Intracoronary Optical Coherence Tomography and Histology of Overlapping Everolimus-Eluting Bioresorbable Vascular Scaffolds in a Porcine Coronary Artery Model

Farooq, Vasim; Serruys, Patrick W.; Heo, Jung Ho; Gogas, Bill D.; Onuma, Yoshinobu; Perkins, Laura E.; Diletti, Roberto; Radu, Maria D.; Räber, Lorenz; Bourantas, Christos V.; Zhang, Yaojun; van Remortel, Eric; Pawar, Ravindra; Rapoza, Richard J.; Powers, Jennifer C.; van Beusekom, Heleen M.M.; Garcìa-Garcìa, Hector M.; Virmani, Renu (2013). Intracoronary Optical Coherence Tomography and Histology of Overlapping Everolimus-Eluting Bioresorbable Vascular Scaffolds in a Porcine Coronary Artery Model. JACC. Cardiovascular Interventions, 6(5), pp. 523-532. Elsevier 10.1016/j.jcin.2012.12.131

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OBJECTIVES:
This study sought to assess the vascular response of overlapping Absorb stents compared with overlapping newer-generation everolimus-eluting metallic platform stents (Xience V [XV]) in a porcine coronary artery model.

BACKGROUND:
The everolimus-eluting bioresorbable vascular scaffold (Absorb) is a novel approach to treating coronary lesions. A persistent inflammatory response, fibrin deposition, and delayed endothelialization have been reported with overlapping first-generation drug-eluting stents.
METHODS:

Forty-one overlapping Absorb and overlapping Xience V (XV) devices (3.0 × 12 mm) were implanted in the main coronary arteries of 17 nonatherosclerotic pigs with 10% overstretch. Implanted coronary arteries were evaluated by optical coherence tomography (OCT) at 28 days (Absorb n = 11, XV n = 7) and 90 days (Absorb n = 11, XV n = 8), with immediate histological evaluation following euthanasia at the same time points. One animal from each time point was evaluated with scanning electron microscopy alone. A total of 1,407 cross sections were analyzed by OCT and 148 cross sections analyzed histologically.

RESULTS:
At 28 days in the overlap, OCT analyses indicated 80.1% of Absorb struts and 99.4% of XV struts to be covered (p < 0.0001), corresponding to histological observations of struts with cellular coverage of 75.4% and 99.6%, respectively (p < 0.001). Uncovered struts were almost exclusively related to the presence of "stacked" Absorb struts, that is, with a direct overlay configuration. At 90 days, overlapping Absorb and overlapping XV struts demonstrated >99% strut coverage by OCT and histology, with no evidence of a significant inflammatory process, and comparable % volume obstructions.

CONCLUSIONS:
In porcine coronary arteries implanted with overlapping Absorb or overlapping XV struts, strut coverage is delayed at 28 days in overlapping Absorb, dependent on the overlay configuration of the thicker Absorb struts. At 90 days, both overlapping Absorb and overlapping XV have comparable strut coverage. The implications of increased strut thickness may have important clinical and design considerations for bioresorbable platforms.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
UniBE Contributor:	Räber, Lorenz, Garcia Garcia, Hector Manuel
Subjects:	600 Technology > 610 Medicine & health 500 Science > 570 Life sciences; biology
ISSN:	1876-7605
Publisher:	Elsevier
Language:	English
Submitter:	Lorenz Räber
Date Deposited:	06 Mar 2014 23:29
Last Modified:	05 Dec 2022 14:29
Publisher DOI:	10.1016/j.jcin.2012.12.131
PubMed ID:	23702016
URI:	https://boris.unibe.ch/id/eprint/43418