Acute Performance of the DynamX Bioadaptor in Complex Coronary Lesions: An Optical Coherence Tomography-based Evaluation

Background: The DynamX Coronary Bioadaptor System incorporates a novel uncaging element that disengages approximately 6 months post-implantation following polymer resorption, while preserving longitudinal structural integrity. This innovative design aims to address the limitations of conventional drug-eluting stents by facilitating restoration of physiological vessel function in the treated segment without compromising radial support. Methods: This retrospective study assessed the acute mechanical performance of the DynamX Bioadaptor in complex coronary lesions, as evaluated by optical coherence tomography (OCT) before and after DynamX implantation, with specific focus on lumen gain, device expansion, and strut apposition. Results: A total of 29 coronary lesions from 24 patients were retrospectively analysed by OCT. Pre-implantation plaque morphology revealed ruptured plaques in 34.5% of lesions and calcified plaques in 55%. An OCT-based calcium score of 3 or 4 was observed in nine lesions. Post-implantation OCT demonstrated an acute lumen gain of 1.37 ± 0.8 mm and a residual area stenosis of 14.7 ± 9%. The incidence of malapposed struts (strut-lumen distance >300 μm) was low (0.64 ± 1.34%). Edge dissections were observed in four lesions, with two (6.9%) requiring bailout stenting. Conclusion: The DynamX Bioadaptor showed favourable acute performance, achieving adequate lumen enlargement and optimal expansion and apposition in calcified and thrombotic lesion subsets, supporting its use in contemporary clinical practice.