Invasive sealing of vulnerable, high-risk lesions

Recent developments in intravascular imaging have permitted more accurate assessment of plaque vulnerability, while advances in computed tomographic coronary angiography (CTCA) have allowed noninvasive assessment of plaque morphology and identification of high-risk plaques. An invasive sealing of high-risk vulnerable lesions can be justified only if the endovascular devices used for this purpose are effective and safe. This chapter discusses the evidence supporting the role of Absorb bioresorbable vascular scaffolds (BVSs) in sealing high-risk plaques. Histology-based studies in porcine arteries have allowed detailed assessment of the vessel wall response following Absorb BVSs implantation. Scaffold implantation promotes the development of a thick layer of fibromuscular neo-tissue that has features associated with plaque stability while at long-term follow-up the deployed scaffold is fully resorbed liberating the vessel from its cage. The technical developments permitted detailed reconstruction and evaluation of the local hemodynamic micro-environment in segments implanted with Absorb BVS.