Hybrid metal/scaffold-jacket versus full-metal jackets in left anterior descending coronary artery diffuse disease: Differences in radiation exposure and fluoroscopic/procedural times.

Background/purpose: Bioabsorbable vascular scaffolds (BVS) are made from a radiolucent material. Their multiple implantations on a single long diffused segment requires a specific technique with imaging magnification, which could cause an increase in dose delivered during percutaneous coronary intervention (PCI) procedure. We aimed to identify differences in radiation dose, fluoroscopy and procedural times in Hybrid DES+ multiple BVS (Absorb, Abbott Inc., USA) implantation (hybrid metal/scaffold jacket) versus multiple III generation Drug-eluting stents (DES) (full-metal jacket) in patients with long and diffuse coronary artery disease of the left anterior descending (LAD) coronary artery.

Methods/materials: Patients with long and diffuse LAD disease were enrolled in a registry from 1st February 2015 to 1st February 2017. Patients treated with hybrid DES/BVS (at least three) jacket (n=72 procedure) were compared with a 2:1 matched cohort of exclusive multiple overlapped DES (full-metal jacket) patients in the same period (n=114 procedures).

Results: Patients had similar baseline characteristics due to matching. Radiation exposure (6035.7±2846.8 vs 4251.1±1787.3cGy∗cm, p<0.0001, Δ=1784.5±1055.6), fluoroscopy time (16.2±4.5 vs 9.1±2.4, p<0.0001) and procedure time (64.2±18.5 vs 5 8.7±13.5, p=0.02) were higher in patients treated using hybrid metal/scaffold jacket compared that regular full-metal jacket.

Conclusion: The use of hybrid metal/scaffold jacket for the treatment of long and diffuse disease of LAD is associated with a higher fluoroscopy time and radiation exposure compared to full-metal jacket, quantifiable in approximately 35%.