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Dimitriadis Z, Polimeni A, Anadol R, Geyer M, Weissner M, Ullrich H, Münzel T, Gori T. Procedural Predictors for Bioresorbable Vascular Scaffold Thrombosis: Analysis of the Individual Components of the "PSP" Technique. J Clin Med 2019; 8:jcm8010093. [PMID: 30650586 PMCID: PMC6352132 DOI: 10.3390/jcm8010093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/04/2019] [Accepted: 01/14/2019] [Indexed: 01/01/2023] Open
Abstract
The technique used at the time of implantation has a central role in determining the risk of thrombosis in bioresorbable vascular scaffolds (BRS). Different definitions of the "optimal" implantation technique exist, however. The impact of individual procedural characteristics on the risk of scaffold thrombosis (ScT) was evaluated in a single-center observational study that enrolled 657 patients (79% males, mean age 63 ± 12 years) with 763 lesions who received a total of 925 BRS for de novo lesions. During a median 1076 (762⁻1206) days' follow-up there were 28 cases of thrombosis. Independent predictors of ScT included the use of predilatation balloons bigger than the nominal BRS diameter (hazard ratio (HR) = 0.4 (0.16⁻0.98), p = 0.04), sizing (implantation in vessels with reference vessel diameter >3.5 mm or <2.5 mm: HR = 5.71 (2.32⁻14.05), p = 0.0002) and the degree of vessel expansion (ratio of minimum lumen to reference vessel diameter, HR: 0.005 (0.0001⁻0.23), p = 0.007). In addition, a mild BRS oversizing (final BRS diameter to vessel diameter 1.14⁻1.28) was associated with a lower thrombosis risk, whereas undersizing and more severe oversizing (final BRS diameter to vessel diameter <1.04 and >1.35, respectively) were associated with an increased risk of ScT (HR = 0.13 (0.02⁻0.59), p = 0.0007). In conclusion, different components of the "optimal" technique have different impacts on the risk of BRS thrombosis. Besides predilatation with a balloon larger than the BRS diameter, correct vessel size selection and a mild to moderate oversizing appear to be protective.
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Affiliation(s)
- Zisis Dimitriadis
- Zentrum für Kardiologie, University Hospital Mainz, 55131 Mainz, Germany.
- German Center for Cardiac and Vascular Research (DZHK), Standort Rhein-Main, 55131 Mainz, Germany.
| | - Alberto Polimeni
- Zentrum für Kardiologie, University Hospital Mainz, 55131 Mainz, Germany.
- German Center for Cardiac and Vascular Research (DZHK), Standort Rhein-Main, 55131 Mainz, Germany.
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, 88100 Catanzaro, Italy.
| | - Remzi Anadol
- Zentrum für Kardiologie, University Hospital Mainz, 55131 Mainz, Germany.
- German Center for Cardiac and Vascular Research (DZHK), Standort Rhein-Main, 55131 Mainz, Germany.
| | - Martin Geyer
- Zentrum für Kardiologie, University Hospital Mainz, 55131 Mainz, Germany.
- German Center for Cardiac and Vascular Research (DZHK), Standort Rhein-Main, 55131 Mainz, Germany.
| | - Melissa Weissner
- Zentrum für Kardiologie, University Hospital Mainz, 55131 Mainz, Germany.
- German Center for Cardiac and Vascular Research (DZHK), Standort Rhein-Main, 55131 Mainz, Germany.
| | - Helen Ullrich
- Zentrum für Kardiologie, University Hospital Mainz, 55131 Mainz, Germany.
- German Center for Cardiac and Vascular Research (DZHK), Standort Rhein-Main, 55131 Mainz, Germany.
| | - Thomas Münzel
- Zentrum für Kardiologie, University Hospital Mainz, 55131 Mainz, Germany.
- German Center for Cardiac and Vascular Research (DZHK), Standort Rhein-Main, 55131 Mainz, Germany.
| | - Tommaso Gori
- Zentrum für Kardiologie, University Hospital Mainz, 55131 Mainz, Germany.
- German Center for Cardiac and Vascular Research (DZHK), Standort Rhein-Main, 55131 Mainz, Germany.
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