Key result
BVS yields ~94% diagnostic CTA images for ISR, outperforming metallic coronary stents.
Why the study?
Does CTA evaluation of bioresorbable vascular scaffolds improve diagnostic feasibility for in-stent restenosis compared to bare metal stents in patients with prior elective PTCA?
Observational (n=73)
No
Does CTA evaluation of bioresorbable vascular scaffolds improve diagnostic feasibility for in-stent restenosis compared to bare metal stents in patients with prior elective PTCA?
CTA evaluation of bioresorbable scaffolds is more feasible and provides a higher rate of diagnostic evaluations for in-stent restenosis compared to metallic stents.
Answers are grounded in this paper and cite their sources.
CTA may be preferable for ISR evaluation after BVS; hypothesis-generating and needs prospective validation.
Background: Computed tomography angiography (CTA) presents important limits in in-stent restenosis (ISR) evaluation in case of metallic coronary stents, due to the artifacts determined by stent struts, which alter in-stent plaque analysis. In case of bioresorbable scaffolds, stent strut resorption allows accurate evaluation of the vessel wall. Aim of the study: This study aims to compare the feasibility of CTA as a follow-up imaging method for ISR diagnosis following elective PTCA procedures, between bioresorbable scaffolds and metallic coronary stents. Material and methods: We conducted a prospective, observational study on 73 patients with elective PTCA procedures in their medical history, in whom 113 stents were assessed via CTA in order to diagnose ISR. Based on stent type, the patients were divided into two groups: Group 1 – patients with bioresorbable vascular scaffolds (BVS) (n = 30); and Group 2 – patients with bare metal stents (BMS) (n = 43). Plaque analysis was possible only in the BVS group with a post-processing research-dedicated software, Syngo.via Frontier, which identified plaque morphology and virtual histology composition. Results: After CTA evaluation, the BVS group presented a significantly higher incidence of severe coronary artery disease (CAD) (Group 1 – 73% vs. Group 2 – 30%, p <0.0001). The proximal part of the right coronary artery (RCA) presented a significantly higher percentage of metallic stents (14% BMS vs. 2% BVS, p = 0.0029). The comparative analysis of CTA sensibility for the visual evaluation of ISR identified a significantly higher percentage of diagnostic CT evaluations in the BVS group (Group 1 – 94% vs. Group 2 – 76.19%, p = 0.0006). CTA evaluation provided the most accurate results for the 3.0 and 3.5 mm devices. Regarding CTA sensibility for ISR diagnosis, the BVS group presented the smallest incidence of non-diagnostic CT evaluations. Conclusions: CTA evaluation of bioresorbable scaffolds is superior to metallic stent assessment, the latter being influenced by numerous sources of error dependent mainly on the presence of the metal structure.
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Ferenț et al. (2018) conducted an observational in Coronary artery disease with prior elective PTCA and stent placement (n=73). Bioresorbable vascular scaffolds (BVS) vs. Metallic coronary stents was evaluated on Diagnostic CTA evaluations for visual evaluation of in-stent restenosis (p=0.0006). CTA evaluation of bioresorbable vascular scaffolds yielded a significantly higher percentage of diagnostic images for in-stent restenosis compared to metallic coronary stents (94% vs. 76.19%, p=0.0006).
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