LONG TERM FOLLOW-UP WITH BVS IN CTO

VICTORIA MARTIN MD, PHD

H CLINIC. BARCELONA. SPAIN

BVS STRUCTURE

SECOND GENERATION OF DES AND CTO PCI

FULL METAL JACKET

AUGMENTED RISK OF RESTENOSIS

PERMANENT IMPAIRMENT OF VASOMOTION

IMPAIRMENT OF POSITIVE REMODELING

ARTIFACTS AT NON-INVASIVE CARDIAC IMAGING TECHNIQUES

INABILITY FOR PLACEMENTS OF BYPASS

CTO & ANY OTHER KIND OF LESIONS

POTENCIAL BENEFICES OF BVS IN CTO

• RESTORATION OF VASOMOTION

12 months

24 months

Eur Heart J. 2012 Jun;33(11):1325-33. doi: 10.1093/eurheartj/ehr466.

Baseline post acetylcholine

• ENLARGMENT OF SCAFFOLD AND LUMEN AREA

J Am Coll Cardiol. 2014 Dec 9;64(22):2343-56. doi: 10.1016/j.jacc.2014.09.029.

• USE OF NON INVASIVE IMAGIN (CCT) FOR FOLLOW-UP

• MAKE MORE FEASIBLE FUTURE SURGICAL REVASCULARIZATIONS

(J Am Coll Cardiol Intv 2013;6:999–1009

POTENCIAL LIMITATIONS

• CROSSABILITY: crossing profile 1.4 mm

• VESSEL SIZE

• MALAPOSITION

• RECOIL:

• LENGTH OF DEVICES

• PRIZE

Circ Cardiovasc Intervent. 2009;2:255-260.

WHAT DO WE REALLY KNOW FROM BVS IN CTO LESIONS?

CTO AGE

(years)

SEX DM HTA DLP TOBACC

O

Ozel et al 41 61.9±9.7 85.4% 51.2% 80.5% 46.3% 34.1%

Lesiak et al 40 59.9±8.3 77.5% 30% 80% 35%

Ojeda et al 46 58±9 98% 33% 57% 64% 19%

Vaquerizo

et al

35 61±10 80% 20%

Wiebe et al 23 60.4±9 80% 34.8% 91% 65.2% 47.8%

BASELINE CHARACTERISTICS

PROCEDURAL CHARACTERISTICS

CTO

Vessel

JCTO

score

Diameter

BVS (mm)

Length (mm) Post

dilatation

Ozel et al 48.7%

RCA

70%<2 2.8 ± 0.29 25.6 ± 4.2 97.5%

Lesiak et

al

57.5%

LAD

45%<2 2.9 ± 0.32 42 ± 21.5 ?

Ojeda et al 48% LAD 54%<2 3.03 ± 0.38 43 ± 21 100%

Vaquerizo

et al

46% RCA 75%<2 2.74 ± 0.4 52.5 ± 22.98 63%

Wiebe et

al

47.8%

RCA

77.5%<

2

3.1 ± 0.2 64.8 ± 24.2 69.6%

Antegrade

approach

Final MINIMAL

BVS diameter

(mm)

IVUS/OCT

Ozel et al 86.7% 2.5 ± 0.25 No

Lesiak et al 85% 2.52 ± 0.8 25%

Ojeda et al 74% 2.7 ± 0.4 8%

Vaquerizo et al 86% 2.18 ± 0.39 100%

Wiebe et al 95.7% 2.13 ± 0.31 60.9%

PROCEDURAL CHARACTERISTICS

FOLLOW - UP

Follow-up

(days)

Resteno

sis

Device

thrombos

is

AMI ANGIO

follow-up

CT

Scan

Ozel et al 365 12.2% 2.4% 2.4% No No

Lesiak et

al

365

(92.5%)

7.5% 5% 5% 68% 12 m No

Ojeda et al 390±150 8% 0% 0% No 6m

Vaquerizo

et al

365 6% 0% 0% 100% 12

m

6 m

Wiebe et

al

108

(79.5/214.5)

4.3% 4.3% 0% 59% No

(Am J Cardiol 2016;117:906e917

CONCLUSIONS

• WE CAN'T GENERALIZE THIS RESULTS

• PROBABLY WE NEED TO WAIT 3-5 YEARS TO HAVE THE

LONG TERM FOLLOW UP FOCCUSING IN LATE

THROMBOSIS/RESTENOSIS OF BVS IN CTO

CONCLUSIONS

•ACCORDING TO THESE STUDYS TO GUARANTEE LONG TERM

RESULTS AVOIDING DEVICE THROMBOSIS

• PREPARE THE LESION WITH AGRESSIVE PREDILATATION

• IF THE LESION IS CALCIFIEF USE LASER OR ROTABLATION

• DON'T USE BVS IN SMALL VESSELS

• USE HIGHT PRESSURE POSTDIATATION WITH A NON COMPLIANT

BALLOON

• IF WE ARE NO SURE ABOUT SIZE AND IMPLANTATION RESULT

USE IMAGIN (OCT

• PAY ATTENTION TO ANTIPLATELET THERAPY

THANK YOU!!!

THANK YOU!!!