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03-01-2024 | Intravascular Ultrasound | Original Paper

Safety and efficacy of everolimus-eluting bioresorbable vascular scaffold for cardiac allograft vasculopathy (CART)

Authors: Michele Pighi, Fabrizio Tomai, Simone Fezzi, Gabriele Pesarini, Alessandro Petrolini, Leonardo Spedicato, Giuseppe Tarantini, Marco Ferlini, Paolo Calabrò, Bruno Loi, Valeria Ferrero, Maria Natalia Tovar Forero, Joost Daemen, Flavio Ribichini

Published in: Clinical Research in Cardiology | Issue 7/2024

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Abstract

Background

Cardiac allograft vasculopathy (CAV) is still the main drawback of heart transplantation (HTx) and percutaneous coronary intervention (PCI) is a palliative measure because of the high incidence of failure.

Objective

This study aimed to investigate the safety and efficacy of bioresorbable scaffolds (BRSs) as potential novel therapeutic tool for the treatment of coronary stenoses in CAV.

Methods

This is a multicenter, single-arm, prospective, open-label study (CART, NCT02377648), that included patients affected by advanced CAV treated with PCI and second-generation ABSORB BRS (Abbott Vascular). The primary endpoint was the incidence of 12-month angiographic in-segment scaffold restenosis (ISSR). Secondary endpoints were the incidence of major adverse cardiac events (MACEs) at 12- and 36-month follow-up and the incidence of ISSR at 36 months. A paired intracoronary imaging analysis at baseline and follow-up was also performed.

Results

Between 2015 and 2017 35 HTx patients were enrolled and treated for 44 coronary lesions with 51 BRSs. The primary endpoint occurred in 13.5% of the lesions (5/37), with a cumulative ISSR rate up to 3 years of 16.2% (6/37). Angiographic lumen loss was 0.40 ± 0.62 mm at 12 months and 0.53 ± 0.57 mm at 36 months. Overall survival rate was 91.4% and 74.3%, and MACEs incidence 14.2% and 31.4% at 12 and 36 months, respectively. At the paired intracoronary imaging analysis, a significant increase of the vessel external elastic membrane area in the treated segment and some progression of CAV proximally to the BRS were detected.

Conclusions

BRS-based PCI for the treatment of CAV is feasible and safe, with an ISSR incidence similar to what reported in retrospective studies with drug-eluting stents.

Graphical abstract

Appendix
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Literature
2.
go back to reference Tremblay-Gravel M, Racine N, De Denus S et al (2017) Changes in outcomes of cardiac allograft vasculopathy over 30 years following heart transplantation. JACC Hear Fail 5:891–901CrossRef Tremblay-Gravel M, Racine N, De Denus S et al (2017) Changes in outcomes of cardiac allograft vasculopathy over 30 years following heart transplantation. JACC Hear Fail 5:891–901CrossRef
4.
go back to reference Chih S, Chong AY, Mielniczuk LM et al (2016) Allograft vasculopathy the achilles’ heel of heart transplantation. J Am Coll Cardiol 68:80–91CrossRefPubMed Chih S, Chong AY, Mielniczuk LM et al (2016) Allograft vasculopathy the achilles’ heel of heart transplantation. J Am Coll Cardiol 68:80–91CrossRefPubMed
24.
go back to reference Tomai F, Adorisio R, De Luca L et al (2014) Coronary plaque composition assessed by intravascular ultrasound virtual histology: association with long-term clinical outcomes after heart transplantation in young adult recipients. Catheter Cardiovasc Interv 83:70–77. https://doi.org/10.1002/ccd.25054CrossRefPubMed Tomai F, Adorisio R, De Luca L et al (2014) Coronary plaque composition assessed by intravascular ultrasound virtual histology: association with long-term clinical outcomes after heart transplantation in young adult recipients. Catheter Cardiovasc Interv 83:70–77. https://​doi.​org/​10.​1002/​ccd.​25054CrossRefPubMed
29.
Metadata
Title
Safety and efficacy of everolimus-eluting bioresorbable vascular scaffold for cardiac allograft vasculopathy (CART)
Authors
Michele Pighi
Fabrizio Tomai
Simone Fezzi
Gabriele Pesarini
Alessandro Petrolini
Leonardo Spedicato
Giuseppe Tarantini
Marco Ferlini
Paolo Calabrò
Bruno Loi
Valeria Ferrero
Maria Natalia Tovar Forero
Joost Daemen
Flavio Ribichini
Publication date
03-01-2024
Publisher
Springer Berlin Heidelberg
Published in
Clinical Research in Cardiology / Issue 7/2024
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI
https://doi.org/10.1007/s00392-023-02351-9

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