Edge Dissections After the Coronary Implantation of Bioresorbable Scaffolds. Serial Analysis Using Optical Coherence Tomography

Background: The incidence of edge dissections after the coronary implantation of bioresorbable scaffolds (BRS) has not been investigated. BRS have thicker struts and require more aggressive pre-dilation for implantation. The incidence of edge dissections after BRS implantation, their morphological aspects and healing process were evaluated using serial optical coherence tomography (OCT) images. Methods: Consecutive patients treated with a polymeric BRS, who had an OCT evaluation after the procedure and at 6-month follow-up, were included in the current analysis. Edge dissections were defined as luminal surface ruptures, 5-mm distally or proximally to the BRS edges. Results: Out of 96 edges from 48 BRS implanted in 48 lesions of 48 patients, 91 edges were available for analysis. Dissections were detected by OCT in 28 edges (30.7%) and in 22 lesions (45.8%), with equal distribution between distal and proximal edges. All dissections appeared as flaps and none were visible by angiography. Atherosclerotic disease was present in 96.4% of all dissected edges; most were fibrocalcific (40.8%), and more than one-third were lipid-rich. Mean dissection length was 1.80 mm, and the mean flap area was 0.30 mm. Most dissections (89.3%) were superficial and restricted to the intima/atheroma layer. At the 6-month follow-up 92.8% of all dissections healed completely, and there was no significant reduction in the luminal dimensions at the edge segments, with only one case of restenosis. Conclusions: Edge dissections are frequent after polymeric BRS implantation. Dissections, only detected by OCT, were short in length, superficial, were not flow-limiting, and presented favorable clinical outcomes. DESCRIPTORS: Percutaneous coronary intervention. Stents. Tomography, optical coherence. Absorbable implants. Coronary restenosis. 1 Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil. 2 Cardiovascular Research Center, São Paulo, SP, Brazil. Correspondence to: Daniel Chamié. Serviço de Cardiologia Invasiva do Instituto Dante Pazzanese de Cardiologia − Avenida Dr. Dante Pazzanese, 500 – Vila Mariana − CEP: 04012-180 − São Paulo, SP, Brazil E-mail: [email protected] Received on: 06/11/2014 • Accepted on: 08/28/2014 Original Article