume, post-
procedure reference vessel diameter (RVD), post-procedure
minimal lesion diameter (MLD), type of CTO technique and
rate of microcatheter use] and one-year clinical follow-up
results [death, myocardial infarction, angina, coronary artery
bypass graft (CABG), target-lesion revascularisation (TLR)
and target-vessel revascularisation (TVR)]. Descriptive and
frequency statistics were used for statistical analysis.
Results: The mean age of the patient group was 61.9 ±
9.7 years, 85.4% were male, and 51.2 % had diabetes.
Prior myocardial infarction incidence was 65.9%, 56.1% of
the patients had percutaneous coronary intervention and
17.1% had a previous history of CABG. The procedure was
performed via the radial route in 24.3% of the patients. The
target vessel was the right coronary artery in 48.7% of the
patients. Post-dilatation was performed on the implanted BVS
in 97.5% of the patients, mainly by non-compliant balloon;
87.8% of the BVS were implanted by the antegrade CTO
technique. Mean procedure time was 92 ± 35.6 minutes. Mean
contrast volume was 146.6 ± 26.7 ml.
At one year, there were no deaths. One patient had lesion-
related myocardial infarction and needed revascularisation
because of early cessation of dual anti-platelet therapy. Elev-
en patients had angina and five of them needed target-vessel
revascularisation.
Conclusions: BVS implantation appeared to be effective
and safe in CTO lesions but randomised studies with a
larger number of patients and with longer follow-up times
are needed.
Keywords: bioresorbable vascular scaffold, chronic total occlu-
sion, percutaneous coronary intervention
Submitted 11/1/16, accepted 13/3/16
Published online 12/4/16
Cardiovasc J Afr 2016; 27: 345–349
DOI: 10.5830/CVJA-2016-033
Chronic total occlusion (CTO) is described as complete
coronary vessel occlusion with a duration of three months or
longer.1 Among patients diagnosed with coronary disease on
angiography, the incidence of CTO lesions was between 20 and
30%.2 Successful CTO recanalisation provides better symptom
control and survival outcome in the long term over failed
revascularisation. 3-5
According to recent guidelines, percutaneous recanalisation of
CTOs should be considered in patients with expected ischaemia
reduction in a corresponding myocardial territory and/or angina
relief with a class 2a indication.6 Clinical outcomes of drug-
eluting stents (DES) are superior to bare-metal stents (BMS) in
percutaneous revascularisation of CTOs. 7,8
The bioresorbable vascular scaffold (BVS) (Absorb, Abbott
Vascular, Santa Clara, CA, USA) is the latest fully absorbable
vascular therapy system that is used to treat coronary artery
disease. BVS has been tested in many randomised trials and
provides some advantages over metallic stents because of its
complete bioresorption process.9-11 BVS can facilitate the return
of vessel vasomotor functions, reduce device thrombosis rates
in the long term, make future surgical revascularisations more
feasible and facilitate non-invasive imaging of the coronary
arteries, since no metallic cage remains after two years.12,13
BVS has been used in different coronary lesion subsets, such
as acute thrombotic lesions, bifurcation lesions, ostial lesions
and lesions originating from bypass grafts. However, data on
the use of BVS in chronic total occlusions (CTO) are limited.
We report our BVS experience for the treatment of CTOs in
terms of procedural features and one-year clinical follow-up
results.
Cardiology Department, Tepecik Training and Research
Hospital, İzmir, Turkey
Erdem Özel, MD,
Baris Kilicaslan,MD
Öner Özdogan, MD
Cardiology Department, Sifa University, İzmir, Turkey
Ahmet Taştan, MD
Ali Öztürk, MD
Cardiology Department, Dokuz Eylul University, İzmir, Turkey
Emin Evren Özcan, MD