1st-in-Man Bioresorbable Scaffold in LIMA Graft
1st-in-Man Bioresorbable Scaffold in LIMA Graft
Bioresorbable vascular scaffold (BVS) has many advantages over metallic stents. The main advantage of the BVS in ostial lesions, as in our case, is that it reduces difficulty in re-engaging the vessel for future interventions if needed since there is no protrusion of struts after 2 years; however, the two technologies are similar in the initial 2 years from the index procedure until complete resorption of the scaffold. Similarly, if the BVS is deployed in a coronary artery with jailing of a major side branch, the patency of the jailed side branch may be recovered once the struts are completely resorbed. The other potential advantages include restoration of vasomotion and adaptive shear stress, reduction in late luminal enlargement and late or very late stent thrombosis, and the ability for non-invasive assessment (computed tomography or magnetic resonance imaging) of coronaries during follow-up since metallic stents produce excessive artifacts. It also facilitates future coronary percutaneous or surgical revascularization if required, since there will be no metallic cage once the scaffold is completely resorbed. In the future, this technology holds promise in pediatric patients as well, since it allows vessel growth and does not require eventual surgical removal of the implant. However, one of the major limitations of the BVS is its limited distensibility, which may lead to strut fracture if deployed at high pressure; therefore, the BVS should be implanted in an appropriately sized vessel.
Although this newer technology is in its infancy, it holds promise to revolutionize coronary interventions in the future. To the best of our knowledge, this is the first case reported with BVS in a LIMA-LAD graft.
Discussion
Bioresorbable vascular scaffold (BVS) has many advantages over metallic stents. The main advantage of the BVS in ostial lesions, as in our case, is that it reduces difficulty in re-engaging the vessel for future interventions if needed since there is no protrusion of struts after 2 years; however, the two technologies are similar in the initial 2 years from the index procedure until complete resorption of the scaffold. Similarly, if the BVS is deployed in a coronary artery with jailing of a major side branch, the patency of the jailed side branch may be recovered once the struts are completely resorbed. The other potential advantages include restoration of vasomotion and adaptive shear stress, reduction in late luminal enlargement and late or very late stent thrombosis, and the ability for non-invasive assessment (computed tomography or magnetic resonance imaging) of coronaries during follow-up since metallic stents produce excessive artifacts. It also facilitates future coronary percutaneous or surgical revascularization if required, since there will be no metallic cage once the scaffold is completely resorbed. In the future, this technology holds promise in pediatric patients as well, since it allows vessel growth and does not require eventual surgical removal of the implant. However, one of the major limitations of the BVS is its limited distensibility, which may lead to strut fracture if deployed at high pressure; therefore, the BVS should be implanted in an appropriately sized vessel.
Although this newer technology is in its infancy, it holds promise to revolutionize coronary interventions in the future. To the best of our knowledge, this is the first case reported with BVS in a LIMA-LAD graft.
