Author + information
- Received March 7, 2014
- Revision received August 28, 2014
- Accepted September 5, 2014
- Published online December 9, 2014.
- Antonios Karanasos, MD∗,
- Cihan Simsek, MD∗,
- Muthukarrupan Gnanadesigan, MSc†,
- Nienke S. van Ditzhuijzen, MSc∗,
- Raphael Freire, MD∗,
- Jouke Dijkstra, PhD‡,
- Shengxian Tu, PhD‡,
- Nicolas Van Mieghem, MD∗,
- Gijs van Soest, PhD†,
- Peter de Jaegere, MD, PhD∗,
- Patrick W. Serruys, MD, PhD∗,
- Felix Zijlstra, MD, PhD∗,
- Robert-Jan van Geuns, MD, PhD∗ and
- Evelyn Regar, MD, PhD∗∗ ()
- ∗Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
- †Department of Biomedical Engineering, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
- ‡Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
- ↵∗Reprint requests and correspondence:
Dr. Evelyn Regar, Erasmus University Medical Center, Department of Cardiology, Thoraxcenter, BA-585, Gravendijkwal 230, 3015 CE Rotterdam, the Netherlands.
Background Although recent observations suggest a favorable initial healing process of the everolimus-eluting bioresorbable vascular scaffold (BVS), little is known regarding long-term healing response.
Objectives This study assessed the in vivo vascular healing response using optical coherence tomography (OCT) 5 years after elective first-in-man BVS implantation.
Methods Of the 14 living patients enrolled in the Thoraxcenter Rotterdam cohort of the ABSORB A study, 8 patients underwent invasive follow-up, including OCT, 5 years after implantation. Advanced OCT image analysis included luminal morphometry, assessment of the adluminal signal-rich layer separating the lumen from other plaque components, visual and quantitative tissue characterization, and assessment of side-branch ostia “jailed” at baseline.
Results In all patients, BVS struts were integrated in the vessel and were not discernible. Both minimum and mean luminal area increased from 2 to 5 years, whereas lumen eccentricity decreased over time. In most patients, plaques were covered by a signal-rich, low-attenuating layer. Minimum cap thickness over necrotic core was 155 ± 90 μm. One patient showed plaque progression and discontinuity of this layer. Side-branch ostia were preserved with tissue bridge thinning that had developed in the place of side-branch struts, creating a neo-carina.
Conclusions At long-term BVS follow-up, we observed a favorable tissue response, with late luminal enlargement, side-branch patency, and development of a signal-rich, low-attenuating tissue layer that covered thrombogenic plaque components. The small size of the study and the observation of a different tissue response in 1 patient warrant judicious interpretation of our results and confirmation in larger studies.
The Thoraxcenter receives unrestricted grants from Abbott and St. Jude Medical. Dr. Karanasos has received funding support from Hellenic Heart Foundation and St. Jude Medical. Dr. Simsek and Mr. Gnanadesigan were supported by research grants from “Nederlandse Hartstichting” (2009B091 to Dr. Simsek and 2010B064 to Mr. Gnanadesigan). Dr. Tu is employed by Medis Medical Imaging Systems; and has a research appointment at the Leiden University Medical Center. Dr. van Geuns has received speaker fees and research grants from Abbott Vascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 7, 2014.
- Revision received August 28, 2014.
- Accepted September 5, 2014.
- American College of Cardiology Foundation