Acute coronary syndrome: an ideal scenario for direct Absorb implantation?

Abstract

Implantation of the drug-eluting bioresorbable vascular scaffold (BVS) (Abbott Vascular, Santa Clara, CA, USA) has been shown to be safe and may offer additional advantages compared to metallic stent implantation. However, due to the specific features of the platform (strut thickness — 152 μm, crossing profile — 1.4 mm) and the high rate of scaffold thrombosis reported, it has been strongly recommended that lesion preparation through predilation and systematic postdilation with proper device sizing be performed prior to BVS implantation. Nevertheless, the characteristics of the treated lesions vary depending on the clinical setting. Our group confirmed the feasibility and safety of direct implantation in favorable lesions: in acute coronary syndromes (ACS), the success rate was 88%, and in stable patient lesions (selected by prior intravascular ultrasound), the success rate was 84%. In the ACS setting, where the plaque is soft and the struts are easily embedded, direct implantation should not be an issue.