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Miyazaki T, Ruparelia N, Kawamoto H, Figini F, Latib A, Colombo A. Clinical outcomes following "off-label" versus "established" indications of bioresorbable scaffolds for the treatment of coronary artery disease in a real-world population. EUROINTERVENTION 2016; 11:1475-8. [PMID: 27107312 DOI: 10.4244/eijv11i13a286] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Our aim was to investigate one-year outcomes in patients treated with bioresorbable scaffolds (BRS) for "off-label" versus currently "established" indications. METHODS AND RESULTS Consecutive patients treated with BRS between May 2012 and September 2014 in two centres were retrospectively recruited. Patients who met inclusion criteria as defined by the ABSORB III study were allocated to the established indication group (ESTG; 21 patients with 35 lesions) and the remaining patients to the off-label group (OFLG; 168 patients with 225 lesions). Target vessel failure (TVF) and ischaemia-driven target lesion revascularisation (id-TLR) at one year were evaluated in both groups. Patients in the OFLG had a higher prevalence of diabetes mellitus and longer lesion length. Predilatation, post-dilatation and intracoronary imaging were conducted in the majority of patients. At one-year follow-up, TVF (0% vs. 7.8%, p=0.32) and id-TLR (0% vs. 4.5%, p=0.31) occurred only in the OFLG with no adverse events in the ESTG. Definite stent thrombosis occurred in two OFLG patients (1.3%). CONCLUSIONS In a real-world setting, the majority (88.9%) of patients were treated with BRS for off-label indications. Off-label use of BRS appears to be associated with an acceptable occurrence of outcomes considering the greater complexity of this patient group.
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Affiliation(s)
- Tadashi Miyazaki
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
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Özel E, Taştan A, Öztürk A, Özcan EE, Kilicaslan B, Özdogan Ö. Procedural and one-year clinical outcomes of bioresorbable vascular scaffolds for the treatment of chronic total occlusions: a single-centre experience. Cardiovasc J Afr 2016; 27:345-349. [PMID: 27078224 PMCID: PMC5408394 DOI: 10.5830/cvja-2016-033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 03/13/2016] [Indexed: 11/07/2022] Open
Abstract
Introduction The bioresorbable vascular scaffold system (BVS) is the latest fully absorbable vascular therapy system that is used to treat coronary artery disease. The BVS has been used in different coronary lesion subsets, such as acute thrombotic lesions, bifurcation lesions, ostial lesions and lesions originating from bypass grafts. However, data about the use of BVS in chronic total occlusions (CTO) are limited. We report our BVS experience for the treatment of CTOs in terms of procedural features and one-year clinical follow-up results. Methods An analysis was made of 41 consecutive patients with CTO lesions who were referred to our clinic between January 2013 and December 2014. A total of 52 BVS were implanted. An analysis was made of patient characteristics, procedural features [target vessel, BVS diameter, BVS length, post-dilatation rate, type of post-dilatation balloon, procedure time, fluoroscopy time, contrast volume, postprocedure reference vessel diameter (RVD), post-procedure minimal lesion diameter (MLD), type of CTO technique and rate of microcatheter use] and one-year clinical follow-up results [death, myocardial infarction, angina, coronary artery bypass graft (CABG), target-lesion revascularisation (TLR) and target-vessel revascularisation (TVR)]. Descriptive and frequency statistics were used for statistical analysis. Results The mean age of the patient group was 61.9 ± 9.7 years, 85.4% were male, and 51.2 % had diabetes. Prior myocardial infarction incidence was 65.9%, 56.1% of the patients had percutaneous coronary intervention and 17.1% had a previous history of CABG. The procedure was performed via the radial route in 24.3% of the patients. The target vessel was the right coronary artery in 48.7% of the patients. Post-dilatation was performed on the implanted BVS in 97.5% of the patients, mainly by non-compliant balloon; 87.8% of the BVS were implanted by the antegrade CTO technique. Mean procedure time was 92 ± 35.6 minutes. Mean contrast volume was 146.6 ± 26.7 ml. At one year, there were no deaths. One patient had lesionrelated myocardial infarction and needed revascularisation because of early cessation of dual anti-platelet therapy. Eleven patients had angina and five of them needed target-vessel revascularisation. Conclusions BVS implantation appeared to be effective and safe in CTO lesions but randomised studies with a larger number of patients and with longer follow-up times are needed
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Affiliation(s)
- Erdem Özel
- Cardiology Department, Tepecik Training and Research Hospital, Izmir, Turkey.
| | - Ahmet Taştan
- Cardiology Department, Sifa University, Izmir, Turkey
| | - Ali Öztürk
- Cardiology Department, Sifa University, Izmir, Turkey
| | | | - Baris Kilicaslan
- Cardiology Department, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Öner Özdogan
- Cardiology Department, Tepecik Training and Research Hospital, Izmir, Turkey
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Miyazaki T, Latib A, Ruparelia N, Kawamoto H, Sato K, Figini F, Colombo A. The use of a scoring balloon for optimal lesion preparation prior to bioresorbable scaffold implantation: a comparison with conventional balloon predilatation. EUROINTERVENTION 2016; 11:e1580-8. [DOI: 10.4244/eijv11i14a308] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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104
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Affiliation(s)
- Davide Capodanno
- Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy
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105
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Clinical outcomes following bioresorbable scaffold implantation in small vessels. Int J Cardiol 2016; 207:59-61. [PMID: 26797331 DOI: 10.1016/j.ijcard.2016.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 01/01/2016] [Indexed: 11/23/2022]
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106
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Tamburino C, Capranzano P, Gori T, Latib A, Lesiak M, Nef H, Caramanno G, Naber C, Mehilli J, Di Mario C, Sabaté M, Münzel T, Colombo A, Araszkiewicz A, Wiebe J, Geraci S, Jensen C, Mattesini A, Brugaletta S, Capodanno D. 1-Year Outcomes of Everolimus-Eluting Bioresorbable Scaffolds Versus Everolimus-Eluting Stents. JACC Cardiovasc Interv 2016; 9:440-9. [DOI: 10.1016/j.jcin.2015.10.042] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 09/30/2015] [Accepted: 10/27/2015] [Indexed: 10/22/2022]
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107
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Yew KL. The buddy balloon technique to release a sticky ABSORB bioresorbable vascular scaffold balloon post-scaffolding. Int J Cardiol 2016; 207:1-2. [DOI: 10.1016/j.ijcard.2016.01.121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Accepted: 01/05/2016] [Indexed: 11/28/2022]
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108
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Capodanno D. Armazones bioabsorbibles y regresión de la placa: subir el listón en la tierra prometida del tratamiento de restauración vascular. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2015.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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109
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Biscaglia S, Ugo F, Ielasi A, Secco GG, Durante A, D'Ascenzo F, Cerrato E, Balghith M, Pasquetto G, Penzo C, Fineschi M, Bonechi F, Templin C, Menozzi M, Aquilina M, Rognoni A, Capasso P, Di Mario C, Brugaletta S, Campo G. Bioresorbable Scaffold vs. Second Generation Drug Eluting Stent in Long Coronary Lesions requiring Overlap: A Propensity-Matched Comparison (the UNDERDOGS study). Int J Cardiol 2016; 208:40-5. [PMID: 26826788 DOI: 10.1016/j.ijcard.2016.01.202] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 01/13/2016] [Accepted: 01/14/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Randomized clinical trials on bioresorbable scaffolds (BRS) enrolled patients with simple coronary lesions. The present study was sought to give preliminary findings about safety of BRS implantation in overlap in long coronary lesions. METHODS From June 2012 to January 2015, we prospectively collected data from 162 consecutive patients receiving overlapping BRS implantation in the 16 participating institutions. We applied a propensity-score to match BRS-treated patients with 162 patients receiving second generation drug eluting stents (DES) in overlap. The primary endpoint was a device-oriented endpoint (DOCE), including cardiac death, target vessel myocardial infarction, and target lesion revascularization. RESULTS DOCE rate did not significantly differ between the two groups (5.6% in BRS group vs. 7.4% in DES group, HR 0.79, 95%CI 0.37-3.55, p=0.6). Also stent/scaffold thrombosis did not differ between groups (1.2% in BRS group vs. 1.9% in DES group, p=0.6). Occurrence of procedural-related myocardial injury was significantly higher in the BRS group (25% vs. 12%, p=0.001), although it was not related to DOCE (HR 1.1, 95%CI 0.97-1.2, p=0.2). Imaging techniques and enhanced stent visualization systems were significantly more employed in the BRS group (p=0.0001 for both). Procedure length, fluoroscopy time and contrast dye amount were significantly higher in the BRS group (p=0.001, p=0.001 and p=0.01, respectively). CONCLUSIONS Overlapping BRS utilization in long coronary lesions showed a comparable DOCE rate at 1year if compared to second generation DES. Further and larger studies are on demand to confirm our findings.
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Affiliation(s)
- Simone Biscaglia
- Cardiovascular Section, Medical Sciences Department, Azienda Ospedaliera Universitaria S.Anna, Ferrara, Italy.
| | - Fabrizio Ugo
- Interventional Cardiology, San Giovanni Bosco Hospital, Turin, Italy
| | - Alfonso Ielasi
- Cardiology Division, , Bolognini Hospital, Seriate, Italy
| | - Gioel Gabrio Secco
- Interventional Cardiology, Santi Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | | | - Fabrizio D'Ascenzo
- Dipartimento di Scienze Mediche, Divisione di Cardiologia, Città della Salute e della Scienza, Turin, Italy
| | | | - Mohammed Balghith
- King Saud Bin Abdulaziz University for Health Sciences, KACC, National Guard, Riyadh, ,Saudi Arabia
| | | | - Carlo Penzo
- Divisione di Cardiologia, Ospedale Civile, Mirano, Italy
| | - Massimo Fineschi
- U.O. Emodinamica, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Francesco Bonechi
- UOS Emodinamica, Ospedale San Giuseppe, Azienda USL 11, Empoli, Italy
| | - Christian Templin
- Department of Cardiology, University Heart Center, University Hospital Zürich, Zürich, Switzerland
| | - Mila Menozzi
- Department of Cardiovascular Disease, Infermi Hospital, Rimini, Italy
| | - Matteo Aquilina
- U.O. Cardiologia, Ospedale S. Maria delle Croci, Ravenna, Italy
| | - Andrea Rognoni
- Cardiologia 2, A.O.U. Maggiore della Carità, Novara, Italy
| | - Piera Capasso
- Division of Cardiology, San Giovanni Bosco Hospital, Turin, Italy
| | - Carlo Di Mario
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Salvatore Brugaletta
- Cardiology Department; Thorax Institute; IDIBAPS, University of Barcelona, Hospital Clinic, Barcelona, Spain
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Centola M, Lucreziotti S, Salerno-Uriarte D, Tresoldi S, Cannone G, Sponzilli C, Carugo S. Subacute recoil in bioresorbable vascular scaffold in a complex coronary lesion: A lesson from daily clinical practice. Int J Cardiol 2016; 203:995-6. [PMID: 26625328 DOI: 10.1016/j.ijcard.2015.11.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 11/16/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Marco Centola
- Division of Cardiology, Ospedale San Paolo, University of Milan, Italy.
| | | | | | - Silvia Tresoldi
- Division of Radiology, Ospedale San Paolo, University of Milan, Italy
| | - Gaspare Cannone
- Division of Cardiology, Ospedale San Paolo, University of Milan, Italy
| | - Carlo Sponzilli
- Division of Cardiology, Ospedale San Paolo, University of Milan, Italy
| | - Stefano Carugo
- Division of Cardiology, Ospedale San Paolo, University of Milan, Italy
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Sabaté M, Windecker S, Iñiguez A, Okkels-Jensen L, Cequier A, Brugaletta S, Hofma SH, Räber L, Christiansen EH, Suttorp M, Pilgrim T, Anne van Es G, Sotomi Y, García-García HM, Onuma Y, Serruys PW. Everolimus-eluting bioresorbable stent vs. durable polymer everolimus-eluting metallic stent in patients with ST-segment elevation myocardial infarction: results of the randomized ABSORB ST-segment elevation myocardial infarction-TROFI II trial. Eur Heart J 2016; 37:229-40. [PMID: 26405232 PMCID: PMC4712350 DOI: 10.1093/eurheartj/ehv500] [Citation(s) in RCA: 174] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 08/26/2015] [Accepted: 08/28/2015] [Indexed: 11/13/2022] Open
Abstract
AIMS Patients with ST-segment elevation myocardial infarction (STEMI) feature thrombus-rich lesions with large necrotic core, which are usually associated with delayed arterial healing and impaired stent-related outcomes. The use of bioresorbable vascular scaffolds (Absorb) has the potential to overcome these limitations owing to restoration of native vessel lumen and physiology at long term. The purpose of this randomized trial was to compare the arterial healing response at short term, as a surrogate for safety and efficacy, between the Absorb and the metallic everolimus-eluting stent (EES) in patients with STEMI. METHODS AND RESULTS ABSORB-STEMI TROFI II was a multicentre, single-blind, non-inferiority, randomized controlled trial. Patients with STEMI who underwent primary percutaneous coronary intervention were randomly allocated 1:1 to treatment with the Absorb or EES. The primary endpoint was the 6-month optical frequency domain imaging healing score (HS) based on the presence of uncovered and/or malapposed stent struts and intraluminal filling defects. Main secondary endpoint included the device-oriented composite endpoint (DOCE) according to the Academic Research Consortium definition. Between 06 January 2014 and 21 September 2014, 191 patients (Absorb [n = 95] or EES [n = 96]; mean age 58.6 years old; 17.8% females) were enrolled at eight centres. At 6 months, HS was lower in the Absorb arm when compared with EES arm [1.74 (2.39) vs. 2.80 (4.44); difference (90% CI) -1.06 (-1.96, -0.16); Pnon-inferiority < 0.001]. Device-oriented composite endpoint was also comparably low between groups (1.1% Absorb vs. 0% EES). One case of definite subacute stent thrombosis occurred in the Absorb arm (1.1% vs. 0% EES; P = ns). CONCLUSION Stenting of culprit lesions with Absorb in the setting of STEMI resulted in a nearly complete arterial healing which was comparable with that of metallic EES at 6 months. These findings provide the basis for further exploration in clinically oriented outcome trials.
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Affiliation(s)
- Manel Sabaté
- Thorax Institute, University Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | | | | | | | | | - Salvatore Brugaletta
- Thorax Institute, University Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | | | | | | | | | | | - Gerrit Anne van Es
- Cardialysis B.V., Rotterdam, The Netherlands European Cardiovascular Research Institute (ECRI), Rotterdam, The Netherlands
| | - Yohei Sotomi
- The Heart Center, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Yoshinobu Onuma
- Cardialysis B.V., Rotterdam, The Netherlands Thorax Centre, Erasmus MC, PO Box 2125, 3000 CC Rotterdam, The Netherlands
| | - Patrick W Serruys
- European Cardiovascular Research Institute (ECRI), Rotterdam, The Netherlands International Center for Circulatory Health, NHLI, Imperial College, London, UK
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Azzalini L, L. L’Allier P, Tanguay JF. Bioresorbable Scaffolds: The Revolution in Coronary Stenting? AIMS MEDICAL SCIENCE 2016. [DOI: 10.3934/medsci.2016.1.126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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113
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Naganuma T, Ishiguro H, Panoulas VF, Fujino Y, Mitomo S, Kawamoto H, Nakamura S, Colombo A. Which child catheter should we choose to deliver a bulky bioresorbable vascular scaffold? Int J Cardiol 2016; 203:781-2. [DOI: 10.1016/j.ijcard.2015.10.242] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 10/27/2015] [Indexed: 11/25/2022]
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114
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Capodanno D. Bioresorbable Scaffolds and Plaque Regression: Raising the Bar in the Promised Land of Vascular Restoration Therapy. ACTA ACUST UNITED AC 2015; 69:91-3. [PMID: 26725972 DOI: 10.1016/j.rec.2015.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 10/15/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Davide Capodanno
- Cardio-thoracic-vascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy.
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115
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Sorrentino S, De Rosa S, Ambrosio G, Mongiardo A, Spaccarotella C, Polimeni A, Sabatino J, Torella D, Caiazzo G, Indolfi C. The duration of balloon inflation affects the luminal diameter of coronary segments after bioresorbable vascular scaffolds deployment. BMC Cardiovasc Disord 2015; 15:169. [PMID: 26654975 PMCID: PMC4676860 DOI: 10.1186/s12872-015-0163-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 12/04/2015] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Adequate expansion is critical to achieve optimal Bioresorbable Vascular Scaffolds (BVS) apposition to the vessel wall. However, compared to metallic stents, BVS present different mechanical properties. Hence, slow deployment and maintenance of balloon inflation for at least 30" is recommended for BVS implantation. However, since no evidences are available demonstrating the superiority of a longer balloon dilatation time, the implantation technique is highly variable among different centers. METHODS A total of 24 BVS-treated lesions were included in the present analysis. After BVS deployment at 12 atmosphere (ATM) the balloon was rapidly deflated and scaffold expansion was documented with an angiogram. The same balloon was then inflated again and kept at 12 ATM for 30". Finally, a further angiogram was obtained to evaluate BVS expansion. Quantitative coronary angiography (QCA) was performed at each step. RESULTS A significant increase of minimal luminal diameter (MLD)-to-reference scaffold diameter (RSD) ratio (MLD to RSD Ration, MR-Ratio) from 0.70 ± 0.10 after initial stent deployment to 0.79 ± 0.10 after the 30"-long balloon dilation was observed (p < 0.001). Of note, this result was consistent across all sub-segments, as well as across almost all lesion subgroups. A substantial reduction in the prevalence of residual stenosis from 29 % to 17 % was registered after the 30"-long dilation. CONCLUSIONS Our results strongly support the maintenance of balloon inflation for at least 30" during BVS deployment to achieve optimal scaffold expansion and minimize the occurrence of residual stenosis.
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Affiliation(s)
- Sabato Sorrentino
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.
| | - Salvatore De Rosa
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.
| | - Giuseppe Ambrosio
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.
| | - Annalisa Mongiardo
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.
| | - Carmen Spaccarotella
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.
| | - Alberto Polimeni
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.
| | - Jolanda Sabatino
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.
| | - Daniele Torella
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.
| | - Gianluca Caiazzo
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.
| | - Ciro Indolfi
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy. .,URT-CNR, Magna Graecia University, Catanzaro, Italy. .,Department of Medical and Surgical Sciences and Director, URT Consiglio Nazionale delle Ricerche (CNR); Magna Graecia University, Catanzaro, 88100, Italy.
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Bioresorbable drug-eluting stent implantation technique: In search of a magic recipe. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2015; 16:439-40. [DOI: 10.1016/j.carrev.2015.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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117
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Fracture of Bioresorbable Vascular Scaffold After Side-Branch Balloon Dilation in Bifurcation Coronary Narrowings. Am J Cardiol 2015; 116:1045-9. [PMID: 26243578 DOI: 10.1016/j.amjcard.2015.07.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 07/03/2015] [Accepted: 07/03/2015] [Indexed: 11/21/2022]
Abstract
The possibility of strut fractures after bioresorbable vascular scaffold (BVS) treatment is a new problem associated with the use of this novel technology. There is little in vivo information regarding the effects of lateral dilation on BVS. The present study aimed to evaluate the effects of lateral balloon dilation after bioresorbable vascular scaffold implantation in the treatment of bifurcation lesions. From January 2012 to February 2015, 49 patients with bifurcation lesions who had been treated with BVS required balloon dilation of the side branch (SB). Optical coherence tomographic studies were performed in each of these patients. In 3 patients (6%), the optical coherence tomographic results met the criteria for rupture. Prolonged inflation using a noncompliant balloon with a diameter within the expansion limits of the device resolved the complication in all patients. The clinical course was favorable in all patients, and there were no inhospital deaths or myocardial infarctions. At 14 ± 8 months of follow-up, 2 patients with integrity of the BVS presented target lesion revascularization (4%). Another patient (2%) suffered a probable stent thrombosis 11 months after the procedure (myocardial infarction and death at home). The patients with the BVS rupture at the index procedure had a favorable clinical outcome, and the 6-month computed tomographic scan revealed maintenance of the initial good results. In conclusion, minor BVS rupture after 2.5-mm lateral balloon dilation may occur but is infrequent (6%). Prolonged balloon inflation of the main vessel may partially restore the geometry of the BVS.
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Bioresorbable vascular scaffold implantation in acute coronary syndromes: clinical evidence, tips and tricks. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2015; 11:161-9. [PMID: 26677353 PMCID: PMC4631727 DOI: 10.5114/pwki.2015.54006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 06/18/2015] [Accepted: 07/08/2015] [Indexed: 11/18/2022] Open
Abstract
Percutaneous coronary intervention (PCI) with a drug-eluting stent (DES) is routine treatment for patients with acute coronary syndromes (ACS). However, permanent metallic caging of the vessel has several shortcomings, such as side branch jailing and impossibility of late lumen enlargement. Moreover, DES PCI is affected by vasomotion impairment. In ACS a high thrombus burden and vasospasm lead to a higher risk of acute and late acquired stent malapposition than in stable patients. This increases the risk of acute, late and very late stent thrombosis. In this challenging clinical setting, the implantation of bioresorbable vascular scaffolds (BVS) could represent an appealing therapeutic option. Temporary vessel scaffolding has proved to have several advantages over metallic stent delivery, such as framework reabsorption, late lumen enlargement, side branch patency, and recovery of physiological reactivity to vasoactive stimuli. In the thrombotic environment of ACS, BVS implantation has the benefit of capping the thrombus and the vulnerable plaque. Bioresorbable vascular scaffolds also seems to reduce the incidence of angina during follow-up. Acute coronary syndromes patients may therefore benefit more from temporary polymeric caging than from permanent stent platform implantation. The aim of this review is to update the available knowledge concerning the use of BVS in ACS patients, by analyzing the potential pitfalls in this challenging clinical setting and presenting tricks to overcome these limitations.
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Sotomi Y, Suwannasom P, Tenekecioglu E, Tateishi H, Abdelghani M, Serruys PW, Onuma Y. Differential aspects between cobalt-chromium everolimus drug-eluting stent and Absorb everolimus bioresorbable vascular scaffold: from bench to clinical use. Expert Rev Cardiovasc Ther 2015; 13:1127-45. [DOI: 10.1586/14779072.2015.1089172] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Cortese B, Ielasi A, Varricchio A, Tarantini G, LaVecchia L, Pisano F, Facchin M, Gistri R, D’Urbano M, Lucci V, Loi B, Tumminello G, Colombo A, Limbruno U, Nicolino A, Calzolari D, Tognoni G, Defilippi G, Buccheri D, Tespili M, Corrado D, Steffenino G. Registro Absorb Italiano (BVS-RAI): an investigators-owned and -directed, open, prospective registry of consecutive patients treated with the Absorb™ BVS: study design. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2015; 16:340-3. [DOI: 10.1016/j.carrev.2015.05.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 05/24/2015] [Accepted: 05/28/2015] [Indexed: 12/22/2022]
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Kimura T, Kozuma K, Tanabe K, Nakamura S, Yamane M, Muramatsu T, Saito S, Yajima J, Hagiwara N, Mitsudo K, Popma JJ, Serruys PW, Onuma Y, Ying S, Cao S, Staehr P, Cheong WF, Kusano H, Stone GW. A randomized trial evaluating everolimus-eluting Absorb bioresorbable scaffolds vs. everolimus-eluting metallic stents in patients with coronary artery disease: ABSORB Japan. Eur Heart J 2015; 36:3332-42. [DOI: 10.1093/eurheartj/ehv435] [Citation(s) in RCA: 227] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 08/12/2015] [Indexed: 11/13/2022] Open
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Biscaglia S, Campo G, Tebaldi M, Tumscitz C, Pavasini R, Fileti L, Secco GG, Di Mario C, Ferrari R. Bioresorbable vascular scaffold overlap evaluation with optical coherence tomography after implantation with or without enhanced stent visualization system (WOLFIE study): a two-centre prospective comparison. Int J Cardiovasc Imaging 2015; 32:211-223. [PMID: 26323356 DOI: 10.1007/s10554-015-0756-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 08/26/2015] [Indexed: 11/29/2022]
Abstract
To assess if enhanced stent visualization (ESV)-guided implantation of overlapping bioresorbable vascular scaffold (BVS) is superior to angiography alone-guided implantation in the reduction of overlap length. WOLFIE is a two-centre prospective open study enrolling 30 patients treated with implantation of at least two overlapping BVS. In the first centre (London), BVS implantation was guided by conventional angiography, while in the second centre (Ferrara), an ESV system was systematically employed. The primary endpoint of the study was overlap length. Secondary endpoints were: stacked struts number, area, thickness, and amount of clusters. In the ESV-guided group, overlap length was significantly lower compared to angiography-guided group [0.9 (0.6-1.8) vs. 2.2 (1.3-3.2) mm, p = 0.02]. Similarly, all secondary endpoints were significantly reduced. ESV-guided implantation of overlapping BVS is safe and effective in minimizing both overlap length and number of stacked struts.
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Affiliation(s)
- Simone Biscaglia
- Cardiovascular Institute, Azienda Ospedaliera Universitaria S.Anna, Via Aldo Moro 8, Cona, Ferrara, FE, Italy.
| | - Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliera Universitaria S.Anna, Via Aldo Moro 8, Cona, Ferrara, FE, Italy.,LTTA Centre, Ferrara, Italy
| | - Matteo Tebaldi
- Cardiovascular Institute, Azienda Ospedaliera Universitaria S.Anna, Via Aldo Moro 8, Cona, Ferrara, FE, Italy
| | - Carlo Tumscitz
- Cardiovascular Institute, Azienda Ospedaliera Universitaria S.Anna, Via Aldo Moro 8, Cona, Ferrara, FE, Italy
| | - Rita Pavasini
- Cardiovascular Institute, Azienda Ospedaliera Universitaria S.Anna, Via Aldo Moro 8, Cona, Ferrara, FE, Italy
| | - Luca Fileti
- Cardiovascular Institute, Azienda Ospedaliera Universitaria S.Anna, Via Aldo Moro 8, Cona, Ferrara, FE, Italy
| | - Gioel G Secco
- Interventional Cardiology, Santi Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy.,NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Carlo Di Mario
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Roberto Ferrari
- Cardiovascular Institute, Azienda Ospedaliera Universitaria S.Anna, Via Aldo Moro 8, Cona, Ferrara, FE, Italy.,LTTA Centre, Ferrara, Italy.,Maria Cecilia Hospital, GVM Care & Research, E.S.: Health Science Foundation, Cotignola, Italy
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Jorge C, Dubois C. Clinical utility of platinum chromium bare-metal stents in coronary heart disease. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2015; 8:359-67. [PMID: 26345228 PMCID: PMC4556305 DOI: 10.2147/mder.s69415] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Coronary stents represent a key development for the treatment of obstructive coronary artery disease since the introduction of percutaneous coronary intervention. While drug-eluting stents gained wide acceptance in contemporary percutaneous coronary intervention practice, further developments in bare-metal stents remain crucial for patients who are not candidates for drug-eluting stents, or to improve metallic platforms for drug elution. Initially, stent platforms used biologically inert stainless steel, restricting stent performance due to limitations in flexibility and strut thickness. Later, cobalt chromium stent alloys outperformed steel as the material of choice for stents, allowing latest generation stents to be designed with significantly thinner struts, while maintaining corrosion resistance and radial strength. Most recently, the introduction of the platinum chromium alloy refined stent architecture with thin struts, high radial strength, conformability, and improved radiopacity. This review will provide an overview of the novel platinum chromium bare-metal stent platforms available for coronary intervention. Mechanical properties, clinical utility, and device limitations will be summarized and put into perspective.
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Affiliation(s)
- Claudia Jorge
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Christophe Dubois
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium ; Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
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