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Rola P, Włodarczak A, Łanocha M, Barycki M, Szudrowicz M, Kulczycki JJ, Jaroszewska-Pozorska J, Gosiewska A, Woźnica K, Lesiak M, Doroszko A. Outcomes of the two generations of bioresorbable scaffolds (Magmaris vs. Absorb) in acute coronary syndrome in routine clinical practice. Cardiol J 2022; 30:VM/OJS/J/86514. [PMID: 35621089 PMCID: PMC10713223 DOI: 10.5603/cj.a2022.0047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 03/08/2022] [Accepted: 05/10/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Acute coronary syndrome (ACS) as a clinical manifestation of coronary artery disease (CAD) remains a significant cause of mortality and morbidity, as reported worldwide annually. The second generation of drug-eluting stents (DES) is a gold standard in percutaneous interventions in ACS patients however, permanent caging of the vessel with metallic DES has some drawbacks. Bioresorbable vascular scaffolds (BRS) were designed as a temporal vessel-supporting technology allowing for anatomical and functional restoration. Nevertheless, following the initial encouraging reports, numerous concerns about the safety of BRS occurred. METHODS In this study, a 1-year performance of 193 patients with magnesium BRS - Magmaris (Biotronik, Berlin, Germany) was evaluated in comparison to 160 patients with polymer BRS - Absorb (Abbott-Vascular, Chicago, USA) in the non-ST-segment elevation-ACS setting. RESULTS The Magmaris, when compared to Absorb showed a significantly lower rate of primary endpoint (death from cardiac causes, myocardial infarction, stent thrombosis) as well as target lesion failure in 30-day and 1 year follow-up. In the Absorb group, a significantly higher rate of stent thrombosis was observed. CONCLUSIONS Data from the present study suggests encouraging safety a profile and more favorable clinical outcomes of Magnesium BRS in comparison to the polymer Absorb - BRS.
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Affiliation(s)
- Piotr Rola
- Department of Cardiology, The Copper Health Center (MCZ), Lubin, Poland.
- Department of Cardiology, Provincial Specialized Hospital, Legnica, Poland.
| | - Adrian Włodarczak
- Department of Cardiology, The Copper Health Center (MCZ), Lubin, Poland
| | | | - Mateusz Barycki
- Department of Cardiology, Provincial Specialized Hospital, Legnica, Poland
| | - Marek Szudrowicz
- Department of Cardiology, The Copper Health Center (MCZ), Lubin, Poland
| | - Jan J Kulczycki
- Department of Cardiology, The Copper Health Center (MCZ), Lubin, Poland
| | | | - Alicja Gosiewska
- Faculty of Mathematics and Information Science, Warsaw University of Technology, Warsaw, Poland
| | - Katarzyna Woźnica
- Faculty of Mathematics and Information Science, Warsaw University of Technology, Warsaw, Poland
| | - Maciej Lesiak
- 1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Adrian Doroszko
- Department of Internal Medicine, Hypertension and Clinical Oncology, Wroclaw Medical University, Wroclaw, Poland
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Selvakumar PP, Rafuse MS, Johnson R, Tan W. Applying Principles of Regenerative Medicine to Vascular Stent Development. Front Bioeng Biotechnol 2022; 10:826807. [PMID: 35321023 PMCID: PMC8936177 DOI: 10.3389/fbioe.2022.826807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 01/17/2022] [Indexed: 11/16/2022] Open
Abstract
Stents are a widely-used device to treat a variety of cardiovascular diseases. The purpose of this review is to explore the application of regenerative medicine principles into current and future stent designs. This review will cover regeneration-relevant approaches emerging in the current research landscape of stent technology. Regenerative stent technologies include surface engineering of stents with cell secretomes, cell-capture coatings, mimics of endothelial products, surface topography, endothelial growth factors or cell-adhesive peptides, as well as design of bioresorable materials for temporary stent support. These technologies are comparatively analyzed in terms of their regenerative effects, therapeutic effects and challenges faced; their benefits and risks are weighed up for suggestions about future stent developments. This review highlights two unique regenerative features of stent technologies: selective regeneration, which is to selectively grow endothelial cells on a stent but inhibit the proliferation and migration of smooth muscle cells, and stent-assisted regeneration of ischemic tissue injury.
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Affiliation(s)
| | | | | | - Wei Tan
- University of Colorado Boulder, Boulder, CO, United States
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Tröbs M, Achenbach S, Nef HM, Gori T, Naber C, Neumann T, Richardt G, Schmermund A, Wöhrle J, Zahn R, Hamm CW. Everolimus eluting bioresorbable vascular scaffolds in patients with acute coronary syndromes: Two-year results from the German-Austrian ABSORB registry. Catheter Cardiovasc Interv 2021; 98:E564-E570. [PMID: 34137482 DOI: 10.1002/ccd.29831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/23/2021] [Accepted: 06/05/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To identify potential differences in 2-year outcome between patients who underwent coronary revascularization using bioresorbable vascular scafffolds (BVS) in stable coronary artery disease (CAD) and acute coronary syndromes (ACS). BACKGROUND Data from randomized trials suggest a significantly higher event rate following coronary revascularization using everolimus-eluting BVS as compared to new generation drug eluting stents. Whether particular patient subgroups are at increased risk for scaffold thrombosis and target lesion failure (TLF) has not clearly been demonstrated. METHODS German-Austrian ABSORB RegIstRy is a prospective all-comer multi-center observational study of consecutive patients who were considered for coronary revascularization with BVS. We compared 1499 patients with stable CAD to 1594 patients with ACS. Endpoints were major adverse cardiac events (MACE), TLF, and scaffold thrombosis. RESULTS While single vessel disease was more prevalent in ACS (46% vs. 37%, p < 0.0001), lesion complexity (B2/C stenosis 37% vs. 36%, bifurcation 2.4% vs. 3.4%, p < 0.05), number of implanted scaffolds/patient (1.34 vs. 1.43), scaffold length (18 vs. 18 mm) or the rate of high pressure postdilatation (68% vs. 70%) did not differ between ACS and stable CAD. Two-year MACE rates were 11.6% in ACS and 11.4% in stable CAD, TLF occurred in 7.0% versus 7.4% and target vessel revascularization in 8.8 versus 10.2% (n.s. for all). Definite scaffold thrombosis rates were not significantly different (ACS 1.9% vs. stable CAD 2.1%). CONCLUSION Real-world 2-year event rates after coronary revascularization with BVS are not significantly different between individuals with ACS as compared to stable CAD.
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Affiliation(s)
- Monique Tröbs
- Friedrich-Alexander Universität Erlangen-Nürnberg, Department of Cardiology, Erlangen, Germany
| | - Stephan Achenbach
- Friedrich-Alexander Universität Erlangen-Nürnberg, Department of Cardiology, Erlangen, Germany
| | - Holger M Nef
- Medizinische Klinik I, Department of Cardiology, University of Giessen, Giessen, Germany
| | - Tomasso Gori
- Department of Medicine II, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Christoph Naber
- Medizinische Klinik 1, Klinikum Wilhelmshaven, Wilhelmshaven, Germany
| | - Till Neumann
- Department of Cardiology, University of Essen, Essen, Germany
| | - Gert Richardt
- Herzzentrum, Segeberger Kliniken GmbH, Bad Segeberg, Germany
| | - Axel Schmermund
- CCB Cardioangiologisches Centrum, Bethanien Hospital, Frankfurt, Germany
| | - Jochen Wöhrle
- Department of Cardiology, Medical Campus Lake Constance, Friedrichshafen, Germany
| | - Ralf Zahn
- Abteilung für Kardiologie, Herzzentrum Ludwigshafen, Ludwigshafen, Germany
| | - Christian W Hamm
- Medizinische Klinik I, Department of Cardiology, University of Giessen, Giessen, Germany.,Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
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Šobot T, Šobot N, Bajić Z, Ponorac N, Babić R. Major adverse cardiovascular events after implantation of absorb bioresorbable scaffold: One-year clinical outcomes. SCRIPTA MEDICA 2021. [DOI: 10.5937/scriptamed52-34467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Background/Aim: Bioresorbable vascular scaffold (BVS) represents a novel generation of intracoronary devices designed to be fully resorbed after healing of the stented lesion, delivering antiproliferative drug to suppress restenosis, providing adequate diameter of the coronary vessel and preserving the vascular endothelial function. It was supposed that BVS will reduce neointimal proliferation and that their late bioresorption will reduce the negative effects of traditional drug-eluting stents, including the late stent thrombosis, local vessel wall inflammation, loss of coronary vasoreactivity and the need for the long-term dual antiplatelet therapy. The purpose of this research was to investigate efficacy and safety of Absorb everolimus-eluting BVS implantation and the prevalence of major adverse cardiovascular events (MACE) at the mid-term follow-up. Methods: The study encompassed 42 patients selected for BVS implantation and fulfilling inclusion criteria - 37 male and 5 female - admitted to the Dedinje Cardiovascular Institute, Belgrade, Serbia over the one-year period (from January 2015 to January 2016) for percutaneous coronary intervention (PCI). Coronary vessel patency before and after stenting was assessed by the Thrombolysis in Myocardial Infarction flow (TIMI) grades. After the index PCI procedure with BVS all patients were clinically followed by regular (prescheduled or event-driven) visits during the next 12-month period. Results: In the intention-to-treat analysis, all Absorb BVS procedures were successful, without the need for conversion to other treatment modalities. The complete reperfusion (TIMI flow grade 3) after the intervention was established in 97.6 % of patients and 100 % of them achieved the TIMI flow grade ≥ 2. The presence of angina pectoris was reduced significantly by the BVS procedure: stable angina 57.1 % to 11.9 %, (p < 0.001) and unstable angina 31 % to 0 %, respectively (p < 0.001). After the one-year follow-up, the MACE rate was 11.9 %. Myocardial infarction occurred in 4.8 % and the need for PCI reintervention in 2.4 % of cases (not influenced by the gender or the age of patients). There were 4 cases of death (all patients were older and had lower values of left ventricular ejection fraction). Conclusion: The results of the current research demonstrated a high interventional success rate of the Absorb BVS implantation, followed by the early improvement of the anginal status. However, that was not translated into the favourable mid-term clinical outcomes, opening debate about the current status of Absorb BVS and the need for future refinements of stent design and implantation techniques.
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Ipema J, Kum S, Huizing E, Schreve MA, Varcoe RL, Hazenberg CE, DE Vries JP, ÜnlÜ Ç. A systematic review and meta-analysis of bioresorbable vascular scaffolds for below-the-knee arterial disease. INT ANGIOL 2020; 40:42-51. [PMID: 33086777 DOI: 10.23736/s0392-9590.20.04462-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Different types of bioresorbable vascular scaffolds (BVSs) have been developed and used in below-the-knee (BTK) arterial diseases. This is the first study reviewing and analyzing the literature on BVS treatment for BTK arterial disease. EVIDENCE ACQUISITION MEDLINE, Embase, and Cochrane were searched for studies published until October 21, 2019. The search, study selection, quality assessment, and data extraction were performed by 2 authors independently. Articles that studied the treatment of BTK arterial disease by using BVSs were eligible. Exclusion criteria were studies with a variant design (e.g. case reports <5 patients), non-BTK indications for BVS use, and nonhuman studies. Primary endpoint was 12-month primary patency. Secondary endpoints were 12-month freedom from clinically driven target lesion revascularization (CD-TLR), limb salvage, survival, and amputation-free survival (AFS). Study quality was assessed by the Methodological Index for Non-randomized Studies score. EVIDENCE SYNTHESIS Five studies representing 155 patients with 160 treated limbs met the inclusion criteria. Pooled 12-month primary patency per limb was 90% (143/160; 95% confidence interval [CI]: 0.84-0.95), freedom from CD-TLR 96% (124/130; 95% CI: 0.91-0.99), limb salvage rate 97% (156/160; 95% CI: 0.94-1.00), survival rate 90% (112/125; 95% CI: 0.82-0.96), and AFS rate 89% (110/125; 95% CI: 0.81-0.94). Subgroup analyses of included Absorb BVS studies showed similar results. All studies were assessed as moderate quality. CONCLUSIONS This meta-analysis of case series showed good 12-month patency and clinical results with BVSs for BTK arterial disease, even in patients with multimorbidity and short but complex lesions. These results encourage a revival of this scaffold.
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Affiliation(s)
- Jetty Ipema
- Department of Vascular Surgery, Northwest Clinics, Alkmaar, the Netherlands -
| | - Steven Kum
- Department of Surgery, Changi General Hospital, Singapore, Singapore
| | - Eline Huizing
- Department of Vascular Surgery, Northwest Clinics, Alkmaar, the Netherlands
| | - Michiel A Schreve
- Department of Vascular Surgery, Northwest Clinics, Alkmaar, the Netherlands
| | - Ramon L Varcoe
- Department of Surgery, Prince of Wales Hospital, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia.,The Vascular Institute, Prince of Wales Hospital, Sydney, Australia
| | - Constantijn E Hazenberg
- Department of Vascular Surgery, University Medical Center (UMC) Utrecht, Utrecht, the Netherlands
| | - Jean-Paul DE Vries
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - Çağdaş ÜnlÜ
- Department of Vascular Surgery, Northwest Clinics, Alkmaar, the Netherlands
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Okada K, Honda Y, Kitahara H, Ikutomi M, Kameda R, Brooke Hollak M, Yock PG, Popma JJ, Kusano H, Cheong WF, Sudhir K, Fitzgerald PJ, Kimura T, on behalf of the ABSORB Japan Investigators. Scaffold underexpansion and late lumen loss after bioresorbable scaffold implantation: Insights from ABSORB JAPAN trial. IJC HEART & VASCULATURE 2020; 31:100623. [PMID: 32944608 PMCID: PMC7481138 DOI: 10.1016/j.ijcha.2020.100623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/26/2020] [Accepted: 08/09/2020] [Indexed: 11/30/2022]
Abstract
Background Device underexpansion is associated with late adverse outcomes after bioresorbable vascular scaffold (BVS) implantation. This study, representing official IVUS results of the ABSORB Japan trial, aimed to characterize IVUS findings, focusing specifically on acute device expansion, and to investigate its impact on late lumen loss (LLL) with Absorb-BVS compared with cobalt-chromium everolimus-eluting stents (CoCr-EES). Methods ABSORB Japan enrolled 148 patients (2:1 randomization) in the IVUS cohort. Serial IVUS was prescheduled at post-procedure and 3 years. Acute device expansion was evaluated with respect to the degree and uniformity of the implanted device. Results Overall, Absorb-BVS showed smaller and more nonuniform device expansion at post-procedure, compared with CoCr-EES, which was particularly prominent in small-vessel lesions. In serial analysis, Absorb-BVS showed unique associations of smaller device expansion (r = 0.40, p = 0.001) and more nonuniformity (r = 0.29, p = 0.007) at post-procedure with greater LLL at 3 years, primarily attributable to greater negative remodeling (r = 0.39, p = 0.006). In contrast, acute device expansion showed no relation with subsequent lumen change in CoCr-EES. In Absorb-BVS, ischemic-driven target lesion or vessel revascularization (ID-TLR or ID-TVR) at 3 years occurred more frequently in small- versus large-vessel lesions (12.5% vs. 0%, p = 0.04 for ID-TLR and 15.6% vs. 2.3%, p = 0.08 for ID-TVR). Conversely, Absorb BVS had no target lesion nor vessel failure, even in small-vessel lesions, when adequate device expansion was achieved at post-procedure. Conclusions Unlike CoCr-EES, underexpansion was associated with greater negative remodeling and LLL in Absorb-BVS. This may in part account for the poorer outcomes of Absorb-BVS than CoCr-EES when under-expanded.
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Key Words
- Absorb BVS
- BVS, bioresorbable vascular scaffolds
- CV, coefficient of variation
- CoCr-EES, cobalt-chromium everolimus-eluting stents
- DS, diameter stenosis
- ID-TLR, ischemic-driven target lesion revascularization
- ID-TVR, ischemic-driven target vessel revascularization
- ISA, incomplete strut apposition
- IVUS, intravascular ultrasound
- LISA, late-acquired incomplete strut apposition
- LLL, late lumen loss
- Late acquired ISA
- Late lumen loss
- MI, myocardial infarction
- MLD, minimum lumen diameter
- QCA, quantitative coronary angiography
- RLD, reference lumen diameter
- RVD, reference vessel diameter
- ST, stent thrombosis
- ScT, scaffold thrombosis
- Scaffold underexpansion
- TLF, target lesion failure
- TVF, target vessel failure
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Affiliation(s)
- Kozo Okada
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, CA, United States
| | - Yasuhiro Honda
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, CA, United States
- Corresponding author at: Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Room H3554, Stanford, CA 94305-5637, United States.
| | - Hideki Kitahara
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, CA, United States
| | - Masayasu Ikutomi
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, CA, United States
| | - Ryo Kameda
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, CA, United States
| | - M. Brooke Hollak
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, CA, United States
| | - Paul G. Yock
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, CA, United States
| | | | - Hajime Kusano
- Clinical Science and Medical Affairs, Abbott Vascular, Santa Clara, CA, United States
| | - Wai-Fung Cheong
- Clinical Science and Medical Affairs, Abbott Vascular, Santa Clara, CA, United States
| | - Krishnankutty Sudhir
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, CA, United States
- Clinical Science and Medical Affairs, Abbott Vascular, Santa Clara, CA, United States
| | - Peter J. Fitzgerald
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, CA, United States
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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A scoring system to predict the occurrence of very late stent thrombosis following percutaneous coronary intervention for acute coronary syndrome. Sci Rep 2020; 10:6378. [PMID: 32286484 PMCID: PMC7156476 DOI: 10.1038/s41598-020-63455-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 03/31/2020] [Indexed: 02/05/2023] Open
Abstract
We aimed to derive and validate an effective risk score to identify high-risk patients of very late stent thrombosis (VLST), following percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). Stepwise multivariable Cox regression was used to build the risk model using data from 5,185 consecutive ACS patients treated with PCI (derivation cohort) and 2,058 patients from the external validation cohort. Eight variables were independently associated with the development of VLST: history of diabetes mellitus, previous PCI, acute myocardial infarction as admitting diagnosis, estimated glomerular filtration rate <90 ml/min/1.73 m2, three-vessel disease, number of stents per lesion, sirolimus-eluting stent, and no post-dilation. Based on the derived score, patients were classified into low- (≤7), intermediate- (8-9), and high- (≥10) risk categories. Observed VLST rates were 0.5%, 2.2%, and 8.7% and 0.45%, 2.3%, and 9.3% across the 3 risk categories in the derivation and validation cohorts, respectively. High discrimination (c-statistic = 0.80 and 0.82 in the derivation and validation cohorts, respectively) and excellent calibration were observed in both cohorts. VLST risk score, a readily useable and efficient tool to identify high-risk patients of VLST after PCI for ACS, may aid in risk-stratification and pre-emptive decision-making.
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Lee CH, Cho YK, Yoon HJ, Hur SH. A case report of a recurrent early and late Bioresorbable vascular scaffold thrombosis: serial angiography and optical coherence tomography findings. BMC Cardiovasc Disord 2020; 20:146. [PMID: 32204697 PMCID: PMC7092538 DOI: 10.1186/s12872-020-01426-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 03/12/2020] [Indexed: 11/10/2022] Open
Abstract
Background In bioresorbable vascular scaffolds (BVSs), there is some concern about a possible increase in the rate of scaffold thromboses (ScTs). Although several characteristics similarly contribute to the development of both early and late ScTs, there are also clearly different pathomechanisms between the two time-dependent types of thromboses, especially with BVSs. Case presentation We recently experienced a very rare case of a 69-year-old man who had recurrent early and late ScTs with somewhat differing pathomechanisms as assessed by optical coherence tomography (OCT). For the late ScT, OCT identified a scaffold dismantling in the same place that a peri-strut low intensity area (PLIA) was observed in the previous OCT finding. Conclusion We report the management of an ScT in a case with findings such as a heterogeneous a BVS degradation, peri-strut low intensity area (PLIA), intraluminal scaffold dismantling, and under-sizing and/or stent malapposition observed in OCT.
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Affiliation(s)
- Cheol Hyun Lee
- Division of Cardiology, Keimyung University Dongsan Medical Center, 56 Dalseong-Ro, Jung-Gu, Daegu, 700-712, South Korea
| | - Yun-Kyeong Cho
- Division of Cardiology, Keimyung University Dongsan Medical Center, 56 Dalseong-Ro, Jung-Gu, Daegu, 700-712, South Korea
| | - Hyuck-Jun Yoon
- Division of Cardiology, Keimyung University Dongsan Medical Center, 56 Dalseong-Ro, Jung-Gu, Daegu, 700-712, South Korea
| | - Seung-Ho Hur
- Division of Cardiology, Keimyung University Dongsan Medical Center, 56 Dalseong-Ro, Jung-Gu, Daegu, 700-712, South Korea.
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Zhao X, Guan C, Yuan J, Xie L, Wang H, Hou S, Zhang M, Zhang X, Gao R, Xu B. A modified predilation, sizing, and postdilation scoring system for patients undergoing metallic drug-eluting stent implantations. Catheter Cardiovasc Interv 2020; 95 Suppl 1:558-564. [PMID: 31909861 DOI: 10.1002/ccd.28711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 12/29/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study sought to assess whether the predilation, scaffold/stent sizing, and postdilation (PSP) score for bioresorbable scaffold (BRS) implantation was associated with outcomes following metallic drug-eluting stent (DES) implantation. BACKGROUND The PSP score is associated with patients' prognoses after BRS implantation. METHODS This study involved 2,348 patients who underwent biodegradable polymer DES implantations during the PANDA III trial. The optimal PSP technique was defined according to previous studies of BRS implantations. The main outcome was target lesion failure (TLF) that comprised cardiac death, target-vessel myocardial infarction, or ischemia-driven target lesion revascularization. RESULTS Twenty-five (1.1%) patients fulfilled all the PSP criteria. The BRS-derived PSP score was of limited prognostic value for 2-year TLF after metallic DES implantation; optimal sizing was a protective factor, but optimal predilation was a risk factor. We built a new PSP model for DESs by identifying the following risk factors: predilation performed with a residual stenosis ≥70% or a balloon-to-quantitative coronary angiography (QCA)-determined reference vessel diameter (RVD) ratio >1:1, sizing performed with an RVD <2.25 mm or a stent diameter >0.25 mm wider than the QCA-RVD, a postprocedural stenosis diameter ≥30%, age, and the baseline SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery (SYNTAX) score. The new PSP scoring system predicted 2-year TLF (area under the curve, 0.69; 95% confidence interval, 0.65-0.73); a cutoff value of 19.2 points identified high-risk patients. CONCLUSIONS The new PSP scoring system, based on redefined PSP criteria, age, and the SYNTAX score, could help optimize metallic DES implantations.
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Affiliation(s)
- Xueyan Zhao
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Changdong Guan
- Catheterization Laboratories, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Jinqing Yuan
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China.,National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Lihua Xie
- Catheterization Laboratories, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Huan Wang
- Data Statistics Department, CCRF (Beijing) Inc., Beijing, China
| | - Shuang Hou
- Data Statistics Department, CCRF (Beijing) Inc., Beijing, China
| | - Min Zhang
- Data Statistics Department, CCRF (Beijing) Inc., Beijing, China
| | - Xinbo Zhang
- Data Statistics Department, CCRF (Beijing) Inc., Beijing, China
| | - Runlin Gao
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China.,National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Bo Xu
- Catheterization Laboratories, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China.,National Clinical Research Center for Cardiovascular Diseases, Beijing, China
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Guided de-escalation of DAPT in acute coronary syndrome patients undergoing percutaneous coronary intervention with BVS implantation: a post-hoc analysis from the randomized TROPICAL-ACS trial. J Thromb Thrombolysis 2019; 47:427-435. [PMID: 30739305 PMCID: PMC6439143 DOI: 10.1007/s11239-019-01811-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
To investigate the safety and efficacy of an early platelet function testing (PFT)-guided de-escalation of dual antiplatelet treatment (DAPT) in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) with bioresorbable vascular scaffolds (BVS). Early DAPT de-escalation is a new non-inferior alternative to 12-months DAPT in patients with biomarker positive ACS treated with stent implantation. In this post-hoc analysis of the TROPICAL-ACS trial, which randomized 2610 ACS patients to a PFT-guided DAPT de-escalation (switch from prasugrel to clopidogrel) or to control group (uniform prasugrel), we compared clinical outcomes of patients (n = 151) who received a BVS during the index PCI. The frequency of the primary endpoint (cardiovascular death, myocardial infarction, stroke or BARC ≥ 2 bleeding) was 8.8% (n = 6) in the de-escalation group vs. 12.0% (n = 10) in the control group (HR 0.72, 95% CI 0.26–1.98, p = 0.52) at 12 months. One early definite stent thrombosis (ST) occurred in the control group (day 19) and 1 possible ST (sudden cardiovascular death) in the de-escalation group (day 86), both despite prasugrel treatment and in a background of high on-treatment platelet reactivity assessed at day 14 after randomization (ADP-induced platelet aggregation values of 108 U and 59 U, respectively). A PFT-guided DAPT de-escalation strategy could potentially be a safe and effective strategy in ACS patients with BVS implantation but the level of platelet inhibition may be of particular importance. This hypothesis-generating post-hoc analysis requires verification in larger studies with upcoming BVS platforms.
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Ellis SG, Gori T, Serruys PW, Nef H, Steffenino G, Brugaletta S, Munzel T, Feliz C, Schmidt G, Sabaté M, Onuma Y, van Geuns RJ, Gao RL, Menichelli M, Kereiakes DJ, Stone GW, Testa L, Kimura T, Abizaid A. Clinical, Angiographic, and Procedural Correlates of Very Late Absorb Scaffold Thrombosis: Multistudy Registry Results. JACC Cardiovasc Interv 2019; 11:638-644. [PMID: 29622141 DOI: 10.1016/j.jcin.2017.11.042] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 11/28/2017] [Accepted: 11/29/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The aim of this study was to identify independent correlates of very late scaffold thrombosis (VLST) from an analysis of consecutively treated patients from 15 multicenter studies. BACKGROUND Recent analyses suggest an increased risk for VLST with the Absorb Bioresorbable Vascular Scaffold compared with drug-eluting stents, but insights as to correlates of risk are limited. METHODS A total of 55 patients were identified with scaffold thrombosis. They were matched 2:1 with control subjects selected randomly from patients without thrombosis from the same study. Quantitative coronary angiography was available for 96.4% of patients. Multiple logistic and Cox regression analysis were used to identify significant independent outcome correlates from 6 pre-specified characteristics. RESULTS Patients had scaffold thrombosis at a median of 20 months (interquartile range: 17 to 27 months). Control subjects were followed for 36 months (interquartile range: 24 to 38 months). For the combined groups, reference vessel diameter (RVD) was 2.84 ± 0.50 mm, scaffold length was 26 ± 16 mm, and post-dilatation was performed in 56%. Univariate correlates of thrombosis were smaller nominal scaffold/RVD ratio (linear p = 0.001; ratio <1.18:1; odds ratio: 7.5; p = 0.002) and larger RVD (linear p = 0.001; >2.72 mm; odds ratio: 3.4; p = 0.001). Post-dilatation at ≥16 atm, post-dilatation balloon/scaffold ratio, final percentage stenosis, and dual antiplatelet therapy were not correlated with VLST. Only scaffold/RVD ratio remained a significant independent correlate of VLST (p = 0.001), as smaller ratio was correlated with RVD (p < 0.001). Post hoc analysis of 8 other potential covariates revealed no other correlates of outcome. CONCLUSIONS In the present analysis, the largest to date of its type, relative scaffold undersizing was the strongest determinant of VLST. Given current understanding of "scaffold dismantling," this finding likely has ramifications for all bioresorbable scaffolds.
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Affiliation(s)
| | - Tommaso Gori
- Kardiologie I, Universitatsmedizin Mainz and DZHK Standort Rhein-Main, Germany
| | - Patrick W Serruys
- Cardiovascular Science Division of the National Heart and Lung Institute (NHLI), Faculty of Medicine, Imperial College, London, United Kingdom
| | - Holger Nef
- UKGM Universitatsklinikum Giessen, Giessen, Germany
| | | | | | - Thomas Munzel
- Kardiologie I, Universitatsmedizin Mainz and DZHK Standort Rhein-Main, Germany
| | - Cordula Feliz
- Cardiovascular Science Division of the National Heart and Lung Institute (NHLI), Faculty of Medicine, Imperial College, London, United Kingdom
| | - Götz Schmidt
- UKGM Universitatsklinikum Giessen, Giessen, Germany
| | - Manel Sabaté
- Hospital Clinic, Institut Clinic Cardiovascular, Barcelona, Spain
| | - Yoshinobu Onuma
- Cardiovascular Science Division of the National Heart and Lung Institute (NHLI), Faculty of Medicine, Imperial College, London, United Kingdom
| | - R J van Geuns
- Cardiovascular Science Division of the National Heart and Lung Institute (NHLI), Faculty of Medicine, Imperial College, London, United Kingdom
| | - Run-Lin Gao
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | | | - Dean J Kereiakes
- The Christ Hospital Heart and Vascular Center and The Lindner Research Center, Cincinnati, Ohio
| | - Gregg W Stone
- Columbia University Medical Center, NewYork-Presbyterian Hospital, New York, New York
| | - Luca Testa
- IRCCS Policlinico San Donato Department of Cardiology, Milan, Italy
| | - Takeshi Kimura
- Department of Cardiovascular Medicine at Kyoto University, Kyoto, Japan
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Incidental Finding of Strut Malapposition Is a Predictor of Late and Very Late Thrombosis in Coronary Bioresorbable Scaffolds. J Clin Med 2019; 8:jcm8050580. [PMID: 31035602 PMCID: PMC6571797 DOI: 10.3390/jcm8050580] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 04/16/2019] [Accepted: 04/25/2019] [Indexed: 12/11/2022] Open
Abstract
Malapposition is a common finding in stent and scaffold thrombosis (ScT). Evidence from studies with prospective follow-up, however, is scarce. We hypothesized that incidental observations of strut malapposition might be predictive of late ScT during subsequent follow-up. One hundred ninety-seven patients were enrolled in a multicentre registry with prospective follow-up. Optical coherence tomography (OCT), performed in an elective setting, was available in all at 353 (0–376) days after bioresorbable scaffold (BRS) implantation. Forty-four patients showed evidence of malapposition that was deemed not worthy of intervention. Malapposition was not associated with any clinical or procedural parameter except for a higher implantation pressure (p = 0.0008). OCT revealed that malapposition was associated with larger vessel size, less eccentricity (all p < 0.01), and a tendency for more uncovered struts (p = 0.06). Late or very late ScT was recorded in seven of these patients 293 (38–579) days after OCT. OCT-diagnosed malapposition was a predictor of late and very late scaffold thrombosis (p < 0.001) that was independent of the timing of diagnosis. We provide evidence that an incidental finding of malapposition—regardless of the timing of diagnosis of the malapposition—during an elective exam is a predictor of late and very late ScT. Our data provide a rationale to consider prolonged dual antiplatelet therapy if strut malapposition is observed.
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Affiliation(s)
- Sergio Buccheri
- Department of Cardiology, Ferrarotto Hospital - Cardio-Thoracic-Vascular Department, Azienda Ospedaliero Universitaria "Policlinico-Vittorio Emanuele", Catania, Italy.,Department of General Surgery and Medical-Surgical Specialties, Università degli Studi di Catania, Italy
| | - Davide Capodanno
- Department of General Surgery and Medical-Surgical Specialties, Università degli Studi di Catania, Italy
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Moscarella E, Ielasi A, Varricchio A, Cortese B, Loi B, Tarantini G, Pisano F, Durante A, Pasquetto G, Colombo A, Tumminello G, Moretti L, Calabrò P, Mazzarotto P, Tespili M, Silva Orrego P, Corrado D, Steffenino G. One-year clinical performance of ABSORB bioresorbable vascular scaffold in patients presenting with acute coronary syndromes: Results from the RAI registry. Catheter Cardiovasc Interv 2019; 93:404-410. [PMID: 30346080 DOI: 10.1002/ccd.27845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 07/28/2018] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To report 1-year clinical outcomes of bioresorbable vascular scaffold (BVS) in acute coronary syndromes (ACS) population. BACKGROUND BVS use has rapidly extended to high-risk patients as those presenting with ACS. To date limited data have been reported on BVS performance in ACS patients. METHODS RAI is a multicenter, prospective registry that included 1,505 patients treated with at least 1 successful BVS implantation. A subgroup analysis on ACS patients was performed and the 1-year outcomes of this cohort compared to the remaining stable coronary artery disease (SCAD) population are reported here. Coprimary endpoints were target-lesion revascularization (TLR) and scaffold thrombosis (ScT) at 1-year follow-up. RESULTS Fifty-nine percent of the patients presented with ACS, of whom 36.5% with ST-elevation myocardial infarctions. ACS patients were significantly younger, with a better cardiovascular risk profile, a lower rate of multivessel disease, chronic total occlusion or in-stent restenosis and a lower Syntax score. Predilation and postdilation were performed in 97.4% and in 96.5% of cases, respectively. No differences were noted in terms of TIMI 3 final flow, but acute gain was greater in ACS compared to SCAD group (P < 0.001). At one-year follow-up no differences were found in terms of TLR (3.3% vs. 3.3%, P = 0.98), and device-oriented composite end-point (4.3% vs. 3.4%, P = 0.4) between ACS and SCAD groups. The rate of definite/probable ScT was numerically higher in ACS vs. stable CAD patients (1.3% vs. 0.8%, P = 0.2). CONCLUSIONS Our data suggest that the use of BVS in ACS patients is associated with a numerically higher rate of ScT compared to SCAD population numerically higher, but without statistical significance.
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Affiliation(s)
- Elisabetta Moscarella
- Department of Cardio-Thoracic Science, Second University of Naples, Presidio Ospedaliero "Monaldi,", Naples, Italy
| | - Alfonso Ielasi
- Division of Cardiology, ASST Bergamo Est, "Bolognini" Hospital, Seriate, BG, Italy
| | - Attilio Varricchio
- Department of Cardiology, Ospedale Santa Maria della Pietà Nola, Naples, Italy
| | - Bernardo Cortese
- Division of Cardiology, ASST Fatebenefratelli-Sacco, "Fatebenefratelli" Hospital, Milan, Italy
| | - Bruno Loi
- Interventional Cardiology Unit, "Brotzu" Hospital, Cagliari, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University Hospital of Padua, Padua, Italy
| | | | | | - Giampaolo Pasquetto
- Division of Cardiology, "Riuniti Hospital Padova Sud,", Monselice, PD, Italy
| | - Alessandro Colombo
- Division of Cardiology, ASST Fatebenefratelli-Sacco, "Fatebenefratelli" Hospital, Milan, Italy
| | | | - Luciano Moretti
- Division of Cardiology, "Mazzoni" Hospital, Ascoli Piceno, Italy
| | - Paolo Calabrò
- Department of Cardio-Thoracic Science, Second University of Naples, Presidio Ospedaliero "Monaldi,", Naples, Italy
| | - Pietro Mazzarotto
- Division of Cardiology, Azienda Socio-Sanitaria Territoriale di Lodi, Lodi, Italy
| | - Maurizio Tespili
- Division of Cardiology, ASST Bergamo Est, "Bolognini" Hospital, Seriate, BG, Italy
| | - Pedro Silva Orrego
- Division of Cardiology, ASST Fatebenefratelli-Sacco, "Fatebenefratelli" Hospital, Milan, Italy
| | | | - Giuseppe Steffenino
- Interventional Cardiology Unit, "Santi Croce e Carle" Hospital, Cuneo, Italy
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Hiczkiewicz J, Iwańczyk S, Araszkiewicz A, Łanocha M, Hiczkiewicz D, Grajek S, Lesiak M. Long-term clinical results of biodegradable vascular scaffold ABSORB BVS™ using the PSP-technique in patients with acute coronary syndrome. Cardiol J 2019; 27:677-684. [PMID: 30761516 DOI: 10.5603/cj.a2019.0018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 09/06/2018] [Accepted: 09/16/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The PSP (predilatation, sizing, post-dilatation)-technique was developed to improve the prognosis of patients after bioresorbable vascular scaffold (BVS) implantation. In acute coronary syndrome (ACS) the use of BVS is particularly demanding and carries some potential risk regarding aggressive lesion preparation, proper vessel sizing due to spasm and thrombus inside the artery. The aim herein, was to determine the long-term results of BVS stenting in ACS patients depending on the scaffold implantation technique. METHODS The present study is a prospective, two-center study, which consisted of 182 patients who underwent percutaneous coronary intervention (PCI) with BVS (Absorb, Abbott Vascular, Santa Clara, California, USA) implantation for the ACS. All patients were divided into two groups. The first consisted of 52 patients treated with the PSP-technique (PSP group). The second group enrolled 130 patients treated with a non-PSP procedure (non-PSP group). RESULTS The procedure was successful in all patients. The mean observation time was 28.8 ± 16.5 months (median 28.3 months, interquartile range 24.0 [17.0-41.0] months). It was found that target vessel failure (TVF) was consistently reduced in patients using the PSP-technique as compared with the non-PSP group (5.8% vs. 17.7%, p = 0.03). Moreover, PSP-technique was superior to non-PSP-technique concerning major adverse cardiac events (MACE) (3.7% vs. 22.3%, p = 0.02). Logistic regression analysis revealed that the use of PSP technique significantly decreased the risk of target vessel revascularization (odds ratio [OR] 0.11, p = 0.01), TVF (OR 0.28, p = 0.03) and MACE (OR 0.29, p = 0.02). CONCLUSIONS The PSP-technique for BVS implantation improves long-term results and should also be recommended for newer generations of the bioresorbable scaffold.
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Affiliation(s)
- Jarosław Hiczkiewicz
- Department of Cardiology, Multidisciplinary District's Hospital, University of Zielona Góra, Chałubińskiego 7, 67-100 Nowa Sól, Poland
| | - Sylwia Iwańczyk
- 1st Department of Cardiology, University of Medical Sciences,Poznan, Poland, Dluga 1/2, 61-848 Poznan, Poland.
| | - Aleksander Araszkiewicz
- 1st Department of Cardiology, University of Medical Sciences,Poznan, Poland, Dluga 1/2, 61-848 Poznan, Poland
| | - Magdalena Łanocha
- 1st Department of Cardiology, University of Medical Sciences,Poznan, Poland, Dluga 1/2, 61-848 Poznan, Poland
| | - Dariusz Hiczkiewicz
- Department of Cardiology, Multidisciplinary District's Hospital, University of Zielona Góra, Chałubińskiego 7, 67-100 Nowa Sól, Poland
| | - Stefan Grajek
- 1st Department of Cardiology, University of Medical Sciences,Poznan, Poland, Dluga 1/2, 61-848 Poznan, Poland
| | - Maciej Lesiak
- 1st Department of Cardiology, University of Medical Sciences,Poznan, Poland, Dluga 1/2, 61-848 Poznan, Poland
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Sakamoto A, Torii S, Jinnouchi H, Virmani R, Finn AV. Histopathologic and physiologic effect of overlapping vs single coronary stents: impact of stent evolution. Expert Rev Med Devices 2018; 15:665-682. [DOI: 10.1080/17434440.2018.1515012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | - Sho Torii
- CVPath Institute, Gaithersburg, MD, USA
| | | | | | - Aloke V. Finn
- CVPath Institute, Gaithersburg, MD, USA
- School of Medicine, University of Maryland, Baltimore, MD, USA
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Understanding the Impact of Stent and Scaffold Material and Strut Design on Coronary Artery Thrombosis from the Basic and Clinical Points of View. Bioengineering (Basel) 2018; 5:bioengineering5030071. [PMID: 30181463 PMCID: PMC6164756 DOI: 10.3390/bioengineering5030071] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 08/23/2018] [Accepted: 08/30/2018] [Indexed: 01/09/2023] Open
Abstract
The technology of percutaneous coronary intervention (PCI) is constantly being refined in order to overcome the shortcomings of present day technologies. Even though current generation metallic drug-eluting stents (DES) perform very well in the short-term, concerns still exist about their long-term efficacy. Late clinical complications including late stent thrombosis (ST), restenosis, and neoatherosclerosis still exist and many of these events may be attributed to either the metallic platform and/or the drug and polymer left behind in the arterial wall. To overcome this limitation, the concept of totally bioresorbable vascular scaffolds (BRS) was invented with the idea that by eliminating long-term exposure of the vessel wall to the metal backbone, drug, and polymer, late outcomes would improve. The Absorb-bioabsorbable vascular scaffold (Absorb-BVS) represented the most advanced attempt to make such a device, with thicker struts, greater vessel surface area coverage and less radial force versus contemporary DES. Unfortunately, almost one year after its initial approval by the U.S. Food and Drug Administration, this scaffold was withdrawn from the market due to declining devise utilization driven by the concerns about scaffold thrombosis (ScT) seen in both early and late time points. Additionally, the specific causes of ScT have not yet been fully elucidated. In this review, we discuss the platform, vascular response, and clinical data of past and current metallic coronary stents with the Absorb-BVS and newer generation BRS, concentrating on their material/design and the mechanisms of thrombotic complications from the pre-clinical, pathologic, and clinical viewpoints.
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Cortese B. Does Late Lumen Loss Represent a Measure of the Efficacy of Bioresorbable Scaffolds? JACC Cardiovasc Interv 2018; 11:1418-1419. [PMID: 30025737 DOI: 10.1016/j.jcin.2018.03.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 03/14/2018] [Accepted: 03/28/2018] [Indexed: 10/28/2022]
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Anadol R, Schnitzler K, Lorenz L, Weissner M, Ullrich H, Polimeni A, Münzel T, Gori T. Three-years outcomes of diabetic patients treated with coronary bioresorbable scaffolds. BMC Cardiovasc Disord 2018; 18:92. [PMID: 29743023 PMCID: PMC5944115 DOI: 10.1186/s12872-018-0811-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 04/20/2018] [Indexed: 12/20/2022] Open
Abstract
Background Diabetes is among the strongest predictors of outcome after coronary artery stenting and the incidence of negative outcomes is still high in this specific group. Data of long-term outcomes comparing diabetic patients with non-diabetic patients treated with bioresorbable scaffolds are still incomplete. This work evaluates the long-term outcomes after implantation of a coronary bioresorbable scaffold (BRS) in diabetic patients compared to non-diabetics. Methods Patients who received at least one Absorb BRS in the time of May 2012 to December 2014 were enrolled into this single-center registry. Quantitative coronary angiography (QCA) was performed. Results Six hundred fifty seven patients including 138 patients (21%, mean age 65 ± 11, 78% male) with diabetes were enrolled. Patients in the diabetic group were significantly older, were more likely to suffer from hypertension and hyperlipidemia and had more often a prior stroke or TIA as well as a reduced renal function (all P < 0.05). The initial stenosis was less severe in the diabetic group (74.8% vs. 79.6%, P = 0.036), but the residual stenosis after BRS implantation exceeded that of the control group (16.7% vs. 13.8%, P = 0.006). History of diabetes had no impact on the incidence of events within one year after BRS implantation. Beyond 1 year, diabetic patients had a higher incidence of cardiovascular death (6.9 vs. 1.4%, HR:5.37 [1.33–21.71], P = 0.001), scaffold restenosis (17.6 vs. 7.8%, HR:3.56 [1.40–9.05], P < 0.0001) and target lesion revascularization (P = 0.016). These results were confirmed in the propensity score analysis. In both diabetics and non-diabetics, there was a strong association (HR:18.6 [4.7–73.3]) between the risk of restenosis and the technique used at implantation; in contrast, the impact of vessel size was more manifest in non-diabetics than in diabetic patients, and an increased risk of restenosis was demonstrated for both large and small vessels. Conclusion As for metal stents, beyond one year after implantation, diabetes was associated with an increased incidence of scaffold restenosis and related outcomes. This negative impact of diabetes was reset when an optimal implantation technique was used. Electronic supplementary material The online version of this article (10.1186/s12872-018-0811-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Remzi Anadol
- Kardiologie I, Zentrum für Kardiologie, German Center for Cardiac and Vascular Research (DZHK), Standort Rhein-Main, University Hospital Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Katharina Schnitzler
- Kardiologie I, Zentrum für Kardiologie, German Center for Cardiac and Vascular Research (DZHK), Standort Rhein-Main, University Hospital Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Liv Lorenz
- Kardiologie I, Zentrum für Kardiologie, German Center for Cardiac and Vascular Research (DZHK), Standort Rhein-Main, University Hospital Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Melissa Weissner
- Kardiologie I, Zentrum für Kardiologie, German Center for Cardiac and Vascular Research (DZHK), Standort Rhein-Main, University Hospital Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Helen Ullrich
- Kardiologie I, Zentrum für Kardiologie, German Center for Cardiac and Vascular Research (DZHK), Standort Rhein-Main, University Hospital Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Alberto Polimeni
- Kardiologie I, Zentrum für Kardiologie, German Center for Cardiac and Vascular Research (DZHK), Standort Rhein-Main, University Hospital Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Thomas Münzel
- Kardiologie I, Zentrum für Kardiologie, German Center for Cardiac and Vascular Research (DZHK), Standort Rhein-Main, University Hospital Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Tommaso Gori
- Kardiologie I, Zentrum für Kardiologie, German Center for Cardiac and Vascular Research (DZHK), Standort Rhein-Main, University Hospital Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
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Impact of PSP Technique on Clinical Outcomes Following Bioresorbable Scaffolds Implantation. J Clin Med 2018; 7:jcm7020027. [PMID: 29415486 PMCID: PMC5852443 DOI: 10.3390/jcm7020027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 01/26/2018] [Accepted: 01/26/2018] [Indexed: 01/18/2023] Open
Abstract
Bioresorbable scaffolds (BRS) were introduced in clinical practice to overcome the long-term limitations of newer-generation drug-eluting stents. Despite some initial promising results of the Absorb BRS, safety concerns have led to the discontinuation of the commercialization of this device. Several retrospective studies have assessed the impact of the so-called Pre-dilation, Sizing and Post-dilation (PSP) technique concluding that an optimal PSP technique can improve clinical outcomes following BRS implantation. In this article, the definition of the PSP technique, and the current evidence of its impact on clinical outcomes are put in perspective. Additionality, the relationship between the PSP technique and the dual-antiplatelet therapy to prevent scaffold thrombosis is addressed. Finally, the future perspectives of BRS technology in clinical practice are commented.
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Pyxaras SA, Wijns W. Polymeric bioresorbable coronary scaffolds: the hype is over, but the dream lives on. EUROINTERVENTION 2018; 13:1506-1509. [PMID: 29345240 DOI: 10.4244/eijv13i13a242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Brugaletta S, Ortega-Paz L, Onuma Y. Data from real-world registries: can it guide development of the bioresorbable scaffolds of tomorrow? EUROINTERVENTION 2017; 13:1259-1262. [DOI: 10.4244/eijv13i11a197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Bioresorbable scaffold -fourth revolution or failed revolution: Is low scaffold strut thickness the wrong target? Indian Heart J 2017; 69:687-689. [PMID: 29174242 PMCID: PMC5717313 DOI: 10.1016/j.ihj.2017.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Bioresorbable scaffold (BRS) technology has currently fallen into disrepute because of inordinately high risk of scaffold thrombosis and post-procedure myocardial infarction. Low tensile and radial strengths of polymeric BRS contributing to improper strut embedment have been identified as major correlates of poor outcomes following BRS implantation. Magnesium has a better tensile/radial strength compared with polymeric BRS but it is still far lower than cobalt-chromium. Newers innovations utilizing alteration in polymer composition and orientation or even newer polymers have focused on attempts to reduce strut thickness but may have little effect on tensile/radial strength of finished product and therefore may not impact the BRS outcome on long run. Currently, newer generation BRS usage may be restricted to suitable low risk younger patients with proper vessel preparation and application of technique.
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Bioresorbable Vascular Scaffold Thrombosis: Solutions to the Problem? JACC Cardiovasc Interv 2017; 10:1816-1818. [PMID: 28935072 DOI: 10.1016/j.jcin.2017.08.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 08/17/2017] [Indexed: 11/20/2022]
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