Long-term invasive follow-up of the everolimus-eluting bioresorbable vascular scaffold: five-year results of multiple invasive imaging modalities

Abstract

Background: Invasive imaging modalities have shown restoration of vasomotion, prevention of restenosis and most importantly increase in lumen area between 6-months and 2-years after first-generation everolimus-eluting bioresorbable vascular scaffold (Absorb BVS) implantation. Our aim was to assess whether these positive findings were sustained in the long-term. Methods: Patients included in the ABSORB Cohort A from the Thoraxcenter Rotterdam cohort underwent coronary catheterization including angiography, intravascular-ultrasound (IVUS), virtual histology, optical coherence tomography (OCT) and vasomotion testing at 5-years. Results: Eight out of 16 patients underwent catheterization and scaffold assessment with multiple imaging modalities. A trend towards an increase in minimum luminal diameter was observed between 2- and 5-years by angiography (1.95±0.37 mm versus 2.14±0.38; p=0.09). IVUS data showed an increase in mean lumen area at 5-years (6.96±1.13 mm2) compared to 6-months (6.17±0.74 mm2; p=0.06) and 2-years (6.56±1.16 mm2; p=0.12), primarily due to a persistent reduction in plaque area size between 6-months and 5-years (9.17±1.86 mm2 versus 7.57±1.63 mm2; p=0.03). The necrotic core area was reduced at 5-years compared to post-procedural results. In OCT, an increase in mean and minimal luminal area was observed. Moreover, no scaffold struts could be identified and a smooth endoluminal lining was observed. The scaffolded coronary segment did not show signs of endothelial dysfunction with acetylcholine testing. Figure 1. OCT-IVUS Conclusions: At 5-years, the Absorb BVS is no longer discernible by any invasive imaging method and endothelial function is restored. Late luminal enlargement persists up to 5-years of follow-up without adaptive vessel remodelling.