Bioresborbable scaffolds in acute coronary syndromes

Attractiveness of BVS

• Vessel enlargement

• Vasomotor restoration

• Completely dissolvable- uncaging of vessel

– Feasible for future CABG options

• Permits assessment with non-invasive CT

angiography

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Bioresborbable Scaffolds in 
Acute Coronary Syndromes 
Koh Tian Hai 
Senior Consultant, Dept of Cardiology 
Senior Advisor 
National Heart Centre, Singapore 
14th VNCC Danang 10-14 Oct 2014 
Conflicts of Interest 
• Abbott – trial grant & travel support 
• BSC, Biosensors- travel support 
2014 ESC Guideline on evaluation & 
revascularisation in ACS 
S Windecker , P Kolh et al. EHJ 2014; 35: 2541-2619 
DES with randomised Trials with 
primary clinical endpoint - ESC 
S Windecker , P Kolh et al. EHJ 2014; 35: 2541-2619 
Some Current BRS undergoing trials 
A Lelasi & M Tespii Fut Card 2014; 10: 409-20 
Attractiveness of BVS 
• Vessel enlargement 
• Vasomotor restoration 
• Completely dissolvable- uncaging of vessel 
– Feasible for future CABG options 
• Permits assessment with non-invasive CT 
angiography 
BRS: Late Lumen Enlargement 
P W Serruys at TCT 2013 
Porcine Model-IVUS: Increase in Lumen 
area: BVS vs EES after 12mths 
JP Lane et al. JACCIntv 2014; 7: june online 
70 pigs with 109 BVS and 70 EES implanted in various arteries; 
Serial angio, IVUS and histomorphometry at various timepoints 1-42 mths 
Porcine IVUS : Increase in lumen area after 
 12mth & pulsatility with BVS vs EES after 6mth 
JP Lane et al. JACCIntv 2014; 7: june online 
Plaque Sealing with BRS 
P W Serruys at TCT 2013 
BVS Case Illustration 
RCA-RAO view showing 
Severe tortuosity 
2 
RCA tortuosity ++ 
-LAO cranial view 
1 
Final post BVS - LAO cranial 
4 
Trackability of BVS 
3 
3 Gen DES & BVS for LAD long CTO 
Synergy Tracking Pre PCI CTO Prox LAD - BVS 
Final Angio & 9mth follow-up 
Final 9 mths angio 
ABSORB Cohort A: MACE to 5 years 
Y Onuma et al. JACCIntv 2013; 6:999-1009 
30 patient Cohort 
No MACE beyond 6 months 
No cardiac deaths 
No Stent Thrombosis 
All 18 pts with MSCT at 5yrs 
show patent Scaffolds 
Why do we need to implant 
BVS in ACS? 
• Younger patients, less Coro Atherosclerosis 
– Free patients from permanent stents 
• Does not obviate CABG for long lesions. 
• ? Long term reduction in need for antiplatelet Rx. 
• ? Safety to stop all antiplatelets temporarily for 
surgical procedures. 
• ? Plaque sealing of vulnerable plaques. 
V Kocka et al. EHJ 2014l 35: 787-94 
142 ppci pts 
3 groups 
Non randomised 
Baseline Characteristics 
V Kocka et al. EHJ 2014l 35: 787-94 
Prague 19: MACE outcomes at 6 mths 
V Kocka et al. EHJ 2014l 35: 787-94 
BRS in ACS Trials & Registries 
Trial Active 
arm n 
MACE 
ST Control n 
(non 
random) 
MACE ST p 
STEMI-First 49 2.6% 
 @ 30 days 
0 123 
PRAGUE-19 
 STEMI 
41 5% 
 @ 6 mths 
1 57 93% - 0.6 
Kajima-
NUHCS 
 STEMI 
11 9.1% 
 @ 53 days 
- 
T Gori-ACS 
UAP,NSTEMI-
STEMI 
150 10-7% 
 @ 30 days 
3 103 15.5% 2 >0.8 
J Weibe- 
 STEMI 
25 8.3% 
@ 137 days 
0 - 
C Naber @ TCT 2014 
Proportion of ACS patients in 
ABSORB FIRST 
C Naber @ TCT 2014 
Cardiac Death & MI to 30 days 
C Naber @ TCT 2014 
ABSORB II 
BVS VS EES 
1yr secondary 
clinical outcomes 
PW Serruys et al. Lancet; online 14 Sept 2014 
501 pt, 2:1 BVS : EES 
Randomised Multicentre 
ABSORB II at 1yr: 
Secondary MACE Endpoints 
PW Serruys et al. Lancet; online 14 Sept 2014 
Absorb 
N=335 
EES 
N=166 P=0.28 
R Dilleti @ BRS 2014 
A Arbb-Zadeh et al. Circ 2012; 25: 1147-56 
Should we stent the Vulnerable Plaque? 
GW Stone et al. NEJM 2011; 364: 226-35 
PROSPECT STUDY 
GW Stone @ BRS 2014 
GW Stone @ BRS 2014 
GDMT=guideline determined med therapy 
ABSORB II at 1yr: Stent Thrombosis 
(Define or Probable) 
PW Serruys et al. Lancet; online 14 Sept 2014 
Absorb 
N=335 
EES 
N=166 
P=0.55 
Ghost Multicentre Registry-1189 patients 
Def/Prob Scaffold Thrombosis to 6 mths 
D Capodanno et al. EuroIntv 2014 July online 
ST= 1.5% at 30 days, 2.1% at 6 mths 
Conclusions : BRS in ACS 
• BRS implantation seems feasible in ACS patients. 
• Stent thrombosis seems to be of some concern in 
nonrandomised real-world BRS studies 
– appears higher than latest generation of DES. 
• Vessel sizing important to prevent malapposition. 
• Better low profile device needed. 
• Major randomised BRS studies in ACS needed, with 
hard clinical endpoints. 
 21st to 24th January 2015
Thank You 
C Tamburino @ TCT 2014 
DES with angio efficacy data 
S Windecker , P Kolh et al. EHJ 2014; 35: 2541-2619 
Biosolve I: Vasoreactivity at 6 mths 
M Haude at EuroPCR may 2014 

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