Introduction
Introduction of new technologies
Lesion selection
Absorb extend-like lesions | Exclusion |
---|---|
‘de novo’ lesions | Left main |
Diameter 2.3–3.8 mm | Arterial or venous grafts |
Length max. 28 mm | In-stent restenosis |
One BVS scaffold overlap | Chronic total occlusion |
Maximum 2 lesions | Ostial lesions |
Stable, unstable or silent ischaemia | Bifurcation lesions with side branches ≥ 2 mm diameter |
Excessive calcification | |
High tortuosity | |
Visible thrombus | |
(N)STEMI | |
LVEF < 30 % |
Appropriate | Absorb A/B and Extend-like lesions: ‘de novo’ lesions, max. length 28 mm, one stent overlap, max. 2 lesions |
Probably appropriate, early evidence | ACS patients, long lesions (> 28 mm), calcified lesions with proper lesion preparation (diameter stenosis < 40 % after preparation), provisional bifurcation treatment (including fenestration into side branch) |
Uncertain | Bifurcations requiring a two scaffold approach |
Chronic total occlusion with subintimal crossing | |
Extensively calcified lesions where aggressive lesion preparation is necessary | |
Off-label | In-stent restenosis |
Arterial and venous grafts | |
Vessels > 4.0 mm in diameter |
Patient selection
Optimal | Young patients or with good life expectancy (i.e. > 5 years) | Age < 70 years or Age 70–80 with maximum 1 of PAD, COPD, CVA, renal failure, DM, BMI > 40 or LVEF < 40 % |
No potential benefit to be expected | Limited life expectancy (i.e. < 1 or 2 years) | Cardiogenic shock, severe heart failure (EF < 30 %), dialysis |