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Zhang X, Guo Z, Zhu L, Liu Y, Wang H, Jiang Y, Du B, Hu Y. Challenges and chances coexist: A visualized analysis and bibliometric study of research on bioresorbable vascular scaffolds from 2000 to 2022. Medicine (Baltimore) 2023; 102:e33885. [PMID: 37233419 PMCID: PMC10219738 DOI: 10.1097/md.0000000000033885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 05/09/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Bioresorbable scaffolds (BVS) provide a transient supporting force for blocked vessels and allow them to return to previous physiological characteristics. After verification with twists and turns, it has been acknowledged as an emerging revolution in percutaneous coronary intervention that expresses the current concept of intervention without placement. Through this bibliometric study, we organized the knowledge structure of bioresorbable scaffolds and attempted to predict future research hotspots in this field. METHODS seven thousand sixty-three articles were retrieved from the web of science core collection database from 2000 to 2022. Then, we utilize CiteSpace 6.1.R2, Biblioshiny and VOS viewer 1.6.18 to analyze the data visually. RESULTS First, according to the spatial analysis, the number of annual publications has shown an approximately increasing trend over the past 2 decades. The USA, the People's Republic of China, and GERMANY published the most articles on bioresorbable scaffolds. Second, SERRUYS P ranked first for his most prolific work and highest cited frequency in this domain. Third, the hotspots in this field can be inferred from the keyword distribution; they were the fabrication technique based on tissue engineering; the factors to be optimized for bioresorbable scaffolds, such as mechanical property, degradation, and implantation; and the common adverse effects of bioresorbable scaffolds, such as thrombosis. Most importantly, in terms of burst detection, we could speculate that cutting-edge technology for manufacturing scaffolds represented by 3D printing constitutes the future hotspots in bioresorbable scaffold development. CONCLUSION In the first visualized bibliometric analysis of BVS, we attempt to provide a panoramic view. By enrolling extensive literature, we review the growing trend of BVSs. Since its first introduction, it has been through periods of early prosperity, questioned safety subsequently and the resultantly advanced techniques in recent years. In future, the research should focus on utilizing novel techniques to consummate the manufacturing quality and assure the safety of BVSs.
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Affiliation(s)
- Xiaohan Zhang
- Department of Cardiovascular Diseases, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zezhen Guo
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Lihong Zhu
- Department of Cerebrovascular Disease, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yao Liu
- The Second Clinical College, Shanxi University of Chinese Medicine, Shanxi, China
| | - Huan Wang
- Department of Cardiovascular Diseases, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yuchen Jiang
- Department of Cardiovascular Diseases, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Bai Du
- Department of Cardiovascular Diseases, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yuanhui Hu
- Department of Cardiovascular Diseases, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Patnaik A, Maddury J. Current Status of the Bioresorbable Scaffolds in Coronary Interventions. INDIAN JOURNAL OF CARDIOVASCULAR DISEASE IN WOMEN 2022. [DOI: 10.25259/ijcdw_11_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Amar Patnaik
- Department of Cardiology, Star Hospitals, Hyderabad, Telangana, India,
| | - Jyotsna Maddury
- Department of Cardiology, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India,
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Jackson-Smith E, Zioupos S, Banerjee P. Bioresorbable vascular scaffolds versus conventional drug-eluting stents across time: a meta-analysis of randomised controlled trials. Open Heart 2022; 9:openhrt-2022-002107. [PMID: 36288820 PMCID: PMC9615997 DOI: 10.1136/openhrt-2022-002107] [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: 07/30/2022] [Accepted: 09/12/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Bioresorbable vascular scaffolds (BVS) were designed to reduce the rate of late adverse events observed in conventional drug-eluting stents (DES) by dissolving once they have restored lasting patency. OBJECTIVES Compare the safety and efficacy of BVS versus DES in patients receiving percutaneous coronary intervention for coronary artery disease across a complete range of randomised controlled trial (RCT) follow-up intervals. METHODS A systematic review and meta-analysis was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. MEDLINE, EMBASE and Web of Science were searched from inception through 5 January 2022 for RCTs comparing the clinical outcomes of BVS versus DES. The primary safety outcome was stent/scaffold thrombosis (ST), and the primary efficacy outcome was target lesion failure (TLF: composite of cardiac death, target vessel myocardial infarction (TVMI) and ischaemia-driven target lesion revascularisation (ID-TLR)). Secondary outcomes were patient-oriented composite endpoint (combining all-death, all-MI and all-revascularisation), its individual components and those of TLF. Studies were appraised using Cochrane's Risk of Bias tool and meta-analysis was performed using RevMan V.5.4. RESULTS 11 919 patients were randomised to receive either BVS (n=6438) or DES (n=5481) across 17 trials (differing follow-up intervals from 3 months to 5 years). BVS demonstrated increased risk of ST across all timepoints (peaking at 2 years with risk ratio (RR): 3.47; 95% CI 1.80 to 6.70; p=0.0002). Similarly, they showed increased risk of TLF (peaking at 3 years, RR: 1.35; 95% CI 1.07 to 1.70; p=0.01) resulting from high rates of TVMI and ID-TLR. Though improvements were observed after device dissolution (5-year follow-up), these were non-significant. All other outcomes were statistically equivalent. Applicability to all BVS is limited by 91% of the BVS group receiving Abbott's Absorb. CONCLUSION This meta-analysis demonstrates that current BVS are inferior to contemporary DES throughout the first 5 years at minimum.
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Affiliation(s)
| | | | - Prithwish Banerjee
- Warwick Medical School, University of Warwick, Coventry, UK,Centre for Sports, Exercise & Life Sciences (CSELS), Coventry University Faculty of Health and Life Sciences, Coventry, UK,Department of Cardiology, University Hospitals Coventry and Warwickshire, Coventry, UK
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Structural and Functional Evaluation of Coronary Arteries Treated With ABSORB Bioresorbable Vascular Scaffold at 5-Year Follow-Up. Am J Cardiol 2022; 182:1-7. [PMID: 36075756 DOI: 10.1016/j.amjcard.2022.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 07/06/2022] [Accepted: 07/11/2022] [Indexed: 11/23/2022]
Abstract
Although complete bioresorbable vascular scaffold (BVS) resorption has been demonstrated at 5-year follow-up, whether corresponding vasomotor function restoration occurs remains unknown. The objective was to simultaneously assess the structural healing response along with vasomotor responses at 5-year follow-up of BVS implantation. We studied consecutive patients treated with ABSORB-BVS at 5-year follow-up (n = 31), who were recruited from a multicenter registry and were contacted to undergo a research protocol-driven repeat coronary angiogram involving intracoronary optical coherence tomography (OCT) and invasive coronary endothelial function testing. Epicardial endothelium-dependent vasomotion was defined as any vasodilatation after intracoronary acetylcholine (ACh), whereas endothelium-independent vasomotion was defined as any vasodilatation after intracoronary nitroglycerine (NTG), using quantitative coronary angiography. The mean implantation time point was 60.5 ± 4.6 months. OCT imaging demonstrated complete scaffold resorption in all patients. New coronary lesions (stenosis >50%) were found in 5 patients (16.1%), 3 of them underwent ad hoc percutaneous revascularization (9.7%). Intracoronary ACh (27 patients) and NTG testing (30 patients) was performed. Quantitative coronary angiography analysis demonstrated vasoconstriction after ACh administration and lack of response to NTG in BVS segments (mean lumen diameter = 2.00 ± 0.61 mm at baseline vs 1.74 ± 0.70 mm post-ACh, p <0.001; 2.05 ± 0.54 mm at baseline vs 2.03 ± 0.50 mm post-NTG, p = 0.69). OCT lumen analysis demonstrated similar vasoconstrictive responses to ACh (mean lumen area = 5.31 ± 2.26 mm2 at baseline vs 5.12 ± 2.55 mm2 post-ACh, p = 0.007) but had a vasodilatory response to NTG (5.96 ± 2.35 mm2 at baseline vs 6.17 ± 2.55 mm2 post-NTG, p<0.001). In conclusion, complete ABSORB-BVS resorption was demonstrated at 5-year follow-up. However, this healing response was associated with endothelium-dependent vasomotor dysfunction within the BVS segment.
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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: 0] [Impact Index Per Article: 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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Gallinoro E, Almendarez M, Alvarez-Velasco R, Barbato E, Avanzas P. Bioresorbable stents: Is the game over? Int J Cardiol 2022; 361:20-28. [DOI: 10.1016/j.ijcard.2022.05.024] [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: 04/19/2022] [Revised: 05/08/2022] [Accepted: 05/11/2022] [Indexed: 11/30/2022]
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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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Tungsten disulfide nanotubes enhance flow-induced crystallization and radio-opacity of polylactide without adversely affecting in vitro toxicity. Acta Biomater 2022; 138:313-326. [PMID: 34798318 PMCID: PMC9505057 DOI: 10.1016/j.actbio.2021.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/17/2021] [Accepted: 11/04/2021] [Indexed: 01/17/2023]
Abstract
Treatment of vascular disease, from peripheral ischemia to coronary heart disease (CHD), is poised for transformation with the introduction of transient implants designed to "scaffold" regeneration of blood vessels and ultimately leave nothing behind. Improved materials could expand the use of these devices. Here, we examine one of the leading polymers for bioresorbable scaffolds (BRS), polylactide (PLA), as the matrix of nanocomposites with tungsten disulfide (WS2) nanotubes (WSNT), which may provide mechanical reinforcement and enhance radio-opacity. We evaluate in vitro cytotoxicity using vascular cells, flow-induced crystallization and radio-opacity of PLA-WSNT nanocomposites at low WSNT concentration. A small amount of WSNT (0.1 wt%) can effectively promote oriented crystallization of PLA without compromising molecular weight. And radio-opacity improves significantly: as little as 0.5 to 1 wt% WSNT doubles the radio-opacity of PLA-WSNT relative to PLA at 17 keV. The results suggest that a single component, WSNT, has the potential to increase the strength of BRS to enable thinner devices and increase radio-opacity to improve intraoperative visualization. The in vitro toxicity results indicate that PLA-WSNT nanocomposites are worthy of investigation in vivo. Although substantial further preclinical studies are needed, PLA-WSNT nanocomposites may provide a complement of material properties that may improve BRS and expand the range of lesions that can be treated using transient implants. STATEMENT OF SIGNIFICANCE: Bioresorbable Scaffolds (BRSs) support regeneration of arteries without permanent mechanical constraint. Poly-L-lactide (PLLA) is the structural material of the first approved BRS for coronary heart disease (ABSORB BVS), withdrawn due to adverse events in years 1-3. Here, we examine tungsten disulfide (WS2) nanotubes (WSNT) in PLA to address two contributors to early complications: (1) reinforce PLLA (enable thinner BRS), and (2) increase radiopacity (provide intraoperative visibility). For BRS, it is significant that WSNT disperse, remain dispersed, reduce friction and improve mechanical properties without additional chemicals or surface modifications. Like WS2 nanospheres, bare WSNT and PLA-WSNT nanocomposites show low cytotoxicity in vitro. PLA-WSNT show enhanced flow-induced crystallization relative to PLA, motivating future study of the processing behavior and strength of these materials.
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Barkholt TØ, Neghabat O, Holck EN, Andreasen LN, Christiansen EH, Holm NR. Bioresorbable magnesium scaffold in the treatment of simple coronary bifurcation lesions: The BIFSORB pilot II study. Catheter Cardiovasc Interv 2021; 99:1075-1083. [PMID: 34967094 PMCID: PMC9540410 DOI: 10.1002/ccd.30051] [Citation(s) in RCA: 1] [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] [Received: 07/05/2021] [Revised: 10/18/2021] [Accepted: 12/12/2021] [Indexed: 11/09/2022]
Abstract
Objectives To evaluate the feasibility, safety, and healing response of a magnesium‐based bioresorbable scaffold (BRS) in the treatment of simple bifurcation lesions using the single stent provisional technique. Background BRS may hold potential advantages in the treatment of coronary bifurcation lesions, however low radial strength and expansion capacity has been an issue with polymer‐based scaffolds. The magnesium BRS may prove suitable for bifurcation treatment as its mechanical properties are closer to those of permanent metallic drug‐eluting stents. Methods The study was a proof‐of‐concept study with planned inclusion of 20 patients with stable angina pectoris and a bifurcation lesion involving a large side branch (SB) > 2.5 mm with less than 50% diameter stenosis. Procedure and healing response were evaluated by optical coherence tomography (OCT). The main endpoints were a composite clinical safety endpoint and an OCT healing index at 1 month (range: 0–98). Results Eleven patients were included in the study. The study was prematurely terminated due to scaffold fractures and embolization of scaffold fragments in three cases requiring bailout stenting with drug‐eluting stents. One patient underwent bypass surgery at 3 months due to stenosis proximal to the study segment. All SB were patent for 1 month. One‐month OCT evaluation showed strut coverage of 96.9% and no malapposition. Scaffold fractures and uncovered jailing struts resulted in a less favorable mean OCT healing index score of 10.4 ± 9.0. Conclusions Implanting a magnesium scaffold by the provisional technique in nontrue bifurcation lesions was associated with scaffold fracture, embolization of scaffold fragments, and a high need for bailout stenting.
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Affiliation(s)
- Trine Ø Barkholt
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Omeed Neghabat
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Emil N Holck
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Lene N Andreasen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Niels R Holm
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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Clinical presentation does not affect acute mechanical performance of the Novolimus-eluting bioresorbable vascular scaffold as assessed by optical coherence tomography. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2021; 17:272-280. [PMID: 34819963 PMCID: PMC8596729 DOI: 10.5114/aic.2021.109239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/29/2021] [Indexed: 02/01/2023] Open
Abstract
Introduction Initial trials of bioresorbable vascular scaffolds (BVS) have mostly excluded patients presenting with acute coronary syndrome (ACS). However, these patients might benefit from a BVS platform, in particular as they are often younger and have been less frequently treated than patients with chronic disease. Aim To compare the acute performance of a Novolimus eluting BVS in ACS and non-ACS patients using optical coherence tomography (OCT) in patients presenting with acute or chronic coronary syndrome. Material and methods The final OCT pullback of 79 patients (34 with ACS, 45 non-ACS) was analysed at 1-mm intervals. The following indices were calculated: mean and minimal area, residual area stenosis, incomplete strut apposition, tissue prolapse, eccentricity index, symmetry index, strut fracture, and edge dissection. Results OCT showed a minimum lumen area (non-ACS vs. ACS) of 6.2 ±2.1 vs. 5.6 ±1.5 mm2 (p = 0.21). Mean residual area stenosis was 14.5% vs. 19.5% (p = 0.39). The mean eccentricity index did not differ significantly (0.78 ±0.13 vs. 0.78 ±0.06; p = 0.42). There was a non-significant tendency for more fractures in the non-ACS group (22.2% vs. 5.9%; p = 0.07). Prolapse area was comparable (4.4 ±7.4 mm2 vs. 5.2 ±10.9 mm2; p = 0.62). Conclusions This is the first study to investigate the acute mechanical performance of a Novolimus-eluting BVS in patients with different clinical presentations using OCT. We found that clinical presentation did not determine acute mechanical performance as assessed by the final OCT pullback. There was evidence of more mechanical complications in terms of fractures and a higher percentage of incomplete strut apposition in the group of patients with chronic coronary syndrome.
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Rapetto C, Leoncini M, Cerrato E, Regazzoli D, Cortese B, Rossi A, Fetiveau R, Geraci S, De Angelis MC, Tespili M, Iannaccone M, Centola A, Durante A, De Carlo M, De Caterina A, Ribichini F, Favaretto E, Testa L, Pirisi R, Varbella F, Nicolini E, di Palma G, Loi B, Poli A, Caramanno G, Varricchio A, Garbo R, Cuculo A, Petronio AS, Berti S, Bollati M, Spedicato L, De Candia G, Piva T, Quadri G, Colombo A, Ielasi A. ImpaCt of an Optimal Implantation Strategy on Absorb Long-Term Outcomes: The CIAO Registry. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 30:1-8. [DOI: 10.1016/j.carrev.2020.09.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 05/16/2020] [Accepted: 09/23/2020] [Indexed: 10/23/2022]
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Wiebe J, Hofmann FJ, West N, Baumbach A, Carrie D, Bermudez EP, Cayla G, Hernandez FH, de la Torre Hernandez JM, Koning R, Loi B, Moscarella E, Tarantini G, Zaman A, Lober C, Riemer T, Achenbach S, Hamm CW, Nef HM. Outcomes of 10,312 patients treated with everolimus-eluting bioresorbable scaffolds during daily clinical practice - results from the European Absorb Consortium. Catheter Cardiovasc Interv 2021; 99:533-540. [PMID: 34463427 DOI: 10.1002/ccd.29932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 08/21/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To asses mid-term clinical outcomes of bioresorbable vascular scaffolds (BVS) for the treatment of coronary artery disease in a large-scale all-comers population. BACKGROUND Several clinical settings are underrepresented in randomized studies investigating BVS against drug-eluting stents. Whether their results can be translated into the heterogeny patient population seen during daily routine requires further investigation. METHODS The European ABSORB Consortium comprises the following European registries: GABI-R, ABSORB UK Registry, ABSORB France, BVS RAI Registry, and REPARA BVS Registry, which all prospectively collected patient-level data regarding outcomes following unrestricted BVS implantation. The primary endpoint of target lesion failure (TLF) includes cardiac death, target-vessel myocardial infarction (TVMI) and target-lesion revascularisation (TLR) at 12 months. The incidence of scaffold thrombosis (ST) according to ARC criteria was also assessed. Multivariable analysis was used to adjust for differences in patient and lesion characteristics. RESULTS A total of 10,312 patients (mean age 58.4 ± 11.4 y) underwent BVS implantation during routine practice. The 12-month follow-up was complete in 95.5% of patients. At 12 months, the primary endpoint of TLF occurred in 3.6%; its components cardiac death, TVMI and TLR were documented in 1.2%, 1.8%, and 2.6%, respectively. The definite/probable ST rate was 1.7%. Absence of predilatation, discontinuation of DAPT and scaffold diameter below 3 mm were independent predictors of ST. CONCLUSIONS The EAC demonstrates reasonable real-world clinical outcome data after BVS implantation. However, the rate of scaffold thrombosis remains high.
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Affiliation(s)
- Jens Wiebe
- Department of Cardiology, Deutsches Herzzentrum Muenchen, Munich, Germany
| | - Felix J Hofmann
- Medizinische Klinik I, University of Giessen, Giessen, Germany
| | - Nick West
- Department of Cardiology, Royal Papworth Hospital, Cambridge, UK
| | | | - Didier Carrie
- Sevice de cardiologie, CHU Toulouse, Université Paul Sabatier, Toulouse, France
| | | | - Guillaume Cayla
- Service de cardiologie, CHU Nîmes, Université de Montpellier, Montpellier, France
| | | | | | - René Koning
- Département de Cardiologie, Clinique Saint-Hilaire, Rouen, France
| | - Bruno Loi
- Interventional Cardiology, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | | | | | - Azfar Zaman
- Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Christiane Lober
- IHF GmbH Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - Thomas Riemer
- IHF GmbH Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-University of Erlangen, Erlangen, Germany
| | - Christian W Hamm
- Medizinische Klinik I, University of Giessen, Giessen, Germany.,Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
| | - Holger M Nef
- Medizinische Klinik I, University of Giessen, Giessen, Germany
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Wiebe J, Hoppmann P, Cassese S, Rheude T, Colleran R, Kuna C, Rai H, Valeskini M, Ibrahim T, Joner M, Schunkert H, Laugwitz KL, Kastrati A, Byrne RA. Evolución de pacientes tratados con armazones coronarios bioabsorbibles liberadores de everolimus tras su disolución completa. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.06.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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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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Boeder NF, Kastner J, Mehilli J, Münzel T, Naber C, Neumann T, Richardt G, Schmermund A, Wöhrle J, Zahn R, Riemer T, Achenbach S, Hamm CW, Nef HM. Predictors of scaffold failure and impact of optimized scaffold implantation technique on outcome: Results from the German-Austrian ABSORB RegIstRy. Catheter Cardiovasc Interv 2021; 98:E555-E563. [PMID: 34143547 DOI: 10.1002/ccd.29829] [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: 04/16/2021] [Revised: 05/28/2021] [Accepted: 06/05/2021] [Indexed: 11/05/2022]
Abstract
AIMS We aimed to investigate predictors of scaffold failure and the potential impact of an optimized scaffold implantation technique by means of a learning curve on long-term clinical outcome after bioresorbable scaffold (BRS) implantation and to evaluate predictors of scaffold failure. METHODS AND RESULTS A total of 3326 patients were included in this prospective, observational, multi-center study (ClinicalTrials.gov NCT02066623) of consecutive patients undergoing BRS implantation between November 2013 and January 2016. The 3144 patients completed follow-up after 24 months, 3265 patients were eligible for time-to-event-analysis. Clinical endpoints were major adverse cardiac events-a composite endpoint of death, target vessel revascularization and myocardial infarction, and scaffold thrombosis (ScT). Patients were grouped according to treatment before or since 2015. During follow-up MACE rate improved from 2.52% after 30 days, 5.45% after 6 months and 12.67% after 24 months to 1.52%, 3.44%, and 10.52%, respectively. A total of 75 ScT occurred. In multiple regression analysis, treatment of bifurcations, long lesions, and procedures performed earlier than 2014 were identified as predictors for the occurrence of ScT. CONCLUSION Treatment of bifurcation lesions is the strongest predictor of ScT following BRS implantation. A significantly lower incidence of ScT and 24-month target lesion revascularization in patients recruited after 2014 into our observational registry suggests the influence of a learning curve.
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Affiliation(s)
- Niklas F Boeder
- Department of Cardiology, University of Giessen, Giessen, Germany
| | - Johannes Kastner
- Department of Cardiology, University of Vienna Medical School, Vienna, Austria
| | - Julinda Mehilli
- Department of Cardiology, Krankenhaus Landshut-Achendorf, Landshut, Germany
| | - Thomas Münzel
- Department of Medicine II, University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Christoph Naber
- Department of Cardiology, Klinikum Wilhelmshaven, Wilhelmshaven, Germany
| | | | - Gert Richardt
- Division of Cardiology, Herzzentrum, Segeberger Kliniken GmbH, Bad Segeberg, Germany
| | - Axel Schmermund
- Division of Cardiology, Cardioangiologisches Centrum Bethanien, Frankfurt am Main, Germany
| | - Jochen Wöhrle
- Department of Cardiology, Medizin Campus Bodensee, Friedrichshafen, Germany
| | - Ralf Zahn
- Department of Cardiology, Herzzentrum Ludwigshafen, Ludwigshafen, Germany
| | - Thomas Riemer
- IHF GmbH - Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Christian W Hamm
- Department of Cardiology, University of Giessen, Giessen, Germany
| | - Holger M Nef
- Department of Cardiology, University of Giessen, Giessen, Germany
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16
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Boeder NF, Dörr O, Koepp T, Blachutzik F, Achenbach S, Elsässer A, Hamm CW, Nef HM. Acute Mechanical Performance of Magmaris vs. DESolve Bioresorbable Scaffolds in a Real-World Scenario. Front Cardiovasc Med 2021; 8:696287. [PMID: 34195239 PMCID: PMC8236697 DOI: 10.3389/fcvm.2021.696287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 05/21/2021] [Indexed: 02/03/2023] Open
Abstract
Background: After the bioresorbable PLLA-based vascular scaffold (Absorb BVS) was taken from the market due to its high adverse event rates, a magnesium-based scaffold (Magmaris) was introduced. Objective: To compare the acute performance of the sirolimus-eluting magnesium alloy Magmaris scaffold with that of the novolimus-eluting PLLA-based DESolve scaffold in terms of appropriate scaffold deployment using optical coherence tomography (OCT). Methods and Results: Data from the final OCT pullback of 98 patients were included (19 Magmaris, 79 DESolve) and analyzed at 1-mm intervals. The following indices were calculated: mean and minimal area, residual area stenosis, incomplete strut apposition, tissue prolapse, eccentricity index, symmetry index, strut fracture, and edge dissection. OCT showed a minimum lumen area for Magmaris vs. DESolve of 6.6 ± 1.6 vs. 6.0 ± 1.9 (p = 0.06). Scaffolds with residual area stenosis >20% were predominantly seen in the DESolve group (15.8 vs. 46.8%; p = 0.01). The mean eccentricity index did differ significantly (0.74 ± 0.06 vs. 0.63 ± 0.09; p < 0.001). No fractures were observed for Magmaris scaffolds, but 15.2% were documented for DESolve BRS (p < 0.001). Incomplete scaffold apposition area was significantly higher in the DESolve group (0.01 ± 0.02 vs. 1.05 ± 2.32 mm2; p < 0.001). Conclusion: This is the first study to compare the acute mechanical performance between Magmaris and DESolve in a real-world setting. The acute mechanical performance of Magmaris BRS seems to be superior to that of DESolve BRS, whereas OCT showed a good acute mechanical performance for both BRS in terms of generally accepted imaging criteria.
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Affiliation(s)
- Niklas F Boeder
- Medical Clinic I, University Hospital of Giessen, Giessen, Germany
| | - Oliver Dörr
- Medical Clinic I, University Hospital of Giessen, Giessen, Germany
| | - Tim Koepp
- Medical Clinic I, University Hospital of Giessen, Giessen, Germany
| | | | - Stephan Achenbach
- Medical Clinic 2, University Hospital of Erlangen, Erlangen, Germany
| | - Albrecht Elsässer
- Department of Cardiology, University Hospital of Oldenburg, Oldeburg, Germany
| | - Christian W Hamm
- Medical Clinic I, University Hospital of Giessen, Giessen, Germany.,Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany.,German Centre for Cardiovascular Research, RheinMain Chapter, Frankfurt am Main, Germany
| | - Holger M Nef
- Medical Clinic I, University Hospital of Giessen, Giessen, Germany
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17
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Wu X, Wu S, Kawashima H, Hara H, Ono M, Gao C, Wang R, Lunardi M, Sharif F, Wijns W, Serruys PW, Onuma Y. Current perspectives on bioresorbable scaffolds in coronary intervention and other fields. Expert Rev Med Devices 2021; 18:351-365. [PMID: 33739213 DOI: 10.1080/17434440.2021.1904894] [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] [Indexed: 10/21/2022]
Abstract
Introduction: The first-generation bioresorbable scaffolds (BRSs) had a large strut profile to compensate for the insufficient radial strength of bioresorbable polymer materials, resulting in higher scaffold thrombosis rates than conventional drug-eluting stents. To improve the clinical safety and efficacy, the new generation BRSs have been improved by optimal structure design, post-processing of bioresorbable polymer materials, or altering bioresorbable metallic alloys.Areas covered: This review summarizes the lessons learned from the first-generation BRS, updates the clinical outcomes of trials evaluating ABSORB bioresorbable vascular scaffold at long-term and bioresorbable metallic alloy-based devices, and examines recent outcomes of BRS treated in STEMI patients. This review also provides an overview of the current clinical data of seven BRSs manufactured in Asia, and of the BRSs extended application in other clinical arenas.Expert opinion: Drawbacks of the first-generation BRSs need to be addressed by the next generation of these stents with novel materials and technologies. Clinical research, including randomized controlled trials, are required to further evaluate BRSs application in coronary artery disease. The encouraging results of BRSs innovation applied in the peripheral arteries and gastrointestinal tracts support other potential clinical applications of BRS technology.
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Affiliation(s)
- Xinlei Wu
- Institute of Cardiovascular Development and Translational Medicine, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland
| | - Sijing Wu
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland.,Department of Cardiology, Beijing Anzhen Hospital, Beijing, China
| | - Hideyuki Kawashima
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland
| | - Hironori Hara
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland
| | - Masafumi Ono
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland
| | - Chao Gao
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland.,Department of Cardiology, Xijing Hospital, Xi'an, China
| | - Rutao Wang
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland.,Department of Cardiology, Xijing Hospital, Xi'an, China
| | - Mattia Lunardi
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland
| | - Faisal Sharif
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland
| | - William Wijns
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland.,National Heart & Lung Institute, Imperial College London, London, UK
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland
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18
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Zhang B, Wang X, Wang D, Guo M, Ren C, Han W, Uyama H, Li Q. Improved Antithrombogenicity of a Poly(lactic acid) Surface Grafted with Chondroitin Sulfate. ACS APPLIED BIO MATERIALS 2021; 4:2696-2703. [DOI: 10.1021/acsabm.0c01629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Bo Zhang
- School of Mechanics Science and Safety Engineering, Zhengzhou University, Zhengzhou 450002, China
- National Center for International Research of Micro-Nano Molding Technology, Key Laboratory of Henan Province for Micro Molding Technology, Zhengzhou 450002, China
| | - Xiaofeng Wang
- School of Mechanics Science and Safety Engineering, Zhengzhou University, Zhengzhou 450002, China
- National Center for International Research of Micro-Nano Molding Technology, Key Laboratory of Henan Province for Micro Molding Technology, Zhengzhou 450002, China
| | - Dongfang Wang
- School of Mechanics Science and Safety Engineering, Zhengzhou University, Zhengzhou 450002, China
- National Center for International Research of Micro-Nano Molding Technology, Key Laboratory of Henan Province for Micro Molding Technology, Zhengzhou 450002, China
| | - Meng Guo
- School of Mechanics Science and Safety Engineering, Zhengzhou University, Zhengzhou 450002, China
- National Center for International Research of Micro-Nano Molding Technology, Key Laboratory of Henan Province for Micro Molding Technology, Zhengzhou 450002, China
| | - Cuihong Ren
- School of Mechanics Science and Safety Engineering, Zhengzhou University, Zhengzhou 450002, China
- National Center for International Research of Micro-Nano Molding Technology, Key Laboratory of Henan Province for Micro Molding Technology, Zhengzhou 450002, China
| | - Wenjuan Han
- School of Materials Science and Engineering, Zhengzhou University, Zhengzhou 450002, China
| | - Hiroshi Uyama
- Department of Applied Chemistry, Graduate School of Engineering, Osaka University, Suita, Japan
| | - Qian Li
- School of Mechanics Science and Safety Engineering, Zhengzhou University, Zhengzhou 450002, China
- National Center for International Research of Micro-Nano Molding Technology, Key Laboratory of Henan Province for Micro Molding Technology, Zhengzhou 450002, China
- School of Materials Science and Engineering, Zhengzhou University, Zhengzhou 450002, China
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19
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Bioresorbable Scaffolds in Percutaneous Coronary Intervention: Facing Old Problems, Raising New Hopes. Curr Cardiol Rep 2021; 23:15. [PMID: 33495895 DOI: 10.1007/s11886-021-01447-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW In this review, we discuss about the reasons behind the failure of the Absorb bioresorbable vascular scaffold (BVS) device and about the challenges the future holds for the next generation of the bioresorbable scaffold (BRS) technology. RECENT FINDINGS Absorb BVS was burdened by intrinsic structural limitations which resulted in augmented rates of device thrombosis and clinical adverse events compared to current-generation metallic stent. Nevertheless, new generation devices with novel design and materials are in development. Second generation BRS have enhanced mechanical strength, smaller footprints, less thrombogenicity and modified bioresorption. These features, paired with proper patient and lesion selection and optimal "user-friendly" implant techniques, could possibly overcome the previous BRS generation limitations, rekindling physicians, and industry interest on this promising technology.
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20
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Kraak RP, Tijssen RYG, van Dongen IM, Elias J, Hofma SH, van der Schaaf RJ, Arkenbout EK, Weevers A, Tijssen JGP, Piek JJ, de Winter RJ, Henriques JPS, Wykrzykowska JJ. Outcomes of bioresorbable vascular scaffolds versus everolimus-eluting stents by coronary complexity: a sub-analysis of the AIDA trial. EUROINTERVENTION 2020; 16:e904-e912. [PMID: 31062692 DOI: 10.4244/eij-d-18-00884] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS We aimed to evaluate the impact of the complexity of coronary disease as assessed by the SYNTAX score (SXscore) on the clinical outcomes in the AIDA trial. METHODS AND RESULTS In the AIDA trial, we compared Absorb versus XIENCE in routine clinical practice. Clinical outcomes were stratified by SXscore tertiles: SXlow (SXscore ≤8), SXmid (SXscore >8 and ≤15) and SXhigh (>15). The SXscore was available in 1,661 of the 1,845 (90%) patients. The event rate of TVF was numerically lower in Absorb compared to XIENCE (3.7% versus 5.6%; p=0.257) in the SXlow tertile, numerically higher in Absorb in the SXmid tertile (11.4% versus 9.3%, p=0.421) and similar in the SXhigh tertile (15.5% versus 15.6%; p=0.960). The rates of definite/probable device thrombosis in Absorb versus XIENCE were significantly higher in the SXmid tertile (3.3% versus 0.8%, p=0.043) and in the SXhigh tertile (3.7% versus 0.8%, p=0.006). CONCLUSIONS We found no significantly different rates of TVF between Absorb and XIENCE patients. Absorb-treated patients in the SXmid and SXhigh tertiles had an increased risk of device thrombosis when compared to XIENCE-treated patients. The rates of device thrombosis in the SXlow tertile, while still higher for Absorb, are more acceptable than in the SXmid and SXhigh score tertiles.
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Affiliation(s)
- Robin P Kraak
- Amsterdam UMC and AMC Heart Center, University of Amsterdam, Amsterdam, the Netherlands
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21
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Eltahlawi MA, Abdel-Aziz AAF, Sherif AS, Shokry KAA, Shehata IE. Long-term follow-up of therapeutic efficacy of everolimus-eluting bioresorbable vascular scaffold in comparison to everolimus-eluting stent in treatment of chronic total occlusion guided by intracoronary imaging. Egypt Heart J 2020; 72:72. [PMID: 33085004 PMCID: PMC7578208 DOI: 10.1186/s43044-020-00104-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 10/05/2020] [Indexed: 11/10/2022] Open
Abstract
Background We hypothesized that 1st generation everolimus-eluting bioresorbable vascular scaffold (BVS) stent associated with less complication and less restenosis rate than everolimus-eluting stent (EES) in chronic total occlusion (CTO) recanalization guided by intracoronary imaging. Therefore, we aimed to assess the safety and performance of BVS stent in CTO revascularization in comparison to EES guided by intracoronary imaging. Our prospective comparative cross-sectional study was conducted on 60 CTO patients divided into two groups according to type of stent revascularization: group I (EES group): 40 (66.7%) patients and group II (BVS group): 20 (33.3%) patients. All patients were subjected to history taking, electrocardiogram (ECG), echocardiography, laboratory investigation, stress thallium study to assess viability before revascularization. Revascularization of viable CTO lesion guided by intracoronary imaging using optical coherence tomography (OCT). Then, long-term follow-up over 1 year clinically and by multi-slice CT coronary angiography (MSCT). Our clinical and angiographic endpoints were to detect any clinical or angiographic complications during the follow-up period. Results At 6 months angiographic follow-up, BVS group had not inferior angiographic parameters but without statistically significant difference (p = 0.566). At 12 months follow-up, there was no difference at end points between the two groups (p = 0.476). No differences were found at angiographic or clinical follow-up between BVS and EES. Conclusion This study shows that 1st generation everolimus-eluting BVS is non-inferior to EES for CTO revascularization. Further studies are needed to clearly state which new smaller footprint BVS, faster reabsorption, magnesium-based less thrombogenicity, and advanced mechanical properties is under development. We cannot dismiss the efficacy and safety of new BVS technology. Trial registration ZU-IRB#2498/3-12-2016 Registered 3 December 2016, email: IRB_123@medicine.zu.edu.eg
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Buono A, Ielasi A, Colombo A. Latest generation stents: is it time to revive the bioresorbable scaffold? Minerva Cardioangiol 2020; 68:415-435. [DOI: 10.23736/s0026-4725.20.05188-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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23
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Verdoia M, Kedhi E, Suryapranata H, Galasso G, Dudek D, De Luca G. Poly (l-lactic acid) bioresorbable scaffolds versus metallic drug-eluting stents for the treatment of coronary artery disease: A meta-analysis of 11 randomized trials. Catheter Cardiovasc Interv 2020; 96:813-824. [PMID: 31730255 DOI: 10.1002/ccd.28594] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 10/05/2019] [Accepted: 10/26/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Bioresorbable vascular scaffolds (BVS) have been proposed for overcoming the long-term limitations of permanent metallic stents, while theoretically warranting similar advantages in plaque stabilization and anti-restenotic drug delivery in the early postrevascularization phase. However, increased rates of malapposition, restenosis, or thrombosis have emerged from initial trials with BVS, that were nevertheless underpowered for the evaluation of the real outcome benefits of these coronary devices. The recent completion of newer randomized clinical trials paves the way to the present meta-analysis, aiming at the comparison of Poly (l-Lactic acid) BVS (PLLA-BVS) versus metallic drug-eluting stents (DES) in the treatment of coronary stenoses. METHODS Literature and main scientific session abstracts were searched for randomized clinical trials (RCTs) comparing drug-eluting BVS versus metallic DES for the treatment of coronary artery disease (CAD). The primary efficacy endpoint was mortality, secondary endpoints were cardiovascular death, myocardial infarction, target lesion revascularization (TLR), stent thrombosis and the composite of device-oriented target lesion failure (TLF). RESULTS We included 11 randomized trials, for a total population of 10,707 patients, 54.5% treated with BVS. The major indication for PCI was stable CAD, whereas acute coronary syndrome represented 30% of the patients. At a mean follow-up of 2.64 years (1-5 years), mortality occurred in 2.71% of the patients, with no difference according to the type of implanted stent (OR[95%CI] = 0.94 [0.74, 1.20], p = .62). No interaction was observed according to patients' risk profile or the rate of diabetes and ACS. However, a significant increase in myocardial infarction, stent thrombosis, TLR and TLF was observed with BVS as compared to DES. CONCLUSIONS The present meta-analysis provides the most updated data on the use of PLLA-BVS for the treatment of CAD. We documented a poorer performance of these new coronary devices, as compared to new generation metallic DES, being associated with an increased rate of recurrent cardiovascular events. However, such ischemic complications did not impact on mortality, with a comparable survival independently from the type of stent.
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Affiliation(s)
- Monica Verdoia
- Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, Novara, Italy
| | - Elvin Kedhi
- Department of Cardiology, ISALA Hospital, Zwolle, the Netherlands
| | | | - Gennaro Galasso
- Divisione di Cardiologia, Università degli Studi di Salerno, Salerno, Italy
| | - Dariusz Dudek
- Institue of Cardiology, Jagiellonian University, Krakow, Poland
| | - Giuseppe De Luca
- Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, Novara, Italy
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24
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Wiebe J, Hoppmann P, Cassese S, Rheude T, Colleran R, Kuna C, Rai H, Valeskini M, Ibrahim T, Joner M, Schunkert H, Laugwitz KL, Kastrati A, Byrne RA. Outcomes after complete dissolution of everolimus-eluting bioresorbable scaffolds implanted during routine practice. ACTA ACUST UNITED AC 2020; 74:584-590. [PMID: 32819850 DOI: 10.1016/j.rec.2020.07.005] [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: 03/29/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND OBJECTIVES Long-term outcomes of unselected patients treated with bioresorbable vascular scaffold (BVS) implantation are lacking, especially for the period after complete dissolution of the BVS. This study sought to evaluate 5-year outcomes in patients treated with BVS in routine practice. METHODS Consecutive patients who underwent implantation of everolimus-eluting BVS during routine clinical practice at 2 high-volume centres in Germany were studied. The patients were followed-up for up to 5 years. The primary endpoints of interest were the composite of death, myocardial infarction and target lesion revascularization, as well as definite scaffold thrombosis. RESULTS A total of 419 patients (mean age 66.6 ± 10.9 years; 31.5% had diabetes) were included, of whom 38.9% presented with an acute coronary syndrome. Of the 527 lesions treated, 49.0% were classified as complex and 13.1% were bifurcation lesions. At 5 years, the composite clinical endpoint occurred in 33.1% of patients and definite scaffold thrombosis occurred in 4.7%. Most definite scaffold thrombosis occurred within 2 years after BVS implantation. CONCLUSIONS In patients treated with BVS implantation in routine clinical practice the rates of adverse clinical events at 5 years were high, including a considerable incidence of scaffold thrombosis.
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Affiliation(s)
- Jens Wiebe
- Deutsches Herzzentrum München, Department of Cardiology, Technische Universität München, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany.
| | - Petra Hoppmann
- 1. med. Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Salvatore Cassese
- Deutsches Herzzentrum München, Department of Cardiology, Technische Universität München, Munich, Germany
| | - Tobias Rheude
- Deutsches Herzzentrum München, Department of Cardiology, Technische Universität München, Munich, Germany
| | - Roisin Colleran
- Deutsches Herzzentrum München, Department of Cardiology, Technische Universität München, Munich, Germany
| | - Constantin Kuna
- Deutsches Herzzentrum München, Department of Cardiology, Technische Universität München, Munich, Germany
| | - Himanshu Rai
- Deutsches Herzzentrum München, Department of Cardiology, Technische Universität München, Munich, Germany
| | - Michael Valeskini
- Deutsches Herzzentrum München, Department of Cardiology, Technische Universität München, Munich, Germany
| | - Tareq Ibrahim
- 1. med. Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Michael Joner
- Deutsches Herzzentrum München, Department of Cardiology, Technische Universität München, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Department of Cardiology, Technische Universität München, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Karl-Ludwig Laugwitz
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany; 1. med. Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Department of Cardiology, Technische Universität München, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Robert A Byrne
- Mater Private Hospital, Department of Cardiology, Dublin, Ireland; Royal College of Surgeons, Dublin, Ireland
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Ochijewicz D, Tomaniak M, Kołtowski L, Rdzanek A, Pietrasik A, Proniewska K, Partyka L, Dijsktra J, Huczek Z, Filipiak K, Opolski G, Kochman J. Peri-strut low intensity areas and in-scaffold neointima growth after bioresorbable scaffold implantation in STEMI. A serial optical coherence tomography study. Int J Cardiol 2020; 312:27-32. [PMID: 32315682 DOI: 10.1016/j.ijcard.2020.04.051] [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: 11/02/2019] [Revised: 04/10/2020] [Accepted: 04/16/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Peri-strut low intensity areas (PLIA) visualized by optical coherence tomography (OCT) have been related to neointimal proliferation and increased incidence of target lesion revascularization in stable coronary artery disease. The aim of this study was to determine the association between PLIA by OCT and the long-term vascular healing response after bioresorbable scaffold (BRS) implantation in the setting of ST-segment elevation myocardial infarction (STEMI). METHODS This is a single-centre, longitudinal, cohort study with a serial: baseline, 1, 2 and 5 years OCT evaluation of neointimal response (lumen area and neoatherosclerosis) after percutaneous coronary intervention (PCI) with BRS Absorb™ 1.0 implantation in patients presenting with STEMI. PLIA was analyzed in every cross section and scored: 0-no PLIA; 1-PLIA < 1 quadrant; 2-PLIA ≥ 1 and <2 quadrants; 3-PLIA ≥ 2 and <3 quadrants; 4-PLIA in ≥3 quadrants. RESULTS Of the 23 patients implanted BRS, 18 completed 2-year follow-up, whereas complete OCT data up to 5 years were available in 12 patients. Presence of PLIA was identified in 100% patients at 1 and 2 years, whereas at 5 years neither PLIA nor scaffold struts were visualized by OCT. Neoatherosclerosis was identified in 73,68% patients after 1 year and in all patients at 2 and 5 years. The mean PLIA score > 1 at 2 years was associated with greater percentage of minimum lumen area decrease after 2 years from index procedure. CONCLUSIONS The extent of PLIA by OCT at 2 years after primary PCI with BRS was associated with lumen area decrease. Neoatherosclerosis formation was detected in all patients at 2 and 5 years. PLIA assessment could serve as an additive means to predict neointimal healing pattern after next generation BRS implantation.
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Affiliation(s)
- Dorota Ochijewicz
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Mariusz Tomaniak
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
| | - Lukasz Kołtowski
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Adam Rdzanek
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | | | | | - Lukasz Partyka
- Krakow Cardiovascular Research Institute, Krakow, Poland
| | - Jouke Dijsktra
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Zenon Huczek
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Krzysztof Filipiak
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Grzegorz Opolski
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Janusz Kochman
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
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Sezavar SH, Hassanzadeh M, Akhlagh Moayed D, Tabandeh M, Ghasemi M, Abdi S, Firoozi I, Golbidi P, Pourjafari M, Taslimi N, Akhlaghi AA, Hashemian M. Current practice of percutaneous coronary intervention on patients with acute coronary syndrome in Iran: A prospective observational study. Med J Islam Repub Iran 2020; 34:13. [PMID: 32551302 PMCID: PMC7293802 DOI: 10.34171/mjiri.34.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Indexed: 11/26/2022] Open
Abstract
Background: Frequent Percutaneous Coronary Intervention (PCI) procedures are being performed on a daily basis in Iran. However, no study has been reported on the current PCI practice in patients with acute coronary syndrome (ACS) in Iran. We aimed to describe the clinical characteristics and treatment patterns in Iranian ACS patients treated with PCI.
Methods: Between February 2017 and July 2017, ACS patients presented to 5 referral hospitals in two major cities of Iran (Tehran and Shiraz) were included in this observational study if aged > 18 years and underwent PCI for ACS during hospitalization; and their clinical and procedural characteristics were collected. All data were entered into SPSS v.21 and descriptive statistics were performed.
Results: Of a total of 314 patients, 228 (73%) were males, 162 (52%) were diagnosed with ST-elevation myocardial infarction and 152 (48%) with Unstable angina/ Non-ST elevation myocardial infarction. Trans-femoral approach was more often (64%) used for PCI procedures. Stent placement was the most frequent (98%) treatment strategy on PCI, with drug-eluting stent selected in the majority of subjects (98%). The overall rate of PCI success was 95%, with 4.1% PCI-related complications, and 1.6% post-PCI bleeding events. The vast majority of the study patients (99%) were discharged with dual anti-platelet therapy.
Conclusion: In this study, we observed a high level of adherence to the currently accepted guidelines in the current PCI practice on ACS patients in Iran. Also we found our practice is highly in line with the global reduction trend in the PCI-related complications.
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Affiliation(s)
- Seyed Hashem Sezavar
- Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology & Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Morteza Hassanzadeh
- Department of Internal Medicine, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | | | - Massoud Ghasemi
- Department of Cardiology, Imam Khomeini Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | | | | | | | - Ali Asghar Akhlaghi
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
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Pellicano M, Di Gioia G, Ciccarelli G, Xaplanteris P, Delrue L, Toth GG, Van Durme F, Heyse A, Wyffels E, Vanderheyden M, Bartunek J, De Bruyne B, Barbato E. Procedural microvascular activation in long lesions treated with bioresorbable vascular scaffolds or everolimus-eluting stents: the PROACTIVE trial. EUROINTERVENTION 2020; 16:e147-e154. [PMID: 31085503 DOI: 10.4244/eij-d-18-01138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.
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Byrne RA. Medical device regulation in Europe - what is changing and how can I become more involved? EUROINTERVENTION 2020; 15:647-649. [PMID: 31625911 DOI: 10.4244/eijv15i8a118] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Byrne RA. What lessons can be learned from the experience with bioresorbable scaffolds to date? EUROINTERVENTION 2020; 15:1471-1473. [DOI: 10.4244/eijv15i17a267] [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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Costantini CR, Denk MA, De Macedo RM, Tarbine SG, Santos MF, Luize MM, Folador JC, Costantini CO, Stone GW. Absorb bioresorbable vascular scaffold outcomes following implantation with routine intravascular imaging guidance. Catheter Cardiovasc Interv 2020; 97:48-55. [DOI: 10.1002/ccd.28699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 12/22/2019] [Indexed: 01/15/2023]
Affiliation(s)
| | - Marcos A. Denk
- Hospital Cardiologico Costantini and Fundação Francisco Costantini Curitiba Paraná Brazil
| | - Rafael M. De Macedo
- Hospital Cardiologico Costantini and Fundação Francisco Costantini Curitiba Paraná Brazil
| | - Sergio G. Tarbine
- Hospital Cardiologico Costantini and Fundação Francisco Costantini Curitiba Paraná Brazil
| | - Marcelo F. Santos
- Hospital Cardiologico Costantini and Fundação Francisco Costantini Curitiba Paraná Brazil
| | - Marcio M. Luize
- Hospital Cardiologico Costantini and Fundação Francisco Costantini Curitiba Paraná Brazil
| | - Joao C. Folador
- Hospital Cardiologico Costantini and Fundação Francisco Costantini Curitiba Paraná Brazil
| | | | - Gregg W. Stone
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, and the Cardiovascular Research Foundation New York New York
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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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Suzuki N, Kozuma K, Nakamura S, Aramaki K, Saito S, Shibata Y, Nanasato M, Fujii K, Kusano H, Ediebah D, Nakamura M. Absorb GT1 Bioresorbable Vascular Scaffold System - 1-Year Post-Marketing Surveillance in Japan. Circ J 2019; 83:2460-2465. [PMID: 31708522 DOI: 10.1253/circj.cj-19-0636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The Japan post-marketing surveillance (PMS) for the Absorb GT1 bioresorbable vascular scaffold (BVS) mandated an intracoronary imaging-guided implantation technique.Methods and Results:We enrolled 135 patients who were planned to undergo PCI with THE Absorb GT1. Adequate lesion preparation, imaging-guided appropriate sizing, and high-pressure post-dilatation using a noncompliant balloon to minimize final diameter stenosis were recommended. The primary endpoint was the scaffold thrombosis rate at 3 months. All patients successfully received at least 1 Absorb GT1 at the index procedure and completed 1-year follow-up. All 139 lesions were predilatated: cutting/scoring balloon and noncompliant balloon were used in 48 (34.5%) and 58 (41.7%) lesions, respectively. Post-dilatation was performed in 137 (98.5%) lesions with mean high pressure of 18.8 atm. Optical coherence tomography (OCT) was used in 127 of 139 (91.4%) lesions, and revealed 56.7% of lesions had incomplete scaffold apposition (ISA) but only in 1.89% in the per strut analysis. All patients received adenosine diphosphate receptor antagonist at discharge, and 132 (97.8%) patients continued therapy through the year. No definite/probable scaffold thrombosis, cardiac death, myocardial infarction, or ischemia-driven target lesion revascularization was reported up to 1 year follow-up. CONCLUSIONS Appropriate OCT-guided BVS implantation may prevent incomplete strut apposition, thereby reducing the risk of target lesion failure and scaffold thrombosis.
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Affiliation(s)
- Nobuaki Suzuki
- Fourth Department of Internal Medicine, Teikyo University School of Medicine
| | - Ken Kozuma
- Department of Medicine, Teikyo University School of Medicine
| | | | - Kazuhiko Aramaki
- Department of Cardiovascular Medicine, Saitama Sekishinkai Hospital
| | - Shigeru Saito
- Department of Cardiovascular Medicine, Shonan Kamakura General Hospital
| | - Yoshisato Shibata
- Department of Cardiovascular Medicine, Miyazaki Medical Association Hospital
| | - Mamoru Nanasato
- Department of Second Cardiovascular Medicine, Red Cross Nagoya Daini Hospital.,Department of Cardiovascular Medicine, Sakakibara Heart Institute
| | - Kenshi Fujii
- Department of Cardiovascular Medicine, Sakurabashi Watanabe Hospital
| | | | | | - Masato Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
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Barkholt TØ, Webber B, Holm NR, Ormiston JA. Mechanical properties of the drug-eluting bioresorbable magnesium scaffold compared with polymeric scaffolds and a permanent metallic drug-eluting stent. Catheter Cardiovasc Interv 2019; 96:E674-E682. [PMID: 31710149 PMCID: PMC7754471 DOI: 10.1002/ccd.28545] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 10/05/2019] [Indexed: 11/24/2022]
Abstract
Objectives To compare on the bench the physical and mechanical properties of Magmaris, a magnesium bioresorbable scaffold (BRS), with Absorb and DESolve polymeric BRS and a permanent metallic stent. Background Understanding the mechanical and physical properties of BRS is crucial for appropriate implantation and postdilatation. Methods Testing was performed in fluid at 37°C and in silicone bifurcation phantoms with a 30° angle between main branch (MB) and side branch. Results The 3.0‐mm Magmaris BRS did not fracture after MB postdilatation up to 4.4 mm in contrast to the Absorb where the safe postdilatation diameter was 3.7 mm. For dilatation through stent cells, there were no Magmaris fractures with 3.0‐mm noncompliant (NC) balloons inflated to nominal pressure. Mini‐kissing balloon postdilatation with two 3.0‐mm NC balloons up to 17 atm was without fracture except for an outlier. Longitudinal and radial strengths were similar for Magmaris and Absorb BRS. The crossing profile for the Magmaris was larger than other devices. Recoil 120 min after deployment was the greatest for Magmaris but 120 min after 3.5 mm postdilatation all devices had similar diameters. Conclusions The Magmaris BRS was more resistant to strut fracture than Absorb. It had a larger crossing profile than other devices and similar radial and longitudinal strengths to Absorb. While recoil after deployment was greater with Magmaris, 120 min after 3.5 mm postdilatation all devices had similar diameters.
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Affiliation(s)
| | | | | | - John A Ormiston
- Intra, Auckland, New Zealand.,University of Auckland, Auckland, New Zealand
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Maillard L, Corseaux D, Altié A, Ung A, Courageot J, Barakat M, Teiger E, Van Belle E. Time Course of Reendothelialization with Polyzene-F Nanocoated Cobra PzF™ Coronary Stent on Rabbit Iliac Arteries. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:195-199. [PMID: 31727585 DOI: 10.1016/j.carrev.2019.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/04/2019] [Accepted: 11/04/2019] [Indexed: 01/23/2023]
Abstract
PURPOSE Evaluation of reendothelialization with a new thin struts cobalt chromium alloy stent coated with a nano-layer of Polyzene™-F (PzF) in a rabbit iliac artery model. METHODS Fifteen stented external rabbit iliac arteries were harvested at Day 7 for electron microscopy analysis following Cobra PzF stents implantation to assess reendothelialization and compare to historical data. Ten additional rabbits were used to assess time course of reendothelialization at 3 and 5 days. RESULTS At Day 7, almost complete coverage of endothelial cells was observed with a coverage of 99.54 ± 0.25% of the stented area. No thrombus area was noted. At Day 3, more than half of examined pieces was reendothelialized and reached 78.30 ± 3.7% at Day 5 (p < .01 between each group). All stents were well expanded against the arterial wall and no struts were mal-apposed. CONCLUSIONS Reendothelialization was rapid and complete at Day 7. This is the fastest reendothelization process after stenting in this model. No stent occlusion was observed.
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Affiliation(s)
- Luc Maillard
- Department of Cardiology, GCS ES Axium Rambot, Aix en Provence, France.
| | - Delphine Corseaux
- Department of EA2693, Université Lille Nord de France, Lille, France
| | - Alexandre Altié
- Department of Service Commun de Microscopie Electronique, Faculté de Médecine La Timone, Marseille, France
| | - Alexandre Ung
- Department of EA2693, Université Lille Nord de France, Lille, France
| | - Joël Courageot
- Department of Service Commun de Microscopie Electronique, Faculté de Médecine La Timone, Marseille, France
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Weighing the potential late benefits versus early hazard associated with bioresorbable vascular scaffolds in percutaneous coronary interventions: a Markov decision analytic model. Coron Artery Dis 2019; 31:230-236. [PMID: 31658137 DOI: 10.1097/mca.0000000000000810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Use of poly-L-lactic acid-based bioresorbable scaffolds (BRS) has been associated with increased risk of device thrombosis during the first 3 years after implantation as compared to metallic everolimus-eluting stents (EES). The long-term performance of BRS relative to EES remains unknown. METHODS We used a Markov decision analysis model to evaluate the effectiveness of BRS vs. EES over a lifetime horizon. In addition to one-way sensitivity analyses of key variables, we evaluated the impact of optimal implantation technique and limiting procedures to larger vessels (>2.6 mm in diameter) on model results. RESULTS Assuming no risk of target lesion revascularization for BRS after 3 years, we found a small increment in quality-adjusted life expectancy (QALE) of 0.02 with the use of BRS relative to EES, with benefit being observed after 21.8 years. Optimal implantation technique and limiting to larger vessels resulted in larger gains in QALE (0.08 and 0.06, respectively) with BRS and shorter times to equipoise (6.7 and 8.3 years, respectively). Model results were highly sensitive to variations in the relative risk of stent thrombosis (BRS vs. EES). CONCLUSIONS Based on currently available data, it would take approximately 21.8 years for the presumed late benefits of current BRS relative to EES to overcome the early hazard associated with their use under favorable assumptions. Optimal implantation technique and limiting procedures to larger vessels improved BRS performance and reduced time to equipoise. Eliminating the higher BRS thrombosis risk is necessary in developing future generations of BRS as an acceptable alternative to EES.
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Stiehm M, Wüstenhagen C, Siewert S, Ince H, Grabow N, Schmitz KP. Impact of strut dimensions and vessel caliber on thrombosis risk of bioresorbable scaffolds using hemodynamic metrics. ACTA ACUST UNITED AC 2019; 64:251-262. [PMID: 29933242 DOI: 10.1515/bmt-2017-0101] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 05/18/2018] [Indexed: 11/15/2022]
Abstract
Bioresorbable scaffolds (BRS) promise to be the treatment of choice for stenosed coronary vessels. But higher thrombosis risk found in current clinical studies limits the expectations. Three hemodynamic metrics are introduced to evaluate the thrombosis risk of coronary stents/scaffolds using transient computational fluid dynamics (CFD). The principal phenomena are platelet activation and effective diffusion (platelet shear number, PSN), convective platelet transport (platelet convection number, PCN) and platelet aggregation (platelet aggregation number, PAN) were taken into consideration. In the present study, two different stent designs (thick-strut vs. thin-strut design) positioned in small- and medium-sized vessels (reference vessel diameter, RVD=2.25 mm vs. 2.70 mm) were analyzed. In both vessel models, the thick-strut design induced higher PSN, PCN and PAN values than the thin-strut design (thick-strut vs. thin-strut: PSN=2.92/2.19 and 0.54/0.30; PCN=3.14/1.15 and 2.08/0.43; PAN: 14.76/8.19 and 20.03/10.18 for RVD=2.25 mm and 2.70 mm). PSN and PCN are increased by the reduction of the vessel size (PSN: RVD=2.25 mm vs. 2.70 mm=5.41 and 7.30; PCN: RVD=2.25 mm vs. 2.70 mm=1.51 and 2.67 for thick-strut and thin-strut designs). The results suggest that bulky stents implanted in small caliber vessels may substantially increase the thrombosis risk. Moreover, sensitivity analyses imply that PSN is mostly influenced by vessel size (lesion-related factor), whereas PCN and PAN sensitively respond to strut-thickness (device-related factor).
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Affiliation(s)
- Michael Stiehm
- Institute for ImplantatTechnology and Biomaterials e.V., Friedrich-Barnewitz-Str. 4, 18119 Rostock-Warnemünde, Germany
| | - Carolin Wüstenhagen
- Institute for ImplantatTechnology and Biomaterials e.V., Friedrich-Barnewitz-Str. 4, 18119 Rostock-Warnemünde, Germany
| | - Stefan Siewert
- Institute for ImplantatTechnology and Biomaterials e.V., Friedrich-Barnewitz-Str. 4, 18119 Rostock-Warnemünde, Germany
| | - Hüseyin Ince
- Center for Internal Medicine, Department of Cardiology, Rostock University Medical Center, Ernst-Heydemann-Straße 6, 18057 Rostock, Germany
| | - Niels Grabow
- Institute for Biomedical Engineering, Rostock University Medical Center, Friedrich-Barnewitz-Str. 4, 18119 Rostock-Warnemünde, Germany
| | - Klaus-Peter Schmitz
- Institute for ImplantatTechnology and Biomaterials e.V., Friedrich-Barnewitz-Str. 4, 18119 Rostock-Warnemünde, Germany.,Institute for Biomedical Engineering, Rostock University Medical Center, Friedrich-Barnewitz-Str. 4, 18119 Rostock-Warnemünde, Germany
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Neverova YV, Tarasov RS, Ivanov SV, Nishonov AB, Barbarash LS. Results of coronary bypass surgery performed in the early stages of non-ST segment elevation acute coronary syndrome. ACTA ACUST UNITED AC 2019. [DOI: 10.15829/1560-4071-2019-8-22-28] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Yu. V. Neverova
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - R. S. Tarasov
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - S. V. Ivanov
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - A. B. Nishonov
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - L. S. Barbarash
- Research Institute for Complex Issues of Cardiovascular Diseases
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Baquet M, Hoppmann P, Grundmann D, Schmidt W, Kufner S, Theiss HD, Brunner S, Wiebe J, Eickhoff M, Jochheim D, Byrne RA, Laugwitz KL, Schunkert H, Massberg S, Kastrati A, Mehilli J. Sex and long-term outcomes after implantation of the Absorb bioresorbable vascular scaffold for treatment of coronary artery disease. EUROINTERVENTION 2019; 15:615-622. [DOI: 10.4244/eij-d-18-00603] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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De Carlo M, Testa L, Leoncini M, Nicolini E, Varbella F, Cortese B, Ribichini F, Bartorelli AL, Calabria P, Indolfi C, Tomai F, Loi B, Fischietti D, Tarantini G, Bedogni F, Petronio AS. Two-year clinical outcomes of the “Italian diffuse/multivessel disease absorb prospective registry” (IT-DISAPPEARS). Int J Cardiol 2019; 290:21-26. [DOI: 10.1016/j.ijcard.2019.04.095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 04/27/2019] [Accepted: 04/29/2019] [Indexed: 10/26/2022]
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Halvorsen S, Storey RF, Rocca B, Sibbing D, Ten Berg J, Grove EL, Weiss TW, Collet JP, Andreotti F, Gulba DC, Lip GYH, Husted S, Vilahur G, Morais J, Verheugt FWA, Lanas A, Al-Shahi Salman R, Steg PG, Huber K. Management of antithrombotic therapy after bleeding in patients with coronary artery disease and/or atrial fibrillation: expert consensus paper of the European Society of Cardiology Working Group on Thrombosis. Eur Heart J 2019; 38:1455-1462. [PMID: 27789570 DOI: 10.1093/eurheartj/ehw454] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 09/11/2016] [Indexed: 01/09/2023] Open
Affiliation(s)
- Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital Ulleval and University of Oslo, Oslo, Norway
| | - Robert F Storey
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Bianca Rocca
- Institute of Pharmacology, Catholic University School of Medicine, Rome, Italy
| | - Dirk Sibbing
- Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität, Munich, Germany and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Jurrien Ten Berg
- Department of Cardiology, St Antonius Hospital, Nieuwegein, Netherlands
| | - Erik Lerkevang Grove
- Department of Cardiology, Aarhus University Hospital, and Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas W Weiss
- 3rd Department of Internal Medicine, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, Montleartstrasse 37, Vienna, A-1160, Austria
| | - Jean-Philippe Collet
- Univ Paris 06 (UPMC), ACTION Study Group, INSERM UMR_S 1166, ICAN, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - Felicita Andreotti
- Institute of Cardiology, Catholic University Medical School, Rome, Italy
| | - Dietrich C Gulba
- Clinic for Internal Medicine and Pneumology, Katholisches Klinikum Oberhausen GmbH, St. Marien Hospital, Oberhausen, Germany
| | - Gregory Y H Lip
- University of Birmingham Institute of Cardiovascular Sciences, City Hospital, United Kingdom; and Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Denmark
| | - Steen Husted
- Medical Department, Region Hospital West, Herning/Holstebro
| | - Gemma Vilahur
- Cardiovascular Research Center, CSIC-ICCC, HSCSP-Barcelona, Spain
| | - Joao Morais
- Department of Cardiology, Leiria Hospital Centre, Portugal
| | - Freek W A Verheugt
- Emeritus Professor of Cardiology, P.C. Hooftstraat 188, CH Amsterdam, 1071, Netherlands
| | - Angel Lanas
- Service of Digestive Diseases. University Hospital. University of Zaragoza. CIBERehd. IIS Aragón. Zaragoza, Spain
| | | | - Philippe Gabriel Steg
- Université Paris-Diderot, Sorbonne Paris Cité, DHU FIRE, AP-HP and INSERM U-1148, all in Paris, France. NHLI, Imperial College, Royal Brompton Hospital, London, UK
| | - Kurt Huber
- 3rd Department of Internal Medicine, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, Montleartstrasse 37, Vienna, A-1160, Austria
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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: 0.4] [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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Cerrato E, Barbero U, Gil Romero JA, Quadri G, Mejia-Renteria H, Tomassini F, Ferrari F, Varbella F, Gonzalo N, Escaned J. Magmaris™ resorbable magnesium scaffold: state-of-art review. Future Cardiol 2019; 15:267-279. [DOI: 10.2217/fca-2018-0081] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Bioresorbable scaffolds (BRS) have been advocated as the ‘fourth revolution’ in interventional cardiology because they could provide temporary scaffolding and then ‘disappear’ (resorb) potentially significantly improving coronary artery disease treatment. BRS technology has gradually matured, and there are many devices available worldwide, which are currently undergoing preclinical or clinical testing. Due to the concerns related to polylactide scaffolds, magnesium alloy is now one of the most promising resorbable technologies despite available evidences on its performances in vivo are limited to small observational studies. In this state-of-art review we present Magmaris™ (Biotronik AG, Buelach, Switzerland) magnesium-based BRS from bench to bedside, reviewing to date available clinical trial data and current recommendations for its optimal use in clinical practice.
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Affiliation(s)
- Enrico Cerrato
- Cardiology Department, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Umberto Barbero
- Interventional Cardiology Unit, Rivoli Infermi Hospital, Rivoli, Turin, Italy
| | | | - Giorgio Quadri
- Cardiology Department, Interventional Cardiology, SS. Annunziata Savigliano, Cuneo, Italy
| | | | - Francesco Tomassini
- Cardiology Department, Interventional Cardiology, SS. Annunziata Savigliano, Cuneo, Italy
| | - Fabio Ferrari
- Cardiology Department, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Ferdinando Varbella
- Cardiology Department, Interventional Cardiology, SS. Annunziata Savigliano, Cuneo, Italy
| | - Nieves Gonzalo
- San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Javier Escaned
- San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
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Lu H, Lee J, Ray S, Tanaka K, Bezerra HG, Rollins AM, Wilson DL. Automated stent coverage analysis in intravascular OCT (IVOCT) image volumes using a support vector machine and mesh growing. BIOMEDICAL OPTICS EXPRESS 2019; 10:2809-2828. [PMID: 31259053 PMCID: PMC6583335 DOI: 10.1364/boe.10.002809] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 04/22/2019] [Accepted: 05/08/2019] [Indexed: 05/23/2023]
Abstract
Absence of vascular-stent tissue coverage by IVOCT is a biomarker for potential stent-related thrombosis. We developed highly-automated algorithms to classify covered and uncovered struts and quantitatively evaluate stent apposition. We trained a machine learning model on 7,125 images, and included an active learning, relabeling step to improve noisy labels. We obtained uncovered strut classification sensitivity/specificity (94%/90%) comparable to analyst inter-and-intra-observer variability and AUC (0.97), and tissue coverage thickness measurement arguably better than the commercial product. By comparing classification models from regular and relabeled data sets, we observed robustness of the support vector machine to noisy data. A graph-based algorithm detected clusters of uncovered struts thought to pose a greater risk than isolated uncovered struts. The software enables highly-automated, objective, repeatable, comprehensive stent analysis.
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Affiliation(s)
- Hong Lu
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
- Currently located at Microsoft, Azure Global, Cambridge, MA, 02142, USA
| | - Juhwan Lee
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Soumya Ray
- Department of Electrical Engineering & Computer Science, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Kentaro Tanaka
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Hiram G. Bezerra
- Cardiovascular Imaging Core Laboratory, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, 44106, USA
| | - Andrew M. Rollins
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - David L. Wilson
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
- Department of Radiology, Case Western Reserve University, Cleveland, OH, 44106, USA
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Vos NS, Fagel ND, Amoroso G, Herrman JPR, Patterson MS, Piers LH, van der Schaaf RJ, Slagboom T, Vink MA. Paclitaxel-Coated Balloon Angioplasty Versus Drug-Eluting Stent in Acute Myocardial Infarction: The REVELATION Randomized Trial. JACC Cardiovasc Interv 2019; 12:1691-1699. [PMID: 31126887 DOI: 10.1016/j.jcin.2019.04.016] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 04/02/2019] [Accepted: 04/09/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study sought to assess the efficacy and safety of a drug-coated balloon (DCB) strategy versus drug-eluting stent (DES) in primary percutaneous coronary intervention for ST-segment elevation myocardial infarction (STEMI). BACKGROUND In primary percutaneous coronary intervention for STEMI, stenting has proved to be beneficial with regard to repeat revascularization, but not recurrent myocardial infarction or death, compared with balloon angioplasty alone. A strategy of DCB angioplasty without stenting might abolish the potential disadvantages of stent implantation while reducing the probability of restenosis observed in plain old balloon angioplasty. METHODS In the prospective, randomized, single-center REVELATION trial, we compared DCB with DES in patients presenting with STEMI. Patients with a new, nonseverely calcified culprit lesion in a native coronary artery and a residual stenosis of <50% after pre-dilatation were randomized to treatment with a DCB or DES. The primary endpoint was fractional flow reserve at 9 months, allowing for a functional measurement of the infarct-related lesion. RESULTS A total of 120 patients were included. At 9 months after enrolment, the mean fractional flow reserve value was 0.92 ± 0.05 in the DCB group (n = 35) and 0.91 ± 0.06 in the DES group (n = 38) (p = 0.27). One abrupt vessel closure requiring treatment occurred after treatment with DCB. Up to 9-months follow-up, 2 patients required nonurgent target lesion revascularization (1 in each group). CONCLUSIONS In the setting of STEMI, the DCB strategy was noninferior to DES in terms of fractional flow reserve assessed at 9 months. Furthermore, it seemed to be a safe and feasible strategy. (Revascularization With Paclitaxel-Coated Balloon Angioplasty Versus Drug-Eluting Stenting in Acute Myocardial Infarction [REVELATION]; NCT02219802).
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Affiliation(s)
- Nicola S Vos
- Onze Lieve Vrouwe Gasthuis Hospital, Amsterdam, the Netherlands
| | - Nick D Fagel
- Onze Lieve Vrouwe Gasthuis Hospital, Amsterdam, the Netherlands
| | | | | | | | - Lieuwe H Piers
- Onze Lieve Vrouwe Gasthuis Hospital, Amsterdam, the Netherlands
| | | | - Ton Slagboom
- Onze Lieve Vrouwe Gasthuis Hospital, Amsterdam, the Netherlands
| | - Maarten A Vink
- Onze Lieve Vrouwe Gasthuis Hospital, Amsterdam, the Netherlands.
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Okada K, Honda Y, Kitahara H, Otagiri K, Tanaka S, Hollak MB, Yock PG, Popma JJ, Kusano H, Cheong WF, Sudhir K, Fitzgerald PJ, Kimura T. Bioresorbable Scaffold for Treatment of Coronary Artery Lesions: Intravascular Ultrasound Results From the ABSORB Japan Trial. JACC Cardiovasc Interv 2019; 11:648-661. [PMID: 29622143 DOI: 10.1016/j.jcin.2017.11.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 11/26/2017] [Accepted: 11/28/2017] [Indexed: 10/17/2022]
Abstract
OBJECTIVES The aim of this study was to characterize post-procedural intravascular ultrasound (IVUS) findings in the ABSORB Japan trial, specifically stratified by the size of target coronary arteries. BACKGROUND Despite overall noninferiority confirmed in recent randomized trials comparing bioresorbable vascular scaffolds (BVS) (Absorb BVS) and cobalt-chromium everolimus-eluting metallic stents (CoCr-EES), higher event rates of Absorb BVS have been reported with suboptimal deployment, especially in small coronary arteries. METHODS In the ABSORB Japan trial, 150 patients (2:1 randomization) were scheduled in the IVUS cohort. Small vessel was defined as mean reference lumen diameter <2.75 mm. Tapered-vessel lesions were defined as tapering index (proximal/distal reference lumen diameter) ≥1.2. RESULTS Overall, IVUS revealed that the Absorb BVS arm had smaller device expansion than the CoCr-EES arm did, which was particularly prominent in small- and tapered-vessel lesions. Higher tapering index was also associated with higher rates of incomplete strut apposition in Absorb BVS, but not in CoCr-EES. With respect to procedural techniques, small-vessel lesions were treated more frequently with noncompliant balloons at post-dilatation but using significantly lower pressure in the Absorb BVS arm. In contrast, tapered-vessel lesions were post-dilated at equivalent pressure but with significantly smaller balloon catheters in the Absorb BVS arm, compared with the CoCr-EES arm. CONCLUSIONS The significantly smaller device expansion especially in small vessels may account for the poorer outcomes of Absorb BVS in this lesion type. Appropriate optimization strategy, possibly different between polymeric and metallic devices, needs to be established for bioresorbable scaffold technology. (AVJ-301 Clinical Trial: A Clinical Evaluation of AVJ-301 Absorb™ BVS) in Japanese Population [ABSORB JAPAN]; NCT01844284).
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Affiliation(s)
- Kozo Okada
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California
| | - Yasuhiro Honda
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California.
| | - Hideki Kitahara
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California
| | - Kyuhachi Otagiri
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California
| | - Shigemitsu Tanaka
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California
| | - M Brooke Hollak
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California
| | - Paul G Yock
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California
| | - Jeffrey J Popma
- Department of Internal Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Hajime Kusano
- Clinical Science and Medical Affairs, Abbott Vascular, Santa Clara, California
| | - Wai-Fung Cheong
- Clinical Science and Medical Affairs, Abbott Vascular, Santa Clara, California
| | - Krishnankutty Sudhir
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California; Clinical Science and Medical Affairs, Abbott Vascular, Santa Clara, California
| | - Peter J Fitzgerald
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Hospital, Kyoto, Japan
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Pellegrini D, Cortese B. Focus on STENTYS ® Xposition S Self-Apposing ® stent: a review of available literature. Future Cardiol 2019; 15:145-159. [PMID: 31023079 DOI: 10.2217/fca-2018-0087] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Percutaneous coronary interventions are the primary revascularization strategy for the vast majority of patients with coronary artery disease. Nevertheless, challenging settings still limit optimal results, especially in case of significant tapering, bifurcations or primary angioplasty in ST-segment elevation myocardial infarction. Stentys® Self-Apposing® stent was designed to improve strut apposition to the vessel wall and to adapt to difficult targets. The Xposition S is a sirolimus-eluting stent with a novel delivery system, to improve accurate positioning. Several studies compared the device with traditional balloon-expandable stents, showing better results in terms of malapposition reduction and a noninferiority in relation to procedural outcomes. Available data show good clinical results, but a direct comparison with balloon-expandable stents from large randomized trials is still lacking. Thus, the Stentys Xposition S can be an alternative to traditional stents in dedicated scenarios, but strong evidence from large randomized trials is needed to derive stronger recommendations.
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Affiliation(s)
- Dario Pellegrini
- Department of Medicine and Surgery, Università degli Studi di Milano-Bicocca, Milan, Italy
| | - Bernardo Cortese
- Department of Cardiac, San Carlo Clinic, Via Leonardo da Vinci, Paderno Dugnano, Milano, Italy
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Floré V, Brown AJ, Giblett JP, Liou K, Cranley J, Hoole SP, West NEJ. Clinical outcomes of bioresorbable vascular scaffolds implanted with routine versus selective optical coherence tomography guidance: results from a single-centre experience. EUROINTERVENTION 2019; 14:1776-1783. [PMID: 30375333 DOI: 10.4244/eij-d-18-00262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS We aimed to investigate the effects of an initial learning period with mandatory optical coherence tomography (OCT) guidance for the implantation of everolimus-eluting bioresorbable vascular scaffolds (BVS). METHODS AND RESULTS We analysed procedural and clinical outcomes of all BVS implantations at a single centre where OCT guidance was mandatory in the initial rollout (OCT-mandatory) phase. We compared these data with the later phase where use of OCT was at operator discretion (OCT-selective or angiography). We implanted 406 BVS in 306 vessels (201 OCT, 105 angiography) in 272 patients. Follow-up duration was 38±10 months. Annualised rates of device-oriented cardiac events (DOCE) and scaffold thrombosis (ScT) were 1.4% and 0.4%, respectively. The risks of DOCE (HR 1.06, 95% CI: 0.33-3.34; p=0.71) and ScT (HR 0.48, 95% CI: 0.07-3.85; p=0.49) were not significantly different when comparing the OCT and angiography groups. CONCLUSIONS Routine use of OCT to guide and optimise BVS implants results in very acceptable outcomes. Further, the benefits of such an early OCT-mandatory "learning" period persist after cessation of routine OCT usage when imaging is not routinely used. A period of mandatory OCT usage for BVS implants may therefore be beneficial in improving patient outcomes with these devices.
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Affiliation(s)
- Vincent Floré
- Department of Interventional Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
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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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Mahtta D, Elgendy IY. Everolimus-eluting bioresorbable vascular scaffolds: learning from the past to improve the future. Minerva Cardioangiol 2019; 67:288-305. [PMID: 30895764 DOI: 10.23736/s0026-4725.19.04900-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Bioresorbable vascular scaffolds (BVS) were developed to overcome the long-term limitations of metallic drug-eluting stents (DES). Shortcomings of DES include their permanent metallic cage which prevents normal coronary vasomotion, vascular remodeling, precludes future bypass grafting, and creates a nidus for very late stent thrombosis. With its transient scaffold which provides early mechanical support and subsequently resorbs thereby restoring physiologic properties and architecture of the vasculature, BVS offers a promising development within the field of interventional cardiology. Even though various BVS have been or are currently under development, the ABSORB BVS from Abbott Vascular was the first FDA approved device. In this review, we shed light on shortcomings of the current generation DES and theoretical advantages of BVS. In addition, we will discuss in detail clinical data from observational studies, meta-analyses, registries, and randomized controlled trials as it pertains to the efficacy and safety outcomes with everolimus-eluting BVS as compared to the current generation everolimus-eluting metallic stents (EES). We will summarize reasons behind the disappointing results from clinical trials and the failure of first generation BVS leading to its withdrawal from the market. Lastly, we will briefly review ongoing developments with the newer-generation BVS and future pre-clinical and clinical studies that are underway to evaluate the efficacy and safety of second-generation BVS.
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Affiliation(s)
- Dhruv Mahtta
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA -
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