Everolimus-eluting bioresorbable coronary scaffold in Asian patients: A 2-year follow-up

Indo-Pakistan population has one of the highest risk of coronary artery disease (CAD) in the world. Percutaneous interventions with the use of stents has been the mainstay of treatment for CAD, evolving from balloon angioplasty to bare metal stents and then to drug eluting stents. However, there are a few drawbacks related to the metal implant in the coronary, leading to the development of bio-resorbable vascular scaffolds (BVS). This case series studies the implantation techniques and 24 month clinical outcome of bioresorbable stent Absorb at Rawalpindi Institute of Cardiology. From November 1, 2013 till June 30, 2018. Fifty patients undergoing angioplasty with Absorb BVS as elective or primary PCI were enrolled. Case selection was at the discretion of the operator. Patients were followed up clinically. Repeat angiogram was conducted if clinically indicated. The study population involved patients with mean age of 42 +/- 8.82. Fourty three (86%) were male and most had single or double vessel disease. The most common treated coronary was left anterior descending. Most of the lesions were predilated with 1:1 sizing. Most scaffolds were post dilated with 0.5mm larger diameter non-compliant balloon at nominal pressure. Angiographic success rate was 92%. On follow up, 4% had stent thrombosis (ST) (compared to <1% for latest generation drug eluting stents (DES) as per available literature). No death was reported. Majority of those with ST had longer median treated lesion length than those without stent thrombosis (32mm versus 28mm). Stent thrombosis occurred in 7.7% of cases with overlapping BVS while 2.8% in single BVS patients. To conclude, current generation Biovascular scaffold has higher thrombosis rates as compared to latest generation DES. Procedure/lesion related risk factors may predispose in addition to the thick stent struts.