RT info:eu-repo/semantics/doctoralThesis
T1 Cambios estructurales y funcionales de las arterias coronarias tratadas con plataformas coronarias bioabsorbibles Absorb BVS
A1 Goncalves Ramírez, Luis Renier
A2 Universidad de Valladolid. Escuela de Doctorado
K1 Arterias coronarias - Anatomía
K1 Absorb
K1 Coronarias
K1 BVS
K1 Bioabsorbibles
K1 32 Ciencias Médicas
AB I-1.1- INTRODUCTION: The complete resorption of the Absorb BVS devices (Abbott Vascular, USA), as well as the structural and functional recovery of the coronary arteries, has not yet been definitively demonstrated in patients in daily clinical practice.I-1.2- OBJECTIVES: To analyse the morphological changes of coronary arteries after the reabsorption of Absorb BVS devices, as well as the state of endothelium-dependent and independent coronary vasoreactivity.I-1.3- METHOD: It was an ambispective, multicenter, non-randomized study that compared the morphological and functional aspects of the coronary arteries in two cohorts of patients who had been treated with Absorb BVS, one with a 3-year follow-up (Cohort 3) and another with a 5-year follow-up (Cohort 5). I-1.4- RESULTS: A total of 92 patients and 102 arterial segments treated with Absorb BVS were recruited and analysed in Cohort 3, obtaining a device/artery ratio of 1.3. Median follow-up time was 3.2 years [3.1 - 3.6], 3 cases of device thrombosis and 5 cases of restenosis were detected. Struts were identified in 80% of the coronary arteries evaluated with optical coherence tomography (OCT), showing signs of dismantling in 29% of cases. OCT showed a neointimal tissue with a fibrous pattern in 84% of cases. The acetylcholine (ACh) test showed that the endothelium-dependent vasomotor response was abolished in the segments treated with Absorb BVS. The nitroglycerin test (NTG) showed that endothelium-independent coronary vasomotion was also absent. Regarding Cohort 5, a total of 31 patients with 44 arterial segments treated with Absorb BVS devices were evaluated (Absorb BVS / artery ratio = 1.4), the mean follow-up was 60.5 ± 4.6 months, one late thrombosis of the device and one restenosis were found. No strut was identified on OCT, finding instead neointimal tissue with a fibrous pattern, concentric reduction of the luminal area (8.84 mm2 ± 1.6 vs. 6.64 mm2 ± 2.19, p<0.001) and stabilization of vulnerable plaques (56.5% vs. 16.7%, p<0.001). The ACh test confirmed the abolition of endothelium-dependent coronary vasoreactivity in the treated coronary segments, while the NTG test showed a blunted endothelium-independent response.I-1.5- CONCLUSIONS: The complete resorption of the Absorb BVS devices develops in a period between 4 and 5 years of follow-up. The luminal area is progressively reduced and acquires a concentric shape. Endothelial repair occurs through neointimal tissue with a fibrous appearance, which is functionally inert, since endothelium-dependent coronary vasoreactivity is abolished in the treated segments, while endothelium-independent coronary vasomotion is present, although decreased.
YR 2021
FD 2021
LK https://uvadoc.uva.es/handle/10324/60968
UL https://uvadoc.uva.es/handle/10324/60968
LA spa
NO Escuela de Doctorado
DS UVaDOC
RD 12-jul-2024