Quantitative Imaging Assessment of Bioresorbable Scaffolds: Preprocedural Sizing and Acute Performance

The use of bioresorbable scaffolds has several challenges that justify careful assessment of this technology.

In the randomised comparison, the Absorb everolimuseluting bioresorbable scaffolds showed similar one-year clinical outcomes to the everolimus-eluting Xience metallic stent, and side branch occlusion and other angiographic complications are not different in the acute performance. Implantation of an oversized Absorb scaffold in a relatively small vessel appears to be associated with a higher 1-year MACE rate driven by more frequent early MI. In the early Absorb studies, several failure modes of bioresorbable scaffolds were documented. To avoid scaffold dislodgement, appropriate lesion preparation is mandatory. In case of unsuccessful initial delivery, a second insertion of the same scaffold should be avoided. Adherence to antiplatelet therapy is of paramount importance to avoid acute or subacute scaffold thrombosis. QCA bifurcation was validated and clinical applicable. IVUS, OCT and MSCT could be used to assess long term bioresorption and serial changes in lumen dimension.

Further investigation using intravascular imaging is needed to establish the relationship between acute potential mechanism and late adverse events.