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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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Peng X, Qu W, Jia Y, Wang Y, Yu B, Tian J. Bioresorbable Scaffolds: Contemporary Status and Future Directions. Front Cardiovasc Med 2020; 7:589571. [PMID: 33330651 PMCID: PMC7733966 DOI: 10.3389/fcvm.2020.589571] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/20/2020] [Indexed: 12/13/2022] Open
Abstract
Percutaneous coronary intervention, which is safe, effective, and timely, has become an important treatment for coronary artery diseases and has been widely used in clinical practice. However, there are still some problems that urgently need to be solved. Permanent vessel caging through metallic implants not only prevents the process of positive vessel remodeling and the restoration of vascular physiology but also makes the future revascularization of target vessels more difficult. Bioresorbable scaffolds (BRSs) have been developed as a potential solution to avoid the above adverse reactions caused by permanent metallic devices. BRSs provide temporary support to the vessel wall in the short term and then gradually degrade over time to restore the natural state of coronary arteries. Nonetheless, long-term follow-up of large-scale trials has drawn considerable attention to the safety of BRSs, and the significantly increased risk of late scaffold thrombosis (ScT) limits its clinical application. In this review, we summarize the current status and clinical experiences of BRSs to understand the application prospects and limitations of these devices. In addition, we focus on ScT after implantation, as it is currently the primary drawback of BRS. We also analyze the causes of ScT and discuss improvements required to overcome this serious drawback and to move the field forward.
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Affiliation(s)
- Xiang Peng
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry of Education, Harbin, China
| | - Wenbo Qu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry of Education, Harbin, China
| | - Ying Jia
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry of Education, Harbin, China
| | - Yani Wang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry of Education, Harbin, China
| | - Bo Yu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry of Education, Harbin, China
| | - Jinwei Tian
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry of Education, Harbin, China.,Guangxi Key Laboratory of Diabetic Systems Medicine, Guilin Medical University, Guilin, China
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Impact of coronary calcification on outcomes after ABSORB scaffold implantation: insights from the GABI-R registry. Coron Artery Dis 2020; 31:578-585. [DOI: 10.1097/mca.0000000000000870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mitomo S, Tanaka A, Candilio L, Azzalini L, Carlino M, Latib A, Colombo A. Different behaviors of bioresorbable vascular scaffold in different types of calcified lesion: Insights from intravascular imaging. J Cardiol Cases 2018; 17:126-129. [PMID: 30279873 DOI: 10.1016/j.jccase.2017.12.003] [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: 09/13/2017] [Revised: 11/08/2017] [Accepted: 12/13/2017] [Indexed: 10/18/2022] Open
Abstract
A 55-year-old male underwent percutaneous coronary intervention (PCI) for left anterior descending artery chronic total occlusion. After lesion preparation with non-compliant (NC) balloon, two bioresorbable vascular scaffolds (2.5/28 mm, 3.0/28 mm, Absorb BVS, Abbott Vascular, Santa Clara, CA, USA) were implanted followed by 1:1 sized NC balloon post-dilatation at 20 atm. Final intravascular ultrasound (IVUS) showed acceptable BVS expansion in diffusely calcified lesions. Twenty-one months' follow-up coronary angiography revealed severe restenosis with reocclusion at the distal edge of the distal BVS. After recanalization with a 1.0 mm balloon, optical coherence tomography (OCT) was performed. Quantitative analysis comparing OCT and IVUS at the index procedure demonstrated that minimum scaffold area at follow-up became significantly smaller and with higher eccentricity, suggesting severe recoil at the lesions with thick calcium spot, whereas these changes were not observed at the lesion with relatively thin calcification. The lesions were successfully revascularized with drug-eluting stents and final OCT showed symmetric expansion of metallic stents. Our case demonstrates that different types of calcification can have an impact on BVS expansion and recoil. In calcified lesions, an optimal implantation technique is mandatory to achieve the best possible results, and characterization of calcified lesions with intravascular imaging may be helpful to decide PCI strategy with BVS. <Learning objective: Calcified lesions represent a challenging lesion subset for bioresorbable vascular scaffold (BVS) because of less radial strength of the latter. Quantitative analysis with intravascular imaging demonstrated that different types of calcification can have an impact on BVS expansion and recoil. In calcified lesions, an optimal implantation technique is mandatory to achieve the best possible results, and characterization of calcified lesions with intravascular imaging may be helpful to decide percutaneous coronary intervention strategy with BVS.>.
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Affiliation(s)
- Satoru Mitomo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Akihito Tanaka
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Luciano Candilio
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy.,The Hammersmith Hospital, Imperial College London, London, UK
| | - Lorenzo Azzalini
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mauro Carlino
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Azeem Latib
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Colombo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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Mitomo S, Jabbour RJ, Latib A, Colombo A. Bioresorbable vascular scaffold implantation for severely calcified lesions after excimer laser lesion preparation. Catheter Cardiovasc Interv 2018; 92:1283-1288. [PMID: 30269391 DOI: 10.1002/ccd.27704] [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] [Received: 12/25/2017] [Revised: 04/03/2018] [Accepted: 05/30/2018] [Indexed: 11/11/2022]
Abstract
Bioresorbable vascular scaffolds (Absorb BVS, Abbott Vascular, Santa Clara, CA) temporarily elute antiproliferative drugs and provide vessel support, which then subsequently resorb to allow restoration of normal vessel function and architecture. To attain the best possible results with BVS, a dedicated implantation technique (PSP: adequate lesion preparation, proper sizing, postdilatation) is considered mandatory, and calcified lesions are one of the most challenging lesion subsets for BVS implantation. In five cases with severe calcifications refractory to balloon predilatation, we performed excimer laser catheter ablation (ELCA: Turbo Elite catheter; Spectranetics Corporation, Colorado Springs, CO, USA), which facilitated adequate lesion expansion with high-pressure noncompliant balloon inflation and BVS implantation. During the follow-up period (481 days [interquartile range: 445-579]), all patients continued dual antiplatelet therapy (DAPT) and there were no cases of cardiac death, myocardial infarction, or scaffold thrombosis. For treatment of severely calcified lesions with bioresorbable scaffolds, ELCA could be considered an effective potential strategy. After the procedure, prolonged DAPT was prescribed.
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Affiliation(s)
- Satoru Mitomo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | | | - Azeem Latib
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Colombo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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Bangalore S, Bezerra HG, Rizik DG, Armstrong EJ, Samuels B, Naidu SS, Grines CL, Foster MT, Choi JW, Bertolet BD, Shah AP, Torguson R, Avula SB, Wang JC, Zidar JP, Maksoud A, Kalyanasundaram A, Yakubov SJ, Chehab BM, Spaedy AJ, Potluri SP, Caputo RP, Kondur A, Merritt RF, Kaki A, Quesada R, Parikh MA, Toma C, Matar F, DeGregorio J, Nicholson W, Batchelor W, Gollapudi R, Korngold E, Sumar R, Chrysant GS, Li J, Gordon JB, Dave RM, Attizzani GF, Stys TP, Gigliotti OS, Murphy BE, Ellis SG, Waksman R. The State of the Absorb Bioresorbable Scaffold: Consensus From an Expert Panel. JACC Cardiovasc Interv 2018; 10:2349-2359. [PMID: 29216997 DOI: 10.1016/j.jcin.2017.09.041] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 08/31/2017] [Accepted: 09/21/2017] [Indexed: 12/26/2022]
Abstract
Significant progress has been made in the percutaneous coronary intervention technique from the days of balloon angioplasty to modern-day metallic drug-eluting stents (DES). Although metallic stents solve a temporary problem of acute recoil following balloon angioplasty, they leave behind a permanent problem implicated in very late events (in addition to neoatherosclerosis). BRS were developed as a potential solution to this permanent problem, but the promise of these devices has been tempered by clinical trials showing increased risk of safety outcomes, both early and late. This is not too dissimilar to the challenges seen with first-generation DES in which refinement of deployment technique, prolongation of dual antiplatelet therapy, and technical iteration mitigated excess risk of very late stent thrombosis, making DES the treatment of choice for coronary artery disease. This white paper discusses the factors potentially implicated in the excess risks, including the scaffold consideration and deployment technique, and outlines patient and lesion selection, implantation technique, and dual antiplatelet therapy considerations to potentially mitigate this excess risk with the first-generation thick strut Absorb scaffold (Abbott Vascular, Abbott Park, Illinois). It remains to be seen whether these considerations together with technical iterations will ultimately close the gap between scaffolds and metal stents for short-term events while at the same time preserving options for future revascularization once the scaffold bioresorbs.
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Affiliation(s)
- Sripal Bangalore
- Department of Medicine, New York University School of Medicine, New York, New York.
| | - Hiram G Bezerra
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - David G Rizik
- Department of Medicine, HonorHealth and the HonorHealth Heart Group, Scottsdale, Arizona
| | | | - Bruce Samuels
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Srihari S Naidu
- Department of Medicine, Westchester Medical Center, Valhalla, New York
| | - Cindy L Grines
- Department of Medicine, North Shore University Hospital, Manhasset, New York
| | - Malcolm T Foster
- Department of Medicine, Tennova Healthcare, Knoxville, Tennessee
| | - James W Choi
- Department of Medicine, Baylor Heart and Vascular Hospital, Dallas, Texas
| | - Barry D Bertolet
- Department of Medicine, North Mississippi Medical Center, Tupelo, Mississippi
| | - Atman P Shah
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Rebecca Torguson
- Department of Medicine, MedStar Washington Hospital Center, Washington, DC
| | - Surendra B Avula
- Department of Medicine, Advocate Christ Hospital and Medical Center, Oak Lawn, Illinois
| | - John C Wang
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, Maryland
| | - James P Zidar
- Department of Medicine, UNC/Rex Healthcare, Raleigh, North Carolina
| | - Aziz Maksoud
- Department of Medicine, Cardiovascular Research Institute of Kansas, Kansas City, Kansas
| | - Arun Kalyanasundaram
- Department of Medicine, Seattle Heart and Vascular Institute, Seattle, Washington
| | | | - Bassem M Chehab
- Department of Medicine, University of Kansas, Kansas City, Kansas
| | - Anthony J Spaedy
- Department of Medicine, Missouri Heart Center, Columbia, Missouri
| | - Srini P Potluri
- Department of Medicine, The Heart Hospital Baylor Plano, Plano, Texas
| | - Ronald P Caputo
- Department of Medicine, St. Joseph's/Trinity Hospital, Syracuse, New York
| | - Ashok Kondur
- Department of Medicine, DMC Heart Hospital/Wayne State University, Detroit, Michigan
| | - Robert F Merritt
- Department of Medicine, Mercy Hospital and Clinic, Springfield, Missouri
| | - Amir Kaki
- Department of Medicine, Heart & Vascular Institute, Detroit, Michigan
| | - Ramon Quesada
- Department of Medicine, Miami Cardiac & Vascular Institute, Baptist Health, Miami, Florida
| | - Manish A Parikh
- Department of Medicine, Columbia University Medical Center, New York, New York
| | - Catalin Toma
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Fadi Matar
- Department of Medicine, University of South Florida, Tampa, Florida
| | - Joseph DeGregorio
- Department of Medicine, Englewood Hospital and Medical Center, Englewood, New Jersey
| | | | - Wayne Batchelor
- Department of Medicine, Tallahassee Memorial Hospital/Florida State University, Tallahassee, Florida
| | - Raghava Gollapudi
- Department of Medicine, San Diego Cardiac Center, San Diego, California
| | - Ethan Korngold
- Department of Medicine, Providence St. Vincent Medical Center, Portland, Oregon
| | - Riyaz Sumar
- Department of Medicine, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - George S Chrysant
- Department of Medicine, INTEGRIS Baptist Medical Center, Oklahoma City, Oklahoma
| | - Jun Li
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - John B Gordon
- Department of Medicine, San Diego Cardiac Center, San Diego, California
| | - Rajesh M Dave
- Department of Medicine, Geisinger Holy Spirit, Harrisburg, Pennsylvania
| | - Guilherme F Attizzani
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Tom P Stys
- Department of Medicine, Sanford Health, Sioux Falls, South Dakota
| | | | - Bruce E Murphy
- Department of Medicine, Arkansas Heart Hospital, Little Rock, Arkansas
| | | | - Ron Waksman
- Department of Medicine, MedStar Washington Hospital Center, Washington, DC
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Impact of calcium on procedural and clinical outcomes in lesions treated with bioresorbable vascular scaffolds - A prospective BRS registry study. Int J Cardiol 2017; 249:119-126. [PMID: 28943146 DOI: 10.1016/j.ijcard.2017.08.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 07/11/2017] [Accepted: 08/14/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND There is limited data on the impact of calcium (Ca) on acute procedural and clinical outcomes in patients with lesions treated with bioresorbable vascular scaffolds (BRS). We sought to evaluate the effect of calcium on procedural and clinical outcomes in a 'real world' population. METHODS Clinical outcomes were compared between patients with at least 1 moderately or heavily calcified lesion (Ca) and patients with no/mild calcified lesions (non-Ca) enrolled in our institutional BRS registry. RESULTS 455 patients (N) with 548 lesions (L) treated with 735 BRS were studied. Patients in the Ca group (N=160, L=200) had more complex (AHA B2/C lesion: 69.0% in Ca vs 14.9% in non-Ca, p<0.001) and significantly longer lesions (27.80±15.27 vs 19.48±9.92mm, p<0.001). Overall device success rate was 99.1% with no significant differences between the groups. Despite more aggressive lesion preparation and postdilation compared to non Ca, acute lumen gain was significantly less in Ca lesions (1.50±0.66 vs 1.62±0.69mm, p=0.040) with lower final MLD (2.28±0.41 vs 2.36±0.43, p=0.046). There were no significant differences in all-cause mortality, total definite scaffold thrombosis (ST), target lesion revascularization and myocardial infarction between the 2 groups. Late ST was more frequent in the Ca group compared to non Ca group (late ST: 2.1 vs 0%, p=0.02). CONCLUSIONS Clinical outcomes after BRS implantation in calcified and non-calcified lesions were similar. A remarkable difference in timing of thrombosis was observed, with an increased rate of late thrombosis in calcified lesions.
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Cheng Y, Gasior P, Shibuya M, Ramzipoor K, Lee C, Estrada EA, Dokko D, McGregor JC, Conditt GB, Kaluza GL, Granada JF. Comparative Characterization of Biomechanical Behavior and Healing Profile of a Novel Ultra-High-Molecular-Weight Amorphous Poly-l-Lactic Acid Sirolimus-Eluting Bioresorbable Coronary Scaffold. Circ Cardiovasc Interv 2017; 9:CIRCINTERVENTIONS.116.004253. [PMID: 27694138 DOI: 10.1161/circinterventions.116.004253] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 08/26/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Clinically available bioresorbable scaffolds (BRS) rely on polymer crystallinity to achieve mechanical strength resulting in limited overexpansion capabilities and structural integrity when exposed to high-loading conditions. We aimed to evaluate the biomechanical behavior and vascular healing profile of a novel, sirolimus-eluting, high-molecular-weight, amorphous poly-l-lactic acid-based BRS (Amaranth BRS). METHODS AND RESULTS In vitro biomechanical testing was performed under static and cyclic conditions. A total of 99 devices (65 Amaranth BRS versus 34 Absorb bioresorbable vascular scaffold [BVS]) were implanted in 99 coronary arteries of 37 swine for pharmacokinetics and healing evaluation at various time points. In the Absorb BVS, the number of fractures per scaffold seen on light microscopy was 6.0 (5.0-10.5) when overexpanded 1.0 mm above nominal values (≈34%). No fractures were observed in the Amaranth BRS group at 1.3 mm above nominal values (≈48% overexpansion). The number of fractures was higher in the Absorb BVS on accelerated cycle testing over time (at 24K cycles=5.0 [5.0-9.0] Absorb BVS versus 0.0 [0.0-0.5] Amaranth BRS). Approximately 90% of sirolimus was found to be eluted by 90 days. Optical coherence tomography analysis demonstrated lower percentages of late scaffold recoil in the Amaranth BRS at 3 months (Amaranth BRS=-10±16.1% versus Absorb BVS=10.7±13.2%; P=0.004). Histopathology analysis revealed comparable levels of vascular healing and inflammatory responses between both BRSs up to 6 months. CONCLUSIONS New-generation high-molecular-weight amorphous poly-l-lactic acid scaffolds have the potential to improve the clinical performance of BRS and provide the ideal platform for the future miniaturization of the technology.
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Affiliation(s)
- Yanping Cheng
- From the CRF-Skirball Center for Innovation, Orangeburg, NY (Y.C., P.G., M.S., J.C.M., G.B.C., G.L.K., J.F.G.); Amaranth Medical, Inc, Mountain View, CA (K.R., C.L., E.A.E., D.D.); and 3rd Department of Cardiology, Medical University of Silesia, Katowice, Poland (P.G.)
| | - Pawel Gasior
- From the CRF-Skirball Center for Innovation, Orangeburg, NY (Y.C., P.G., M.S., J.C.M., G.B.C., G.L.K., J.F.G.); Amaranth Medical, Inc, Mountain View, CA (K.R., C.L., E.A.E., D.D.); and 3rd Department of Cardiology, Medical University of Silesia, Katowice, Poland (P.G.)
| | - Masahiko Shibuya
- From the CRF-Skirball Center for Innovation, Orangeburg, NY (Y.C., P.G., M.S., J.C.M., G.B.C., G.L.K., J.F.G.); Amaranth Medical, Inc, Mountain View, CA (K.R., C.L., E.A.E., D.D.); and 3rd Department of Cardiology, Medical University of Silesia, Katowice, Poland (P.G.)
| | - Kamal Ramzipoor
- From the CRF-Skirball Center for Innovation, Orangeburg, NY (Y.C., P.G., M.S., J.C.M., G.B.C., G.L.K., J.F.G.); Amaranth Medical, Inc, Mountain View, CA (K.R., C.L., E.A.E., D.D.); and 3rd Department of Cardiology, Medical University of Silesia, Katowice, Poland (P.G.)
| | - Chang Lee
- From the CRF-Skirball Center for Innovation, Orangeburg, NY (Y.C., P.G., M.S., J.C.M., G.B.C., G.L.K., J.F.G.); Amaranth Medical, Inc, Mountain View, CA (K.R., C.L., E.A.E., D.D.); and 3rd Department of Cardiology, Medical University of Silesia, Katowice, Poland (P.G.)
| | - Edward A Estrada
- From the CRF-Skirball Center for Innovation, Orangeburg, NY (Y.C., P.G., M.S., J.C.M., G.B.C., G.L.K., J.F.G.); Amaranth Medical, Inc, Mountain View, CA (K.R., C.L., E.A.E., D.D.); and 3rd Department of Cardiology, Medical University of Silesia, Katowice, Poland (P.G.)
| | - Daniell Dokko
- From the CRF-Skirball Center for Innovation, Orangeburg, NY (Y.C., P.G., M.S., J.C.M., G.B.C., G.L.K., J.F.G.); Amaranth Medical, Inc, Mountain View, CA (K.R., C.L., E.A.E., D.D.); and 3rd Department of Cardiology, Medical University of Silesia, Katowice, Poland (P.G.)
| | - Jenn C McGregor
- From the CRF-Skirball Center for Innovation, Orangeburg, NY (Y.C., P.G., M.S., J.C.M., G.B.C., G.L.K., J.F.G.); Amaranth Medical, Inc, Mountain View, CA (K.R., C.L., E.A.E., D.D.); and 3rd Department of Cardiology, Medical University of Silesia, Katowice, Poland (P.G.)
| | - Gerard B Conditt
- From the CRF-Skirball Center for Innovation, Orangeburg, NY (Y.C., P.G., M.S., J.C.M., G.B.C., G.L.K., J.F.G.); Amaranth Medical, Inc, Mountain View, CA (K.R., C.L., E.A.E., D.D.); and 3rd Department of Cardiology, Medical University of Silesia, Katowice, Poland (P.G.)
| | - Greg L Kaluza
- From the CRF-Skirball Center for Innovation, Orangeburg, NY (Y.C., P.G., M.S., J.C.M., G.B.C., G.L.K., J.F.G.); Amaranth Medical, Inc, Mountain View, CA (K.R., C.L., E.A.E., D.D.); and 3rd Department of Cardiology, Medical University of Silesia, Katowice, Poland (P.G.)
| | - Juan F Granada
- From the CRF-Skirball Center for Innovation, Orangeburg, NY (Y.C., P.G., M.S., J.C.M., G.B.C., G.L.K., J.F.G.); Amaranth Medical, Inc, Mountain View, CA (K.R., C.L., E.A.E., D.D.); and 3rd Department of Cardiology, Medical University of Silesia, Katowice, Poland (P.G.).
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Naganuma T, Kawamoto H, Panoulas VF, Latib A, Tanaka A, Mitomo S, Ruparelia N, Jabbour RJ, Chieffo A, Carlino M, Montorfano M, Colombo A. Mid-term clinical outcomes of ABSORB bioresorbable vascular scaffold versus everolimus-eluting stent for coronary bifurcation lesions. Int J Cardiol 2017; 246:26-31. [DOI: 10.1016/j.ijcard.2017.03.123] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 02/21/2017] [Accepted: 03/24/2017] [Indexed: 10/18/2022]
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Ali ZA, Gao R, Kimura T, Onuma Y, Kereiakes DJ, Ellis SG, Chevalier B, Vu MT, Zhang Z, Simonton CA, Serruys PW, Stone GW. Three-Year Outcomes With the Absorb Bioresorbable Scaffold: Individual-Patient-Data Meta-Analysis From the ABSORB Randomized Trials. Circulation 2017; 137:464-479. [PMID: 29089314 DOI: 10.1161/circulationaha.117.031843] [Citation(s) in RCA: 136] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 10/12/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND The Absorb bioresorbable vascular scaffold (BVS) completely resorbs within 3 years after coronary artery implantation. The safety and effectiveness of BVS through this critical 3-year period have not been characterized. METHODS We performed an individual-patient-data pooled meta-analysis of the 4 randomized ABSORB trials in which 3389 patients with coronary artery disease were randomly assigned to everolimus-eluting Absorb BVS (n=2164) or cobalt-chromium everolimus-eluting stents (n=1225). The primary efficacy outcome measure was target lesion failure (cardiac mortality, target vessel myocardial infarction, or ischemia-driven target lesion revascularization), and the primary safety outcome measure was device thrombosis. RESULTS BVS compared with cobalt-chromium everolimus-eluting stents resulted in higher 3-year rates of target lesion failure (11.7% versus 8.1%; risk ratio [RR], 1.38; 95% confidence interval [CI], 1.10-1.73; P=0.006), driven by greater target vessel myocardial infarction (7.8% versus 4.2%; RR, 1.72; 95% CI, 1.26-2.35; P=0.0006) and ischemia-driven target lesion revascularization (6.6% versus 4.4%; RR, 1.44; 95% CI, 1.05-1.98; P=0.02), with comparable cardiac mortality (1.1% versus 1.1%; RR, 0.93; 95% CI, 0.47-1.88; P=0.85). Device thrombosis rates through 3 years were also higher with BVS (2.4% versus 0.6%; RR, 3.71; 95% CI, 1.70-8.11; P=0.001). Between 1 and 3 years, target lesion failure rates (6.1% versus 3.9%; P=0.02) and device thrombosis rates (1.1% versus 0.0%; P<0.0001) were higher with BVS than cobalt-chromium everolimus-eluting stents. CONCLUSIONS In the present individual-patient-data pooled meta-analysis of the ABSORB trials, BVS was associated with increased rates of target lesion failure and device thrombosis between 1 and 3 years and cumulatively through 3 years of follow-up compared with everolimus-eluting stents. CLINICAL TRIAL REGISTRATION URL: https://clinicaltrials.gov. Unique identifiers: NCT01751906, NCT01844284, NCT01923740, and NCT01425281.
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Affiliation(s)
- Ziad A Ali
- New York-Presbyterian Hospital/Columbia University Medical Center, New York (Z.A.A., G.W.S.).,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (Z.A.A., G.W.S.)
| | - Runlin Gao
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China (R.G.)
| | | | - Yoshinobu Onuma
- Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands (Y.O.)
| | - Dean J Kereiakes
- The Christ Hospital, Heart and Vascular Center, Lindner Research Center, Cincinnati, OH (D.J.K.)
| | | | | | - Minh-Thien Vu
- Abbott Vascular, Santa Clara, CA (M.-t.V., Z.Z., C.A.S.)
| | - Zhen Zhang
- Abbott Vascular, Santa Clara, CA (M.-t.V., Z.Z., C.A.S.)
| | | | - Patrick W Serruys
- International Centre for Cardiovascular Health, Imperial College, London, UK (P.W.S.)
| | - Gregg W Stone
- New York-Presbyterian Hospital/Columbia University Medical Center, New York (Z.A.A., G.W.S.) .,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (Z.A.A., G.W.S.)
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11
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Correlates and Impact of Coronary Artery Calcifications in Women Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents: From the Women in Innovation and Drug-Eluting Stents (WIN-DES) Collaboration. JACC Cardiovasc Interv 2017; 9:1890-901. [PMID: 27659564 DOI: 10.1016/j.jcin.2016.06.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 05/17/2016] [Accepted: 06/16/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The aim of this study was to investigate the clinical correlates and prognostic impact of coronary artery calcification (CAC) in women undergoing percutaneous coronary intervention with drug-eluting stents (DES). BACKGROUND The clinical correlates and the prognostic significance of CAC in women undergoing percutaneous coronary intervention with DES remain unclear. METHODS Patient-level data from female participants in 26 randomized trials of DES were pooled. Study population was categorized according to the presence of moderate or severe versus mild or no target lesion CAC, assessed through coronary angiography. Co-primary endpoints of interest were the composite of death, myocardial infarction (MI), or target lesion revascularization and death, MI, or stent thrombosis at 3-year follow-up. RESULTS Among 11,557 women included in the pooled dataset, CAC status was available in 6,371 women. Of these, 1,622 (25.5%) had moderate or severe CAC. In fully adjusted models, independent correlates of CAC were age, hypertension, hypercholesterolemia, smoking, previous coronary artery bypass graft surgery, and worse left ventricular and renal function. At 3 years, women with CAC were at higher risk for death, MI, or target lesion revascularization (18.2% vs. 13.1%; adjusted hazard ratio: 1.56; 95% confidence interval: 1.33 to 1.84; p < 0.0001) and death, MI, or stent thrombosis (12.7% vs. 8.6%; adjusted hazard ratio: 1.48; 95% confidence interval: 1.21 to 1.80; p = 0.0001). The adverse effect of CAC on ischemic outcomes appeared to be consistent across clinical and angiographic subsets of women, including new-generation DES. CONCLUSIONS Women undergoing PCI of calcified lesions tend to have worse clinical profile and remain at increased ischemic risk, irrespective of new-generation DES.
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12
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Ang HY, Huang YY, Lim ST, Wong P, Joner M, Foin N. Mechanical behavior of polymer-based vs. metallic-based bioresorbable stents. J Thorac Dis 2017; 9:S923-S934. [PMID: 28894598 PMCID: PMC5583085 DOI: 10.21037/jtd.2017.06.30] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 05/18/2017] [Indexed: 11/06/2022]
Abstract
Bioresorbable scaffolds (BRS) were developed to overcome the drawbacks of current metallic drug-eluting stents (DES), such as late in-stent restenosis and caging of the vessel permanently. The concept of the BRS is to provide transient support to the vessel during healing before being degraded and resorbed by the body, freeing the vessel and restoring vasomotion. The mechanical properties of the BRS are influenced by the choice of the material and processing methods. Due to insufficient radial strength of the bioresorbable material, BRS often required large strut profile as compared to conventional metallic DES. Having thick struts will in turn affect the deliverability of the device and may cause flow disturbance, thereby increasing the incidence of acute thrombotic events. Currently, the bioresorbable poly-l-lactic acid (PLLA) polymer and magnesium (Mg) alloys are being investigated as materials in BRS technologies. The bioresorption process, mechanical properties, in vitro observations and clinical outcomes of PLLA-based and Mg-based BRS will be examined in this review.
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Affiliation(s)
- Hui Ying Ang
- National Heart Centre Singapore, Singapore, Singapore
| | - Ying Ying Huang
- School of Materials Science and Engineering, Nanyang Technological University, Singapore, Singapore
| | - Soo Teik Lim
- National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Philip Wong
- National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Michael Joner
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Nicolas Foin
- National Heart Centre Singapore, Singapore, Singapore
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13
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Bennett J, Adriaenssens T, Desmet W, Dubois C. Complex bifurcation lesions: Randomized comparison of a fully bioresorbable modified t stenting strategy versus bifurcation reconstruction with a dedicated self-expanding stent in combination with bioresorbable scaffolds, an OCT study: Rationale and design of the COBRA II trial. Catheter Cardiovasc Interv 2016; 88:843-853. [PMID: 27184586 DOI: 10.1002/ccd.26571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 04/11/2016] [Accepted: 04/22/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE There is an ongoing controversy regarding the efficacy and safety of different percutaneous stenting techniques for coronary bifurcation lesions needing >1 stent. The promise of safe vessel restoration with bioresorbable scaffolds (BRS) may not be transferable to complex double BRS bifurcation techniques, and permanent metallic scaffolding of the bifurcation core may be needed. We identified modified-T stenting as the most promising fully bioresorbable 2-stent strategy in a preclinical setting. The objective of this study is to assess acute performance and compare long-term vessel healing with this strategy, versus an approach combining BRS with a dedicated metallic drug-eluting bifurcation stent. STUDY DESIGN In a single center, 60 consecutive patients with true and complex coronary bifurcation lesions will be randomly assigned to treatment with the dedicated self-expanding Axxess™ biolimus-eluting bifurcation stent in the proximal main vessel and additional Absorb™ everolimus-eluting BRS in the branches versus a modified T technique using Absorb™ only. Angiography and optical coherence tomography (OCT) will be performed immediately after implantation and at 30 months, and clinical follow-up is foreseen up to 5 years after implantation. The primary endpoint is the change in minimal luminal area assessed with OCT from baseline to 30 months in pre-specified bifurcation segments. CONCLUSION To date the use of Absorb™ BRS in complex coronary bifurcations has not been evaluated in a randomized clinical trial setting. The COBRA II study will examine the role and safety of a double BRS strategy in coronary bifurcations, alone or in combination with a metallic dedicated bifurcation device. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- J Bennett
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - T Adriaenssens
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - W Desmet
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - C Dubois
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
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14
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Lee WC, Fang HY, Wu CJ. Coronary artery perforation and acute scaffold thrombosis after bioresorbable vascular scaffold implantation for a calcified lesion. Int J Cardiol 2016; 222:620-621. [PMID: 27517650 DOI: 10.1016/j.ijcard.2016.08.063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 08/03/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Wei-Chieh Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Hsiu-Yu Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Chiung-Jen Wu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China.
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15
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Ming Fam J, van Der Sijde JN, Karanasos A, Felix C, Diletti R, van Mieghem N, de Jaegere P, Zijlstra F, Jan van Geuns R, Regar E. Comparison of acute expansion of bioresorbable vascular scaffolds versus metallic drug-eluting stents in different degrees of calcification: An optical coherence tomography study. Catheter Cardiovasc Interv 2016; 89:798-810. [DOI: 10.1002/ccd.26676] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 07/03/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Jiang Ming Fam
- Thorax Centre; Erasmus University Medical Centre; Rotterdam Netherlands
- National Heart Centre Singapore
| | | | | | - Cordula Felix
- Thorax Centre; Erasmus University Medical Centre; Rotterdam Netherlands
| | - Roberto Diletti
- Thorax Centre; Erasmus University Medical Centre; Rotterdam Netherlands
| | | | - Peter de Jaegere
- Thorax Centre; Erasmus University Medical Centre; Rotterdam Netherlands
| | - Felix Zijlstra
- Thorax Centre; Erasmus University Medical Centre; Rotterdam Netherlands
| | | | - Evelyn Regar
- Thorax Centre; Erasmus University Medical Centre; Rotterdam Netherlands
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16
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Kawamoto H, Ruparelia N, Latib A, Miyazaki T, Sato K, Tanaka A, Naganuma T, Sticchi A, Chieffo A, Carlino M, Montorfano M, Colombo A. Expansion in calcific lesions and overall clinical outcomes following bioresorbable scaffold implantation optimized with intravascular ultrasound. Catheter Cardiovasc Interv 2016; 89:789-797. [PMID: 27545845 DOI: 10.1002/ccd.26725] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 04/16/2016] [Accepted: 07/21/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVES This study aimed to investigate clinical outcomes following bioresorbable scaffold (BRS) optimized with intravascular ultrasound (IVUS), and furthermore expansion of BRS in calcific lesions. BACKGROUND Although IVUS use has contributed to improved clinical outcomes with metallic stent implantation, it is unclear if this is also true with regards to BRS, especially in calcified lesions. METHODS Between May 2012 and April 2015, 291 lesions in 198 patients were treated with BRS with IVUS use. We evaluated overall clinical outcomes at 1-year and investigated the expansion and eccentricity index of BRS amongst quadrants categorized by calcium arc (CA) every 90-degrees. RESULTS The rates of major adverse cardiac events were 5.4% (at 6 months) and 10.7% (at 12 months). TLR was observed in 3.1% at 6-month and 7.5% at 12-month follow up. Although there was a significant difference among quadrants regarding to eccentricity of calcium (0°≦CA < 90°: 0.82 ± 0.09, 90°≦CA < 180°: 0.75 ± 0.12, 180°≦CA < 270°: 0.78 ± 0.11, and 270°≦CA≦360°: 0.79 ± 0.09, ANOVA P = 0.002), the BRS expansion index [minimal scaffold area (MSA) divided by BRS area expanded at a nominal pressure] was comparable between quadrants. CONCLUSIONS The use of IVUS to optimize BRS implantation results in favorable clinical outcomes even for complex lesions. Although eccentric calcium distribution resulted in asymmetric expansion of BRS, the final MSA was comparable irrespective of calcium distribution. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Hiroyoshi Kawamoto
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy.,Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
| | - Neil Ruparelia
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy.,Department of Cardiology, Imperial College, London, United Kingdom
| | - Azeem Latib
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Tadashi Miyazaki
- Department of Cardiovascular Medicine, Juntendo University Hospital, Tokyo, Japan
| | - Katsumasa Sato
- Department of Cardiology, Fukuyama Cardiovascular Hospital, Hiroshima, Japan
| | - Akihito Tanaka
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Toru Naganuma
- Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
| | - Alessandro Sticchi
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Mauro Carlino
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Colombo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
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17
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Bennett J, Vanhaverbeke M, Vanden Driessche N, Adriaenssens T, Hiltrop N, Desmet W, Sinnaeve P, Dubois C. Absorb Bioresorbable Vascular Scaffold in Complex Coronary Bifurcation Interventions: Insights From an In Vivo Multimodality Imaging Study. Circ Cardiovasc Interv 2016; 9:CIRCINTERVENTIONS.116.003849. [PMID: 27512090 DOI: 10.1161/circinterventions.116.003849] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 07/15/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND Although bioresorbable scaffolds offer potential advantages compared with metallic drug-eluting stents in the treatment of complex coronary bifurcation lesions, there are concerns that the polymeric scaffold integrity may be compromised. This in vivo study sought to provide insights about the feasibility of performing complex bifurcation stenting with Absorb bioresorbable vascular scaffolds (Abbott Vascular, Santa Clara, CA). METHODS AND RESULTS Twenty New Zealand white rabbits underwent stenting of the nondiseased aortoiliac bifurcation with bioresorbable vascular scaffolds using provisional (PS, n=5), culotte (n=5), modified-T (n=5), or T-and protrusion (n=5) stenting techniques. Angiography, optical coherence tomography, and microcomputed tomography were performed. Angiographic results were excellent without evidence of dissection or side branch (SB) compromise. PS optimally opened the SB ostium without deforming the main vessel (MV) bioresorbable vascular scaffolds, avoiding malapposition, and revealing a single connector fracture in 1 of 5 cases on microcomputed tomography. Culotte stenting resulted in complete bifurcation coverage with extensive segments of double-layered struts and inappropriately apposed struts at the bifurcation level in 3 of 5 cases. On microcomputed tomography, there was MV and SB scaffold distortion at the bifurcation with single strut fractures in 4 of 5 and double fractures in 1 of 5. Modified-T and T-and protrusion resulted in complete bifurcation coverage and in minimal double-strut layers at the neocarina. On microcomputed tomography, no strut fractures were present after modified-T, whereas in 3 of 5 T-and protrusion procedures single strut fractures were noted. CONCLUSIONS Bifurcation stenting using bioresorbable vascular scaffolds is feasible with excellent angiographic results. PS with additional T-and protrusion whenever needed seems a reasonable approach. Whenever a 2-stent technique is planned, modified T-stenting appears the most promising.
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Affiliation(s)
- Johan Bennett
- From the Department of Cardiovascular Medicine, University Hospitals Leuven, Belgium (J.B., T.A., N.H., W.D., P.S., C.D.); and Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Belgium (J.B., M.V., N.V.D., T.A., W.D., P.S., C.D.).
| | - Maarten Vanhaverbeke
- From the Department of Cardiovascular Medicine, University Hospitals Leuven, Belgium (J.B., T.A., N.H., W.D., P.S., C.D.); and Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Belgium (J.B., M.V., N.V.D., T.A., W.D., P.S., C.D.)
| | - Nina Vanden Driessche
- From the Department of Cardiovascular Medicine, University Hospitals Leuven, Belgium (J.B., T.A., N.H., W.D., P.S., C.D.); and Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Belgium (J.B., M.V., N.V.D., T.A., W.D., P.S., C.D.)
| | - Tom Adriaenssens
- From the Department of Cardiovascular Medicine, University Hospitals Leuven, Belgium (J.B., T.A., N.H., W.D., P.S., C.D.); and Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Belgium (J.B., M.V., N.V.D., T.A., W.D., P.S., C.D.)
| | - Nick Hiltrop
- From the Department of Cardiovascular Medicine, University Hospitals Leuven, Belgium (J.B., T.A., N.H., W.D., P.S., C.D.); and Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Belgium (J.B., M.V., N.V.D., T.A., W.D., P.S., C.D.)
| | - Walter Desmet
- From the Department of Cardiovascular Medicine, University Hospitals Leuven, Belgium (J.B., T.A., N.H., W.D., P.S., C.D.); and Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Belgium (J.B., M.V., N.V.D., T.A., W.D., P.S., C.D.)
| | - Peter Sinnaeve
- From the Department of Cardiovascular Medicine, University Hospitals Leuven, Belgium (J.B., T.A., N.H., W.D., P.S., C.D.); and Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Belgium (J.B., M.V., N.V.D., T.A., W.D., P.S., C.D.)
| | - Christophe Dubois
- From the Department of Cardiovascular Medicine, University Hospitals Leuven, Belgium (J.B., T.A., N.H., W.D., P.S., C.D.); and Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Belgium (J.B., M.V., N.V.D., T.A., W.D., P.S., C.D.)
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18
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Affiliation(s)
- Davide Capodanno
- Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy
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19
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Shimamura K, Guagliumi G. Optical Coherence Tomography for Online Guidance of Complex Coronary Interventions. Circ J 2016; 80:2063-72. [PMID: 27616595 DOI: 10.1253/circj.cj-16-0846] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Giulio Guagliumi
- Cardiovascular Department, Azienda Ospedaliera Papa Giovanni XXIII
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20
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Panoulas VF, Mastoris I, Konstantinou K, Tespili M, Ielasi A. Everolimus-eluting stent platforms in percutaneous coronary intervention: comparative effectiveness and outcomes. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2015; 8:317-29. [PMID: 26244031 PMCID: PMC4521664 DOI: 10.2147/mder.s66360] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Despite the remarkable benefits obtained following the introduction of the first-generation drug-eluting stent (DES), concerns were raised over its long-term safety, particularly with regard to very late (beyond 1 year) stent thrombosis. Newer-generation DESs have been developed to overcome this limitation using novel stent platforms, new drugs, more biocompatible durable polymers, and bioabsorbable polymers or backbones. To date, new-generation DESs have virtually replaced the use of first-generation DESs worldwide. In this review article, we discuss in detail the design, pharmacology, and mechanism of action of the newer-generation permanent and bioresorbable everolimus-eluting platforms. Furthermore, we present and evaluate the current evidence on the performance and safety of these devices compared to those of other available stent platforms.
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Affiliation(s)
| | - Ioannis Mastoris
- Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York NY, USA
| | - Klio Konstantinou
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Maurizio Tespili
- Cardiology Department, Bolognini Hospital Seriate, Seriate (BG), Italy
| | - Alfonso Ielasi
- Cardiology Department, Bolognini Hospital Seriate, Seriate (BG), Italy
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