Imaging-guided pre-dilatation, stenting, post-dilatation: a protocolized approach highlighting the importance of intravascular imaging for implantation of bioresorbable scaffolds

ABSTRACT

Introduction: The advent of the fully bioresorbable vascular scaffold (BVS) is the latest step in a series of advancements in the design of intracoronary stents over the past few decades. The novelty of this technology is in providing temporary vessel scaffolding and local antiproliferative therapy to prevent neointimal hyperplasia after percutaneous coronary intervention followed by gradual resorption of the scaffold to restore the native vessel anatomy and physiology – a process termed vascular reparative therapy.

Areas covered: The first generation of BVS has not been able to fully match the high benchmark in safety and efficacy set by contemporary metallic drug-eluting stents. These shortcomings of BVS may be due to factors related to the device itself, the complexity of the underlying lesion, or the implantation technique.

Expert commentary: Here, how intravascular imaging may be used to minimize these shortcomings is described and moreover, an imaging-guided step-by-step approach for BVS implantation that integrates the recently described pre-dilatation, stenting, post-dilatation (PSP) strategy is explained.

KEYWORDS:

• Intravascular imaging
• optical coherence tomography
• intravascular ultrasound
• bioresorbabale scaffold
• drug-eluting stent

Declaration of interest

Z Ali reports grants from St. Jude Medical and personal fees from St. Jude Medical (now Abbott Vascular), and his employer, Columbia University, receives royalties from the sale of the MitraClip. A Maehara has received consulting fees from Boston Scientific and OCT Medical Imaging Inc.; and research grants from Boston Scientific and Abbott Vascular. G Mintz has received consulting fees from ACIST, Boston Scientific, Volcano, and Infraredx; and research or fellowship support from Boston Scientific, Volcano, and Abbott Vascular. A Abizaid has received research grants from Abbott Vascular, Medtronic, Elixir, and Riva. D Chamié has received consulting fees from St. Jude Medical. RA Shlofmitz has served as a member of the Speakers Bureau for Cardiovascular Systems. J Hill is part of the Consultant Advisory Board at St Jude Medical. Y Onuma and P Serruys report serving as consultants to Abbott Vascular. G Stone is a consultant to Reva Medical, and his employer, Columbia University, receives royalties from the sale of the MitraClip. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.