OCT is the way to go

Bioresorbable vascular scaffolds (BRSs) represent a new treatment for coronary artery disease. While imaging sightings have shown a favorable healing response after scaffold implantation with complete strut resorption and recovery of vasomotor function [1] and clinical studies have demonstrated similar clinical outcomes of BRSs compared to best-in-class drug eluting metallic platform stents (MPSs) [2-4] in highly selected, simple lesions, there are still limitations facing the use of BRSs in percutaneous coronary intervention (PCI). Compared to MPSs, BRSs have a limited range of expansion, limiting their use in cases of vessel tapering. While small malapposition may be correctable by postdilatation and resolve at follow-up, large malapposition can be uncorrectable and persist at follow-up until resorption occurs. Attempts to correct large malapposition by overexpansion with a large balloon can lead to acute disruption of the scaffold (Figure 5.7.1). Therefore, exact sizing and device matching of lumen dimension is crucial. As BRSs are relatively bulky and have thicker struts (approximately 150 µm), it becomes even more important to achieve close matching of scaffold edges with minimal regions of overlap. Long regions of scaffold overlap should preferably be avoided as it increases the risk of scaffold thrombosis and also increases the risk of side branch occlusion. In addition, polymers are invisible under X-ray and thus suffer from poor visualization by coronary angiography. Most of the BRSs such as the ABSORB BVSs are equipped with radio-opaque markers on both ends of the scaffold (Figure 5.7.2) or on both ends of the delivery balloon [2,5,6] whereas in the REVA bioresorbable scaffold a proprietary iodinated material is added to the polymer that allows visualization of the entire scaffold under X-ray [7] (Figure 5.7.3). Therefore, acute placement of the scaffold can be challenging especially in regions of significant overlap or foreshortening. Finally, the paucity of visualization of the scaffold under direct angiography also makes it difficult to assess expansion of the scaffold postimplantation and the need for further scaffold optimization.

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