Bioresorbable Vascular Scaffold - Procedures, Preparation, Cost, and Recovery

A Bioresorbable Vascular Scaffold (BVS) is an innovative medical device used in the treatment of coronary artery disease. Unlike traditional metal stents, which remain permanently in the body, bioresorbable scaffolds are designed to provide temporary support to the artery while allowing it to heal naturally. Over time, these scaffolds gradually dissolve and are absorbed by the body, leaving behind a restored artery without any permanent foreign material.

The procedure involves the insertion of the scaffold into a narrowed or blocked artery, typically through a minimally invasive technique known as percutaneous coronary intervention (PCI). During this procedure, a catheter is guided through the blood vessels to the site of the blockage. Once in place, the scaffold expands to hold the artery open, allowing blood to flow freely. The primary purpose of a BVS is to treat conditions such as atherosclerosis, where plaque buildup narrows the arteries, leading to reduced blood flow and potential heart complications.

Bioresorbable scaffolds are particularly beneficial for patients who may require future interventions, as their temporary nature allows for more treatment options down the line. They are also thought to reduce the risk of late stent thrombosis, a serious complication associated with permanent stents, where a blood clot forms on the stent long after the initial procedure.

Why is Bioresorbable Vascular Scaffold Done?

The Bioresorbable Vascular Scaffold procedure is typically recommended for patients experiencing symptoms of coronary artery disease. Common symptoms include chest pain (angina), shortness of breath, fatigue, and in some cases, heart attacks. These symptoms arise when the heart muscle does not receive enough oxygen-rich blood due to narrowed or blocked arteries.

The decision to perform a BVS procedure is often based on the severity of the patient's condition, as determined by diagnostic tests such as angiography, which visualizes the blood vessels, or stress tests that assess heart function. If these tests reveal significant blockages that could lead to serious complications, a BVS may be recommended to restore blood flow and alleviate symptoms.

In addition to symptomatic patients, BVS may also be indicated for those with stable coronary artery disease who are at risk of future cardiac events. The goal is to improve quality of life and reduce the likelihood of more severe heart issues down the line.

Indications for Bioresorbable Vascular Scaffold

Several clinical situations and diagnostic findings can make a patient a candidate for a Bioresorbable Vascular Scaffold. These include:

• Significant Coronary Artery Disease: Patients with moderate to severe blockages in one or more coronary arteries are prime candidates for this procedure. The degree of blockage is typically assessed through imaging studies.
• Angina Symptoms: Individuals experiencing recurrent chest pain or discomfort that limits their daily activities may be recommended for a BVS to relieve these symptoms.
• Acute Coronary Syndrome: Patients who have experienced a heart attack or unstable angina may require immediate intervention to restore blood flow and prevent further damage to the heart muscle.
• Previous Stent Failure: In cases where a traditional stent has failed or where there is a risk of restenosis (re-narrowing of the artery), a bioresorbable scaffold may be considered as an alternative.
• Younger Patients: Younger individuals or those with a longer life expectancy may benefit from a BVS due to its temporary nature, allowing for future treatment options without the complications associated with permanent stents.
• Diabetes: Patients with diabetes often have more complex coronary artery disease and may be at higher risk for complications. A BVS can provide a safer option for these patients.
• Complex Lesions: Certain types of arterial blockages, such as those located in bifurcations (where arteries split) or those that are long and diffuse, may be better treated with a bioresorbable scaffold.

Types of Bioresorbable Vascular Scaffold

While there are various designs and materials used in bioresorbable scaffolds, they generally fall into two main categories based on their composition:

• Polymer-Based Scaffolds: These are made from biodegradable polymers that gradually dissolve in the body. They provide structural support to the artery while allowing for endothelial healing. Examples include the Absorb scaffold, which was one of the first bioresorbable scaffolds used in clinical practice.
• Metal-Based Scaffolds: Some newer designs incorporate metals that are bioresorbable, such as magnesium. These scaffolds offer the strength of metal while still being absorbed by the body over time.

Each type has its own set of advantages and potential drawbacks, and the choice of scaffold often depends on the specific clinical scenario and the patient's individual needs. As research continues, new designs and materials are being developed to enhance the effectiveness and safety of bioresorbable vascular scaffolds.

In conclusion, the Bioresorbable Vascular Scaffold procedure represents a significant advancement in the treatment of coronary artery disease. By providing temporary support to the arteries, it allows for natural healing while minimizing long-term complications associated with traditional stents. As with any medical procedure, it is essential for patients to discuss their options with their healthcare provider to determine the best course of action for their specific condition.

Contraindications for Bioresorbable Vascular Scaffold

While bioresorbable vascular scaffolds (BVS) offer innovative solutions for treating coronary artery disease, certain conditions may render a patient unsuitable for this procedure. Understanding these contraindications is crucial for ensuring patient safety and optimal outcomes.

• Allergic Reactions: Patients with known allergies to the materials used in bioresorbable scaffolds, such as polylactic acid or other polymers, should avoid this treatment. An allergic reaction could lead to severe complications.
• Severe Coronary Artery Disease: Individuals with extensive coronary artery disease, particularly those with multiple blockages or complex lesions, may not be ideal candidates. The scaffold may not adequately support the artery in such cases.
• Acute Myocardial Infarction: Patients experiencing a heart attack may require immediate intervention with traditional stents rather than bioresorbable scaffolds, which may not provide the necessary support during acute events.
• Uncontrolled Diabetes: Patients with poorly managed diabetes may have impaired healing and increased risk of complications, making them less suitable for bioresorbable scaffolds.
• Bleeding Disorders: Those with conditions that affect blood clotting or who are on anticoagulant therapy may face increased risks during and after the procedure.
• Pregnancy: Pregnant women are generally advised against undergoing procedures involving bioresorbable scaffolds due to potential risks to both the mother and the fetus.
• Infection: Active infections, particularly in the area where the procedure will be performed, can complicate the use of bioresorbable scaffolds and increase the risk of complications.
• Severe Renal Impairment: Patients with significant kidney dysfunction may not be suitable candidates, as their ability to process medications and recover from the procedure may be compromised.
• History of Stent Thrombosis: A previous history of stent thrombosis may indicate a higher risk of similar complications with bioresorbable scaffolds.
• Non-compliance: Patients who are unlikely to adhere to post-procedure care and follow-up appointments may not be suitable candidates, as proper management is crucial for the success of the treatment.

How to Prepare for Bioresorbable Vascular Scaffold

Preparation for a bioresorbable vascular scaffold procedure is essential to ensure a smooth process and successful outcome. Here are the steps patients should follow:

• Consultation with Healthcare Provider: Schedule a thorough consultation with your cardiologist or interventional cardiologist. Discuss your medical history, current medications, and any concerns you may have.
• Pre-Procedure Testing: Your doctor may recommend several tests, including:
  • Electrocardiogram (ECG): To assess heart rhythm and function.
  • Echocardiogram: To visualize heart structures and function.
  • Coronary Angiography: To evaluate the extent of coronary artery disease and determine the best approach for treatment.
• Medication Review: Inform your doctor about all medications you are taking, including over-the-counter drugs and supplements. You may need to stop certain medications, such as blood thinners, a few days before the procedure.
• Lifestyle Modifications: Adopt a heart-healthy lifestyle leading up to the procedure. This includes:
  • Eating a balanced diet rich in fruits, vegetables, whole grains, and lean proteins.
  • Engaging in regular physical activity, as advised by your healthcare provider.
  • Avoiding smoking and limiting alcohol consumption.
• Fasting Instructions: You may be instructed to fast for a certain period before the procedure, typically for at least 6-8 hours. This is to ensure your stomach is empty during the procedure.
• Transportation Arrangements: Since the procedure may involve sedation, arrange for someone to drive you home afterward. You may not be able to drive for at least 24 hours post-procedure.
• Post-Procedure Care Plan: Discuss the post-procedure care plan with your healthcare provider. Understand the importance of follow-up appointments and any lifestyle changes you may need to implement.
• Emotional Preparation: It’s normal to feel anxious before a medical procedure. Consider discussing your feelings with your healthcare team or a trusted friend or family member.

Bioresorbable Vascular Scaffold: Step-by-Step Procedure

Understanding the step-by-step process of receiving a bioresorbable vascular scaffold can help alleviate anxiety and prepare you for what to expect.

1. Pre-Procedure Preparation: On the day of the procedure, you will arrive at the hospital or outpatient center. After checking in, you will change into a hospital gown. An intravenous (IV) line will be placed in your arm to administer medications and fluids.
2. Anesthesia: You will receive a sedative to help you relax. In some cases, local anesthesia may be used to numb the area where the catheter will be inserted.
3. Accessing the Blood Vessel: The doctor will typically access a blood vessel in your wrist or groin. A small incision will be made, and a catheter (a thin, flexible tube) will be inserted into the blood vessel.
4. Guiding the Catheter: Using fluoroscopy (a type of real-time X-ray), the doctor will guide the catheter through your blood vessels to the site of the blockage in your coronary artery.
5. Balloon Angioplasty: Once the catheter is in place, a small balloon at the tip of the catheter will be inflated at the site of the blockage. This helps to open the artery and prepare it for the scaffold.
6. Deploying the Bioresorbable Scaffold: After the balloon has expanded the artery, the bioresorbable scaffold will be delivered through the catheter and positioned at the site of the blockage. The scaffold will then be expanded to hold the artery open.
7. Post-Deployment Assessment: The doctor will assess the placement of the scaffold using imaging techniques to ensure it is correctly positioned and functioning as intended.
8. Removing the Catheter: Once the scaffold is in place, the catheter will be carefully removed. Pressure will be applied to the insertion site to prevent bleeding.
9. Recovery: You will be moved to a recovery area where healthcare professionals will monitor your vital signs and overall condition. This monitoring typically lasts for a few hours.
10. Discharge Instructions: After recovery, you will receive instructions on how to care for yourself at home, including medications to take, signs of complications to watch for, and follow-up appointments.

Risks and Complications of Bioresorbable Vascular Scaffold

Like any medical procedure, the use of bioresorbable vascular scaffolds carries certain risks. Understanding these risks can help you make informed decisions about your treatment.

• Common Risks:
  • Bleeding: Minor bleeding at the catheter insertion site is common but usually resolves quickly.
  • Infection: There is a small risk of infection at the site of catheter insertion.
  • Allergic Reactions: Some patients may experience allergic reactions to the materials used in the scaffold or medications administered during the procedure.
• Cardiovascular Risks:
  • Restenosis: There is a possibility that the artery may become narrowed again after the scaffold is placed.
  • Thrombosis: A rare but serious risk is the formation of a blood clot within the scaffold, which can lead to a heart attack.
• Rare Complications:
  • Vascular Injury: Damage to the blood vessels during catheter insertion can occur, leading to complications that may require additional treatment.
  • Heart Attack: Although rare, there is a risk of a heart attack during or shortly after the procedure.
  • Stroke: In very rare cases, a stroke may occur due to embolism or other complications.
• Long-Term Risks:
  • Scaffold Degradation: While bioresorbable scaffolds are designed to dissolve over time, the rate of degradation can vary among patients, potentially leading to complications if the scaffold does not fully support the artery during the healing process.
• Patient-Specific Risks: Individual factors such as age, overall health, and the presence of other medical conditions can influence the likelihood of complications.

Recovery After Bioresorbable Vascular Scaffold

The recovery process after receiving a bioresorbable vascular scaffold (BVS) is generally smooth, but it varies from patient to patient. Most individuals can expect to stay in the hospital for one to two days post-procedure, depending on their overall health and any complications that may arise. During this time, healthcare providers will monitor your heart function and ensure that the scaffold is functioning as intended.

Expected Recovery Timeline:

• First Week: Patients may experience mild discomfort, swelling, or bruising at the catheter insertion site. Pain management is typically handled with over-the-counter medications. Light activities, such as walking, are encouraged to promote circulation.
• Weeks 2-4: Many patients can gradually resume normal activities, including returning to work, as long as their job does not involve heavy lifting or strenuous exercise. Follow-up appointments will be scheduled to monitor recovery and the effectiveness of the scaffold.
• 1-3 Months: By this time, most patients can return to their regular exercise routines, but it’s essential to consult with your healthcare provider before doing so. Cardiac rehabilitation programs may be recommended to help patients regain strength and endurance.
• 3-6 Months: The bioresorbable scaffold will begin to dissolve, and patients should notice improvements in their overall cardiovascular health. Regular check-ups will continue to ensure that the heart is functioning well.

Aftercare Tips:

• Follow your doctor’s instructions regarding medications, especially antiplatelet therapy, to prevent blood clots.
• Maintain a heart-healthy diet rich in fruits, vegetables, whole grains, and lean proteins.
• Stay hydrated and limit salt intake to manage blood pressure.
• Avoid smoking and limit alcohol consumption.
• Engage in light physical activity as advised by your healthcare provider.

When Normal Activities Can Resume:

Most patients can return to their normal daily activities within a few weeks, but high-impact sports or heavy lifting should be avoided for at least three months. Always consult your healthcare provider for personalized advice based on your recovery progress.

Benefits of Bioresorbable Vascular Scaffold

The bioresorbable vascular scaffold offers several key health improvements and quality-of-life outcomes for patients with coronary artery disease. Here are some of the primary benefits:

• Restoration of Natural Vessel Function: Unlike traditional metal stents, bioresorbable scaffolds dissolve over time, allowing the artery to regain its natural function and flexibility. This can lead to improved blood flow and reduced risk of long-term complications.
• Reduced Risk of Late Stent Thrombosis: BVS has a lower risk of late stent thrombosis compared to permanent metal stents. This is crucial for patients who may be at risk for blood clots forming around a foreign object in the body.
• Improved Quality of Life: Patients often report a better quality of life post-procedure, as the bioresorbable scaffold can alleviate symptoms of angina and improve exercise tolerance. This leads to increased physical activity and overall well-being.
• Less Need for Long-term Antiplatelet Therapy: Since the scaffold is designed to dissolve, patients may not need to remain on antiplatelet medications for as long as those with permanent stents, reducing the risk of bleeding complications.
• Aesthetic and Psychological Benefits: The absence of a permanent implant can provide psychological comfort to patients who are concerned about having a foreign object in their body.

Overall, the bioresorbable vascular scaffold represents a significant advancement in cardiovascular treatment, offering patients a promising option for managing coronary artery disease while minimizing long-term risks.

What is the Cost of a Bioresorbable Vascular Scaffold in India?

The cost of a bioresorbable vascular scaffold in India typically ranges from ₹1,00,000 to ₹2,50,000. Several factors can influence the overall cost of the procedure, including:

• Hospital Choice: Different hospitals may have varying pricing structures based on their facilities, expertise, and reputation.
• Location: Costs can differ significantly between urban and rural areas, with metropolitan hospitals generally charging more.
• Room Type: The choice of room (general ward, private room, or suite) can affect the total cost of hospitalization.
• Complications: If any complications arise during or after the procedure, additional treatments may be necessary, increasing the overall cost.

Apollo Hospitals offers several advantages, including state-of-the-art facilities, experienced medical professionals, and comprehensive care, which can enhance the overall patient experience. Additionally, the cost of bioresorbable vascular scaffolds in India is significantly lower than in Western countries, making it an affordable option for many patients seeking high-quality care.

For exact pricing and personalized information, we encourage you to contact Apollo Hospitals directly. Our team is here to assist you in understanding the costs and options available to you.

Frequently Asked Questions about Bioresorbable Vascular Scaffold

• What dietary changes should I make before undergoing a Bioresorbable Vascular Scaffold procedure?
  Before your Bioresorbable Vascular Scaffold procedure, it’s essential to maintain a heart-healthy diet. Focus on consuming fruits, vegetables, whole grains, and lean proteins. Avoid high-fat and high-sugar foods. Staying hydrated is also crucial. Consult your healthcare provider for personalized dietary recommendations.
• Can elderly patients safely undergo a Bioresorbable Vascular Scaffold procedure? 
  Yes, elderly patients can safely undergo a Bioresorbable Vascular Scaffold procedure. However, it’s essential to evaluate their overall health and any comorbidities. A thorough assessment by a cardiologist at Apollo Hospitals can help determine the best approach for elderly patients.
• Is it safe to have a Bioresorbable Vascular Scaffold if I am pregnant?
  If you are pregnant or planning to become pregnant, discuss your situation with your healthcare provider. While the Bioresorbable Vascular Scaffold is generally safe, individual circumstances may vary, and your doctor can provide tailored advice.
• Are there any pediatric cases where a Bioresorbable Vascular Scaffold is used?
  Bioresorbable Vascular Scaffolds are primarily designed for adults. However, in specific cases of congenital heart disease, they may be considered for pediatric patients. Consultation with a pediatric cardiologist at Apollo Hospitals is essential for personalized care.
• What should I do if I have a history of heart surgery and need a Bioresorbable Vascular Scaffold?
  If you have a history of heart surgery, it’s crucial to inform your healthcare provider. They will evaluate your medical history and determine if a Bioresorbable Vascular Scaffold is appropriate for your condition.
• How does obesity affect the Bioresorbable Vascular Scaffold procedure?
  Obesity can increase the risk of complications during and after the Bioresorbable Vascular Scaffold procedure. It’s essential to discuss your weight and any related health issues with your healthcare provider at Apollo Hospitals to ensure a safe and effective treatment plan.
• Can I undergo a Bioresorbable Vascular Scaffold procedure if I have diabetes? 
  Yes, patients with diabetes can undergo a Bioresorbable Vascular Scaffold procedure. However, managing blood sugar levels before and after the procedure is crucial for optimal recovery. Your healthcare team at Apollo Hospitals will provide guidance on managing diabetes during this time.
• What precautions should I take after receiving a Bioresorbable Vascular Scaffold?
  After receiving a Bioresorbable Vascular Scaffold, follow your doctor’s instructions regarding medications, diet, and activity levels. Regular follow-up appointments are essential to monitor your recovery and ensure the scaffold is functioning correctly.
• How long will I need to take medications after a Bioresorbable Vascular Scaffold procedure? 
  Patients typically need to take antiplatelet medications for a limited time after a Bioresorbable Vascular Scaffold procedure. Your healthcare provider at Apollo Hospitals will provide specific recommendations based on your individual case.
• What lifestyle changes should I consider after a Bioresorbable Vascular Scaffold?
  After a Bioresorbable Vascular Scaffold procedure, consider adopting a heart-healthy lifestyle. This includes regular exercise, a balanced diet, maintaining a healthy weight, and avoiding smoking. These changes can significantly improve your cardiovascular health.
• Is there a risk of complications with a Bioresorbable Vascular Scaffold?
  As with any medical procedure, there are risks associated with a Bioresorbable Vascular Scaffold, including bleeding, infection, or scaffold failure. However, these risks are generally low, and your healthcare team at Apollo Hospitals will take precautions to minimize them.
• How does the Bioresorbable Vascular Scaffold compare to traditional stents?
  The Bioresorbable Vascular Scaffold dissolves over time, allowing the artery to regain its natural function, while traditional stents remain permanently in place. This difference can lead to fewer long-term complications and a better quality of life for patients.
• Can I travel after receiving a Bioresorbable Vascular Scaffold?
  Most patients can travel after a Bioresorbable Vascular Scaffold procedure, but it’s essential to consult your healthcare provider first. They can provide guidance on when it’s safe to travel and any precautions you should take.
• What should I do if I experience chest pain after a Bioresorbable Vascular Scaffold?
  If you experience chest pain after receiving a Bioresorbable Vascular Scaffold, seek medical attention immediately. It’s crucial to rule out any complications and ensure your heart is functioning correctly.
• How does the cost of a Bioresorbable Vascular Scaffold in India compare to other countries?
  The cost of a Bioresorbable Vascular Scaffold in India is significantly lower than in Western countries, making it an affordable option for many patients. Apollo Hospitals offers high-quality care at competitive prices, ensuring patients receive excellent treatment without financial strain.
• What follow-up care is necessary after a Bioresorbable Vascular Scaffold procedure?
  Follow-up care is essential after a Bioresorbable Vascular Scaffold procedure. Patients will typically have regular check-ups to monitor heart health, assess the scaffold’s effectiveness, and adjust medications as needed. Your healthcare provider at Apollo Hospitals will guide you through this process.
• Can I continue my regular exercise routine after a Bioresorbable Vascular Scaffold?
  Most patients can resume light exercise within a few weeks after a Bioresorbable Vascular Scaffold procedure. However, it’s essential to consult your healthcare provider for personalized recommendations based on your recovery progress.
• What are the signs of a successful Bioresorbable Vascular Scaffold procedure? 
  Signs of a successful Bioresorbable Vascular Scaffold procedure include improved blood flow, reduced angina symptoms, and overall better cardiovascular health. Regular follow-up appointments will help monitor your progress and ensure the scaffold is functioning correctly.
• How can I manage stress after a Bioresorbable Vascular Scaffold procedure?
  Managing stress is crucial for heart health. Consider engaging in relaxation techniques such as yoga, meditation, or deep breathing exercises. Regular physical activity and maintaining a support network can also help reduce stress levels.
• What resources are available for patients considering a Bioresorbable Vascular Scaffold?
  Patients considering a Bioresorbable Vascular Scaffold can access various resources at Apollo Hospitals, including educational materials, support groups, and consultations with experienced healthcare professionals. Don’t hesitate to reach out for more information and support.

Conclusion

The bioresorbable vascular scaffold represents a significant advancement in the treatment of coronary artery disease, offering patients a promising option for improving heart health. With its unique ability to dissolve over time, it provides numerous benefits, including reduced long-term risks and improved quality of life. If you or a loved one is considering this procedure, it’s essential to speak with a medical professional to understand the best options for your individual health needs. Your journey to better heart health starts with informed decisions and expert guidance.