Abstract
Background: Computed tomography angiography (CTA) presents important limits in in-stent restenosis (ISR) evaluation in case of metallic coronary stents, due to the artifacts determined by stent struts, which alter in-stent plaque analysis. In case of bioresorbable scaffolds, stent strut resorption allows accurate evaluation of the vessel wall. Aim of the study: This study aims to compare the feasibility of CTA as a follow-up imaging method for ISR diagnosis following elective PTCA procedures, between bioresorbable scaffolds and metallic coronary stents.
Material and methods: We conducted a prospective, observational study on 73 patients with elective PTCA procedures in their medical history, in whom 113 stents were assessed via CTA in order to diagnose ISR. Based on stent type, the patients were divided into two groups: Group 1 – patients with bioresorbable vascular scaffolds (BVS) (n = 30); and Group 2 – patients with bare metal stents (BMS) (n = 43). Plaque analysis was possible only in the BVS group with a post-processing research-dedicated software, Syngo.via Frontier, which identified plaque morphology and virtual histology composition.
Results: After CTA evaluation, the BVS group presented a significantly higher incidence of severe coronary artery disease (CAD) (Group 1 – 73% vs. Group 2 – 30%, p <0.0001). The proximal part of the right coronary artery (RCA) presented a significantly higher percentage of metallic stents (14% BMS vs. 2% BVS, p = 0.0029). The comparative analysis of CTA sensibility for the visual evaluation of ISR identified a significantly higher percentage of diagnostic CT evaluations in the BVS group (Group 1 – 94% vs. Group 2 – 76.19%, p = 0.0006). CTA evaluation provided the most accurate results for the 3.0 and 3.5 mm devices. Regarding CTA sensibility for ISR diagnosis, the BVS group presented the smallest incidence of non-diagnostic CT evaluations.
Conclusions: CTA evaluation of bioresorbable scaffolds is superior to metallic stent assessment, the latter being influenced by numerous sources of error dependent mainly on the presence of the metal structure.