Coronary magnetic resonance imaging after routine implantation of bioresorbable vascular scaffolds allows non-invasive evaluation of vascular patency

PLoS One. 2018 Jan 25;13(1):e0191413. doi: 10.1371/journal.pone.0191413. eCollection 2018.

Abstract

Background: Evaluation of recurrent angina after percutaneous coronary interventions is challenging. Since bioresorbable vascular scaffolds (BVS) cause no artefacts in magnetic resonance imaging (MRI) due to their polylactate-based backbone, evaluation of vascular patency by MRI might allow for non-invasive assessment and triage of patients with suspected BVS failure.

Methods: Patients with polylactate-based ABSORB-BVS in proximal coronary segments were examined with 3 Tesla MRI directly (baseline) and one year after implantation. For assessment of coronary patency, a high-resolution 3D spoiled gradient echo pulse sequence with fat-saturation, T2-preparation (TE: 40 ms), respiratory and end-diastolic cardiac gating, and a spatial resolution of (1.08 mm)3 was positioned parallel to the course of the vessel for bright blood imaging. In addition, a 3D navigator-gated T2-weighted variable flip angle turbo spin echo (TSE) sequence with dual-inversion recovery black-blood preparation and elliptical k-space coverage was applied with a voxel size of (1.14 mm)3. For quantitative evaluation lumen diameters of the scaffolded areas were measured in reformatted bright and black blood MR angiography data.

Results: 11 patients with implantation of 16 BVS in the proximal coronary segments were included, of which none suffered from major adverse cardiac events during the one year follow up. Vascular patency in all segments implanted with BVS could be reliably assessed by MRI at baseline and after one year, whereas segments with metal stents could not be evaluated due to artefacts. Luminal diameter within the BVS remained constant during the one year period. One patient with atypical angina after BVS implantation was noninvasively evaluated showing a patent vessel, also confirmed by coronary angiography.

Conclusions: Coronary MRI allows contrast-agent free and non-invasive assessment of vascular patency after ABSORB-BVS implantation. This approach might be supportive in the triage and improvement of diagnostic workflows in patients with postinterventional angina and scaffold implantation.

Trial registration: German Register of Clinical Studies DRKS00007456.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Absorbable Implants* / adverse effects
  • Aged
  • Angina Pectoris / diagnostic imaging*
  • Angina Pectoris / etiology*
  • Humans
  • Imaging, Three-Dimensional / methods
  • Magnetic Resonance Angiography / methods*
  • Middle Aged
  • Percutaneous Coronary Intervention / adverse effects*
  • Polyesters
  • Tissue Scaffolds / adverse effects
  • Tissue Scaffolds / chemistry
  • Vascular Patency*

Substances

  • Polyesters
  • poly(lactide)

Associated data

  • figshare/7730401ca3eb19713613

Grants and funding

This work was supported by a grant from the European Society of Cardiology & Böringer Ingelheim (Timo Heidt, Constantin von zur Mühlen and Michael Bock), a grant from the German Research Foundation (DFG) under grant number BO 3025/2-2 (Michael Bock), and a grant from ABBOTT Vascular (Constantin von zur Mühlen and Michael Bock). The funder provided support in the form of salaries for TP, but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section.