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Rodriguez-Arias JJ, Gomez-Lara J, Caballero-Borrego J, Ortega-Paz L, Arévalos V, Teruel L, Gil-Jimenez T, Oyarzabal L, Romaguera R, Moreno-Terribas G, Gomez-Hospital JA, Sabate M, Brugaletta S. Long-term vascular function in CTO recanalization: A randomized clinical trial of ticagrelor vs. clopidogrel. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 37:61-67. [PMID: 34238679 DOI: 10.1016/j.carrev.2021.06.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/26/2021] [Accepted: 06/28/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Coronary vascular function of a chronic coronary total occlusion (CTO) immediately after recanalization is known to be poor and to be partially improved by pre-treatment with loading dose of ticagrelor vs. clopidogrel. It is unknown if this vascular dysfunction is maintained at long-term follow-up and may be improved by 1-year dual antiplatelet therapy (DAPT). METHODS The TIGER is a prospective, open-label, two parallel-group controlled clinical trial, which 1:1 randomized 50 CTO patients to pre-PCI loading dose and subsequent 1-year DAPT with ticagrelor vs. clopidogrel. Coronary blood flow (CBF) under stepwise adenosine infusion was assessed after drug loading dose and at follow-up and compared between the two drug groups, adjusting for time of follow-up. RESULTS Out of 50 patients with index CBF evaluation, 38 (76%) patients underwent angiographic follow-up (23 and 15 at 1 and 3-year, respectively) and Doppler data was available in 35 (70%). A high CBF area under the curve (AUC), already observed after loading dose in ticagrelor vs. clopidogrel group (p = 0.027), was maintained at follow-up (AUC 34815.22 ± 24,206.06 vs. AUC 22712.47 ± 13,768.95; p = 0.071). Specifically, whereas high ticagrelor loading dose-related CBF was sustained at follow-up (p = 0.933), clopidogrel loading dose-related CBF increased at follow-up (p = 0.039). CONCLUSION The TIGER trial showed that DAPT with ticagrelor maintained a non-significantly higher CBF in a recanalized CTO as compared to clopidogrel, whose treated patients exhibit a lower CBF immediately after PCI with a significant increase at follow-up. The clinical value of such sustained high coronary flow should be evaluated in a larger group of patients. CLINICAL TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT02211066 (ClinicalTrials.gov number NCT02211066).
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Affiliation(s)
- Juan J Rodriguez-Arias
- Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Josep Gomez-Lara
- Heart Disease Institute, Bellvitge University Hospital, University of Barcelona, IDIBELL, Spain
| | - Juan Caballero-Borrego
- Unidad de Cardiologia Intervencionista, Servicio de Cardiologia, Hospital Universitario Clinico San Cecilio, Granada, Spain
| | - Luis Ortega-Paz
- Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Victor Arévalos
- Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Luis Teruel
- Heart Disease Institute, Bellvitge University Hospital, University of Barcelona, IDIBELL, Spain
| | - Teresa Gil-Jimenez
- Unidad de Cardiologia Intervencionista, Servicio de Cardiologia, Hospital Universitario Clinico San Cecilio, Granada, Spain
| | - Loreto Oyarzabal
- Heart Disease Institute, Bellvitge University Hospital, University of Barcelona, IDIBELL, Spain
| | - Rafael Romaguera
- Heart Disease Institute, Bellvitge University Hospital, University of Barcelona, IDIBELL, Spain
| | - Gerardo Moreno-Terribas
- Unidad de Cardiologia Intervencionista, Servicio de Cardiologia, Hospital Universitario Clinico San Cecilio, Granada, Spain
| | | | - Manel Sabate
- Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Salvatore Brugaletta
- Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, (IDIBAPS), University of Barcelona, Barcelona, Spain.
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Budassi S, Zivelonghi C, Muyldermans P, Agostoni P, Verheye S. Is the Dream of Vascular Restoration Still Alive? A Case of 7 Years, Follow-Up After Bioresorbable Vascular Scaffold Implantation. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:158-161. [PMID: 32029391 DOI: 10.1016/j.carrev.2019.12.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/27/2019] [Accepted: 12/31/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Bioresorbable scaffold (BRS) have the aim to combine short-term radial force by vessel scaffold (which should dissolve after few months), with drug eluting capability. It has been hypothesized that complete resorption would result in restoration of vasomotion, reduction in angina and reduction of restenosis. CASE PRESENTATION We report a case of 7 years angiographic follow up after DESolve Novolimus eluting Bioresorbable Coronary Scaffold System implantation. CONCLUSION The invasive control showed persistence of scaffold patency and evidence of restored vascular motility by the growing in vessel diameter at QCA control after nitrates administration.
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Affiliation(s)
- Simone Budassi
- Antwerp Cardiovascular Center Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium; Cardiology and Interventional Cardiology Department, Policlinico Tor Vergata, Rome, Italy
| | - Carlo Zivelonghi
- Antwerp Cardiovascular Center Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Philip Muyldermans
- Antwerp Cardiovascular Center Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Pierfrancesco Agostoni
- Antwerp Cardiovascular Center Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Stefan Verheye
- Antwerp Cardiovascular Center Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium.
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Jeżewski MP, Kubisa MJ, Eyileten C, De Rosa S, Christ G, Lesiak M, Indolfi C, Toma A, Siller-Matula JM, Postuła M. Bioresorbable Vascular Scaffolds-Dead End or Still a Rough Diamond? J Clin Med 2019; 8:E2167. [PMID: 31817876 PMCID: PMC6947479 DOI: 10.3390/jcm8122167] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/02/2019] [Accepted: 12/04/2019] [Indexed: 02/06/2023] Open
Abstract
Percutaneous coronary interventions with stent-based restorations of vessel patency have become the gold standard in the treatment of acute coronary states. Bioresorbable vascular scaffolds (BVS) have been designed to combine the efficiency of drug-eluting stents (DES) at the time of implantation and the advantages of a lack of foreign body afterwards. Complete resolution of the scaffold was intended to enable the restoration of vasomotor function and reduce the risk of device thrombosis. While early reports demonstrated superiority of BVS over DES, larger-scale application and longer observation exposed major concerns about their use, including lower radial strength and higher risk of thrombosis resulting in higher rate of major adverse cardiac events. Further focus on procedural details and research on the second generation of BVS with novel properties did not allow to unequivocally challenge position of DES. Nevertheless, BVS still have a chance to present superiority in distinctive indications. This review presents an outlook on the available first and second generation BVS and a summary of results of clinical trials on their use. It discusses explanations for unfavorable outcomes, proposed enhancement techniques and a potential niche for the use of BVS.
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Affiliation(s)
- Mateusz P. Jeżewski
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology, Medical University of Warsaw, 02091 Warsaw, Poland; (M.P.J.); (M.J.K.); (C.E.); (M.P.)
| | - Michał J. Kubisa
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology, Medical University of Warsaw, 02091 Warsaw, Poland; (M.P.J.); (M.J.K.); (C.E.); (M.P.)
| | - Ceren Eyileten
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology, Medical University of Warsaw, 02091 Warsaw, Poland; (M.P.J.); (M.J.K.); (C.E.); (M.P.)
| | - Salvatore De Rosa
- Department of Medical and Surgical Sciences, Division of Cardiology, “Magna Graecia” University, 88100 Catanzaro, Italy; (S.D.R.); (C.I.)
| | - Günter Christ
- Department of Cardiology, 5th Medical Department with Cardiology, Kaiser Franz Josef Hospital, 31100 Vienna, Austria;
| | - Maciej Lesiak
- 1st Department of Cardiology, Poznan University of Medical Sciences, 1061701 Poznań, Poland;
| | - Ciro Indolfi
- Department of Medical and Surgical Sciences, Division of Cardiology, “Magna Graecia” University, 88100 Catanzaro, Italy; (S.D.R.); (C.I.)
| | - Aurel Toma
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 231090 Vienna, Austria;
| | - Jolanta M. Siller-Matula
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology, Medical University of Warsaw, 02091 Warsaw, Poland; (M.P.J.); (M.J.K.); (C.E.); (M.P.)
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 231090 Vienna, Austria;
| | - Marek Postuła
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology, Medical University of Warsaw, 02091 Warsaw, Poland; (M.P.J.); (M.J.K.); (C.E.); (M.P.)
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Multimodality intravascular imaging of bioresorbable vascular scaffolds implanted in vein grafts. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2019; 15:151-157. [PMID: 31497047 PMCID: PMC6727228 DOI: 10.5114/aic.2019.86010] [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: 12/30/2018] [Accepted: 02/28/2019] [Indexed: 11/29/2022] Open
Abstract
Introduction There are no data presenting a serial assessment of vein graft healing after bioresorbable vascular scaffold (BVS) implantation at long-term follow-up. Aim To describe ABSORB BVS healing in vein grafts by optical coherence tomography (OCT) and high-definition intravascular imaging (HD-IVUS) at long-term follow-up. Material and methods: The study group consisted of 6 patients. The first patient had serial OCT assessment of BVS implanted in the saphenous vein grafts (SVG) at baseline and at 3-, 6-, 18-month follow-up and the second patient had OCT assessment of BVS implanted in the SVG at baseline and 24-, 48-month follow-up. The second and the third patients had OCT and HD-IVUS imaging at baseline and 48-month follow-up. The last 3 patients had OCT imaging of BVS implanted in the native coronary artery at 48-month follow-up. Results There were no differences in neointimal hyperplasia after BVS implantation between each time point. However, complete scaffold coverage was observed only 48 months after implantation. Out of 202 analyzed scaffold struts, there were 67 (33%) black boxes detectable at 48-month follow-up. HD-IVUS presented plaque burden up to 67% at the segment of BVS implantation at 48-months follow-up. There was a difference in neointimal hyperplasia thickness (1.27 (0.953–1.696) vs. 0.757 (0.633–0.848), p < 0.001) between a native coronary artery and BVS scaffolds at 48-month follow-up. Conclusions Bioresorbable vascular scaffold implanted in SVG characterized moderate neointimal hyperplasia as excessive as compared to native coronary arteries at long-term follow-up. The complete scaffold coverage was observed only 48 months after implantation.
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