P2628OCT-assessment of scaffold resorption: analysis of strut intensity via the brs-resorb-index for poly-L-lactic acid bioresorbable vascular scaffolds

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Background: Resorption of bioresorbable vascular scaffolds is influenced by numerous factors. Purpose: The aim of this study was to analyze individual differences in resorption of BRS and identify factors potentially influencing the resorption process through optical coherence tomography (OCT) analysis. Methods: Between April 2016 and July 2017 clinically driven invasive coronary angiography and OCT were performed in 36 patients who had previously been treated with a total of 48 BRS. OCT-analysis was performed using QCU-CMS v4.69 OCT analysis software (Leiden University Medical Center, Leiden, Netherlands). Normalized light intensity (= Number of color pixels per BRS strut divided through number of color pixels per equivalent area in the adjacent intima) of each BRS strut was calculated using ImageJ 1.51j8 (National Institutes of Health, USA). Subsequently, the BRS-RESORB-INDEX (BRI) was calculated per scaffold (=Normalized light intensity x 1000 divided through time since BRS implantation (days)). Results: The mean time interval since implantation was 789±321 days (range: 380–1173). BRS struts were still discernible in all 48 BRS. Target lesion revascularization due to in-BRS restenosis was performed in 6 patients (17%) with 8 BRS (17%). Restenosis was characterized as mature neointima in all cases. Normalized light intensity as a marker for resorption of BRS struts increased with time in a linear fashion (Spearman Rho: p<0.001, correlation coefficient=0.90; R2 (linear) = 0.91). BRS resorption, as measured by the BRI, varied widely between different individuals (range: 0.09–0.85) but showed very little variability within different BRS implanted in one patient (inter-patient variance: 0.32±0.38, intra-patient variance: 0.02±0.06; p<0.001). Multivariable analysis identified diabetes (mean BRI of patients with diabetes vs. patients without diabetes: 0.34±0.13 vs. 0.58±0.22; p=0.002) and presence of PSLIA (peri-strut low intensity area) (mean BRI of patients with PSLIA vs. patients without PSLIA: 0.44±0.21 vs. 0.61±18; p=0.027) as independent predictors of prolonged BRS resorption, whereas the resorption rate in ACS patients (STEMI, NSTEMI and unstable angina; n=13) was significantly higher as compared to patients without ACS (mean BRI 0.62±0.17 vs. 0.43±0.24; p=0.012).

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