Cardiac allograft vasculopathy: Optical coherence guided innovative treatment options with the bioresorbable vascular scaffold: Proof of concept

I. Édes, Ágota Hajas, Balázs Sax, Andrea Bartykowszki, Dávid Becker, B. Merkely

Research output: Contribution to journalReview article

Abstract

The aim of our work was to assess a novel interventional therapy option in cardiac allograft vasculopathy (CAV), a complex form of coronary disease presenting only in heart transplant (HTx) recipients. It is typically a rapidly progressing phenomenon, affecting the entire coronary circulation causing diffuse, severe coronary lesions and has no one unique cause. Treatment options are limited, but where eligible, palliation via percutaneous revascularization (PCI) mainly using new generation drug eluting stents (DES) is recommended. Our working group sought to assess outcomes of CAV PCI using an Absorb (Abbott Vascular, Santa Clara, CA, USA) fully bioresorbable, everolimus eluting vascular scaffold (BVS), under optical coherence tomography (OCT) guidance. Our initial, proof-of-concept case showed a late CAV, macrophage and foam-cell rich lesion, with typical asymmetric intimal hyperplasia and contralateral thin-cap fibroatheroma formation. Post-PCI OCT showed underexpansion, requiring aggressive postdilatation. Ninety-day follow-up CT angiogram identified the scaffold and displayed a patent lumen of the device. BVS use thus seems eligible in CAV, yet needs proper, meticulous implantation. Use may also delay CAV progression as lesion healing is promoted, with restoration of vasomotion and a natural increase in vascular lumen. Furthermore, the chronically present vascular irritation surrounding stent/scaffold struts may subside, as no permanent metal is present as an increased substrate for inflammation. To assess full efficacy, further studies will be needed.

Original languageEnglish
Pages (from-to)487-493
Number of pages7
JournalMinerva Cardioangiologica
Volume64
Issue number4
Publication statusPublished - Aug 1 2016

Fingerprint

Allografts
Blood Vessels
Optical Coherence Tomography
Tunica Intima
Therapeutics
Foam Cells
Coronary Circulation
Drug-Eluting Stents
Population Growth
Atherosclerotic Plaques
Hyperplasia
Stents
Coronary Disease
Angiography
Metals
Macrophages
Inflammation
Equipment and Supplies

Keywords

  • Heart transplantation
  • Optical coherence
  • Percutaneous coronary intervention
  • Tomography
  • Vascular diseases

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Cardiac allograft vasculopathy : Optical coherence guided innovative treatment options with the bioresorbable vascular scaffold: Proof of concept. / Édes, I.; Hajas, Ágota; Sax, Balázs; Bartykowszki, Andrea; Becker, Dávid; Merkely, B.

In: Minerva Cardioangiologica, Vol. 64, No. 4, 01.08.2016, p. 487-493.

Research output: Contribution to journalReview article

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