Original title: Incidence and Short-Term Clinical Outcomes of Small Side Branch Occlusion Alter Implantation of an Everolimus-Eluting Bioresorbable Vascular Scaffold Reference: Takashi Muramatsu et al. J Am Coll Cardiol Intv 2013;6:247–57.

Small Side Branch Occlusion (SBO) during coronary angioplasty has been associated with periprocedural infarction. Among the factors that cause SBO are carina displacement, plaque displacement and artery rectification. Drug eluting first generation stents presented a better incidence of SBO compared to the newer ones and this may be associated to the thicker struts. Bioresorbable vascular scaffolds present thicker struts and this may be compromising side branches more frequently. A post-hoc analysis was performed including 435 patients with 1,209 SBO that received the Absorb stent (Abbott Vascular, Santa Clara, California) and 237 patients with 682 SBO that received the Xience V stent (Abbott Vascular, Santa Clara, California). Both devices are everolimus eluting. SBO was defined as a 0 to 1 TIMI flow.

The angiographic characteristics of secondary branches were similar. In the multivariable analysis SB was associated to the length and degree of the main branch obstruction, its localization in the side branch, ostial lesions of side branches and the use of the Absorb stent (odds ratio: 2.09, 95% CI: 1.18 a 3.68, p=0.01).

Conclusion 

Bioresorbable stents were associated with a greater side branch occlusion; this effect was more frequent in smaller secondary branches with ≤0.5 mm reference diameter.

Editorial Comment 

This analysis shows that Bioresorbable stents Absorb present a greater incidence of occlusion of the smaller side branches and this effect may be associated to the thicker struts that are of 157 micras, much thicker than the Xience. However, greater occlusion of the secondary branches was significant only for those with a reference diameter of ≤0.5 mm, which reduces its clinical relevance. 

Cortesy of Dr Carlos Fava
Interventional Cardiology
Favaloro Foundation. Argentina. 

Dr. Carlos Fava para SOLACI.ORG