Impact of Implantation Technique and Plaque Morphology on Strut Embedment and Scaffold Expansion of Polylactide Bioresorbable Scaffold　– Insights From ABSORB Japan Trial

• Published in: Circulation Journal Vol. 80; no. 11; pp. 2317 - 2326
• Main Authors: Sotomi, Yohei, Onuma, Yoshinobu, Dijkstra, Jouke, Eggermont, Jeroen, Liu, Shengnan, Tenekecioglu, Erhan, Zeng, Yaping, Asano, Taku, Winter, Robbert J. de, Popma, Jeffrey J., Kozuma, Ken, Tanabe, Kengo, Serruys, Patrick W., Kimura, Takeshi
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 2016
• Subjects: Absorbable Implants; Bioresorbable vascular scaffold; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation - methods; Coronary Angiography; Female; Humans; Implantation technique; Male; Optical coherence tomography; Plaque, Atherosclerotic - diagnostic imaging; Plaque, Atherosclerotic - surgery; Polyesters; Scaffold expansion; Strut embedment; Tissue Scaffolds
• ISSN: 1346-9843; 1347-4820
• DOI: 10.1253/circj.CJ-16-0818

Background:The optimal implantation technique for the bioresorbable scaffold (Absorb, Abbott Vascular) is still a matter of debate. The purpose of the present study was to evaluate the effect of implantation technique on strut embedment and scaffold expansion.Methods and Results:Strut embedment depth and scaffold expansion index assessed by optical coherence tomography (OCT) (minimum scaffold area/reference vessel area) were evaluated in the ABSORB Japan trial (OCT subgroup: 87 lesions) with respect to implantation technique using either quantitative coronary angiography (QCA) or OCT. Strut embedment was assessed at the strut level (n=667), while scaffold expansion was assessed at the lesion level (n=81). The mean embedment depth was 63±59 µm. Balloon sizing and inflation pressure had no direct effect on strut embedment. Plaque morphology affected strut embedment [nonatherosclerotic (58.9±54.3 µm), fibroatheroma (73.3±59.6 µm), fibrous plaque (59.7±51.1 µm), and fibrocalcific plaque (–3.1±61.6 µm, negative value means malapposition), P <0.001]. The balloon-artery ratio positively correlated with the expansion index. This relationship was stronger when the OCT-derived reference vessel diameter (RVD) was used as a reference for balloon selection rather than the QCA-derived one [predilatation (Pearson correlation r: QCA: 0.167 vs. OCT: 0.552), postdilatation (QCA: 0.316 vs. OCT: 0.717)].Conclusions:Underlying plaque morphology influenced strut embedment, whereas implantation technique had no direct effect on it. Optimal balloon sizing based on OCT-derived RVD might be recommended. However, the safety of such a strategy should be investigated in a prospective trial. (Circ J 2016; 80: 2317–2326)