Dealing with bioresorbable vascular scaffolds (BVS) implantation in long lesions requiring device overlapping in this particular moment might seem a little provocative for several reasons. First, most studies testing BVS have focused on their safety and efficacy profile in simple patients with simple lesions. Second, ABSORB II did not meet its primary endpoint, while ABSORB III showed a higher rate of target vessel-myocardial infarction (TV-MI) at 2 years. Third, data on porcine model showed that overlapping zone has delayed but greater neointimal proliferation with consequent higher risk for scaffold thrombosis in the short-term and of in-scaffold restenosis in the long-term. Fourth, recently published data showed higher risk of TVF in patients treated with ≥60 mm BVS. Given all these premises, it may seem right to put aside this technology, while it may seem inappropriate to hypothesize the use of BVS in long lesions. The aim of the present review is precisely to critically review the available evidences regarding BVS with particular regard to overlapping BVS in order to understand whether this technology has a future per se and especially in long coronary lesions requiring overlap.
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机译:由于某些原因,在需要特定时间重叠器械的长病变中处理生物可吸收血管支架(BVS)植入似乎有些挑衅。首先,大多数测试BVS的研究都将重点放在其具有简单病变的简单患者的安全性和疗效方面。其次,ABSORB II未达到其主要终点,而ABSORB III在2年时显示出更高的目标血管-心肌梗塞(TV-MI)发生率。第三,关于猪模型的数据显示,重叠区域延迟了,但新内膜的增殖更大,因此短期内支架血栓形成的风险更高,长期内支架内再狭窄的风险更高。第四,最近发表的数据显示,≥60 mm BVS治疗的患者发生TVF的风险更高。在所有这些前提下,抛弃这项技术似乎是正确的,而假设在长病变中使用BVS似乎是不合适的。本综述的目的恰恰是严格地审查有关BVS的现有证据,特别是关于重叠BVS的知识,以便了解该技术本身是否有未来,尤其是在需要重叠的长冠状动脉病变中。
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