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Pernigotti A, Moscarella E, Spitaleri G, Scardino C, Ishida K, Brugaletta S. Methods to assess bioresorbable vascular scaffold devices behaviour after implantation. J Thorac Dis 2017; 9:S959-S968. [PMID: 28894602 DOI: 10.21037/jtd.2017.06.110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Bioresorbable vascular scaffolds (BRS) represent a novel approach for coronary revascularization offering several advantages as compared to current generation DES, potentially reducing rate of late adverse events and avoiding permanent vessel caging. Nevertheless, safety concerns have been raised for an increased risk of scaffold thrombosis (ScT) in both early and late phases, probably related to a suboptimal scaffold implantation. In this context, the use of different imaging methodologies has been strongly suggested in order to guarantee an optimal implantation. We herein analyze the different imaging methodologies available to assess BRS after implantation and at follow-up.
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Affiliation(s)
- Alberto Pernigotti
- Hospital Clinic, Institut Clinic Cardiovascular, IDIBAPS, Barcelona, Spain
| | | | - Giosafat Spitaleri
- Hospital Clinic, Institut Clinic Cardiovascular, IDIBAPS, Barcelona, Spain
| | - Claudia Scardino
- Hospital Clinic, Institut Clinic Cardiovascular, IDIBAPS, Barcelona, Spain
| | - Kohki Ishida
- Hospital Clinic, Institut Clinic Cardiovascular, IDIBAPS, Barcelona, Spain
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Narayan P, Sarkar K, Trehan N, Chandra P, Chouhan NS, Puskas JD, Taggart DP, Yadava OP. Key updates from international coronary congress 2016—a review. Indian J Thorac Cardiovasc Surg 2017. [DOI: 10.1007/s12055-017-0579-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Arterial Remodeling After Bioresorbable Scaffolds and Metallic Stents. J Am Coll Cardiol 2017; 70:60-74. [PMID: 28662808 DOI: 10.1016/j.jacc.2017.05.028] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 04/23/2017] [Accepted: 05/01/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Although previous observational studies have documented late luminal enlargement and expansive remodeling following implantation of a bioresorbable vascular scaffold (BVS), no comparison with metallic stents has been conducted in a randomized fashion. OBJECTIVES This study sought to compare vessel remodeling patterns after either Absorb BVS or Xience metallic drug-eluting stent (DES) implantation (Abbott Vascular, Santa Clara, California) and determine the independent predictors of remodeling. METHODS In the ABSORB II randomized trial, 383 lesions (n = 359) were investigated by intravenous ultrasound both post-procedure and at 3-year follow-up. According to vessel and lumen area changes over 3 years, we categorized 9 patterns of vessel remodeling that were beyond the reproducibility of lumen and vessel area measurements. RESULTS The relative change in mean vessel area was significantly greater with the BVS compared to the DES (6.7 ± 12.6% vs. 2.9 ± 11.5%; p = 0.003); the relative change in mean lumen area was significantly different between the 2 arms (1.4 ± 19.1% vs. -1.9 ± 10.5%, respectively; p = 0.031). Multivariate analysis indicated that use of the BVS, female sex, balloon-artery ratio >1.25, expansion index ≥0.8, previous percutaneous coronary intervention, and higher level of low-density lipoprotein cholesterol were independent predictors of expansive remodeling. Furthermore, in the BVS arm, necrotic core pre-procedure was an independent determinant of expansive remodeling. CONCLUSIONS Expansive vessel wall remodeling was more frequent and intense with the BVS than the metallic DES and could be determined by patient baseline characteristics and periprocedural factors. The clinical effect of the observed lumen and vessel remodeling must be investigated in further large clinical studies to optimize the clinical outcome of patients and lesions treated by bioresorbable scaffolds. (ABSORB II Randomized Controlled Trial; NCT01425281).
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Sotomi Y, Onuma Y, Miyazaki Y, Asano T, Katagiri Y, Tenekecioglu E, Jonker H, Dijkstra J, de Winter R, Wykrzykowska J, Stone G, Popma J, Kozuma K, Tanabe K, Serruys P, Kimura T. Is quantitative coronary angiography reliable in assessing the late lumen loss of the everolimus-eluting bioresorbable polylactide scaffold in comparison with the cobalt-chromium metallic stent? EUROINTERVENTION 2017; 13:e585-e594. [DOI: 10.4244/eij-d-17-00070] [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] [Indexed: 11/23/2022]
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Optical Coherence Tomography Characterization of Coronary Lithoplasty for Treatment of Calcified Lesions. JACC Cardiovasc Imaging 2017; 10:897-906. [DOI: 10.1016/j.jcmg.2017.05.012] [Citation(s) in RCA: 153] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 04/25/2017] [Accepted: 05/16/2017] [Indexed: 11/19/2022]
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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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Serruys PW, Katagiri Y, Onuma Y. Shaking and Breaking Calcified Plaque. JACC Cardiovasc Imaging 2017; 10:907-911. [DOI: 10.1016/j.jcmg.2017.05.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 05/04/2017] [Indexed: 11/27/2022]
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Sotomi Y, Suwannasom P, Tenekecioglu E, Collet C, Nakatani S, Okamura T, Muramatsu T, Ishibashi Y, Tateishi H, Miyazaki Y, Asano T, Katagiri Y, von zur Muehlen C, Tanabe K, Kozuma K, Ozaki Y, Serruys PW, Onuma Y. Imaging assessment of bioresorbable vascular scaffolds. Cardiovasc Interv Ther 2017; 33:11-22. [DOI: 10.1007/s12928-017-0486-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 07/26/2017] [Indexed: 10/19/2022]
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Asano T, Suwannasom P, Katagiri Y, Miyazaki Y, Sotomi Y, Kraak RP, Wykrzykowska J, Rensing BJ, Piek JJ, Gyöngyösi M, Serruys PW, Onuma Y. First-in-Man Trial of SiO 2 Inert-Coated Bare Metal Stent System in Native Coronary Stenosis - The AXETIS FIM Trial. Circ J 2017; 82:477-485. [PMID: 28717068 DOI: 10.1253/circj.cj-17-0337] [Citation(s) in RCA: 3] [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 A novel bare metal stent with an SiO2coating was developed to prevent excessive neointimal hyperplasia by inertization of the metallic stent surface. The efficacy of the device was demonstrated in a preclinical model. The aim of this first-in-man trial was to assess the safety and feasibility of the new device.Methods and Results:This prospective non-randomized single-arm trial was designed to enroll 35 patients with a de novo coronary lesion. Quantitative coronary angiography and optical coherence tomography (OCT) were performed at the baseline procedure and at the 6-month follow-up. Stent implantation was performed with OCT guidance according to optimal stent implantation criteria. The trial was terminated upon the advice of the data safety monitoring board after enrolling 14 patients due to the high incidence of re-intervention. Optimal OCT implantation criteria were achieved in only 8.3% of lesions. At 6 months, angiographic in-stent late lumen loss as the primary endpoint was 0.77±0.44 mm, and binary restenosis occurred in 33.3% of lesions. At the 6-month OCT, neointimal volume obstruction was 32.8±15.6% with a neointimal thickness of 237±117 µm. At 12 months, the device-oriented composite endpoint (defined as cardiac death, target vessel myocardial infarction, and clinically indicated target lesion revascularization rate) was 33.3%. CONCLUSIONS In contrast with the preclinical study, the Axetis stent did not efficiently suppress neointimal hyperplasia in humans in this trial.
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Affiliation(s)
- Taku Asano
- AMC Heart Center, Academic Medical Center, University of Amsterdam
| | | | - Yuki Katagiri
- AMC Heart Center, Academic Medical Center, University of Amsterdam
| | | | - Yohei Sotomi
- AMC Heart Center, Academic Medical Center, University of Amsterdam
| | - Robin P Kraak
- AMC Heart Center, Academic Medical Center, University of Amsterdam
| | | | | | - Jan J Piek
- AMC Heart Center, Academic Medical Center, University of Amsterdam
| | | | - Patrick W Serruys
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London
| | - Yoshinobu Onuma
- Thorax Center, Erasmus Medical Center, Erasmus University.,Cardialysis
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Effect of strut distribution on neointimal coverage of everolimus-eluting bioresorbable scaffolds: an optical coherence tomography study. J Thromb Thrombolysis 2017; 44:161-168. [PMID: 28597206 DOI: 10.1007/s11239-017-1511-3] [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] [Indexed: 10/19/2022]
Abstract
The thick struts of bioresorbable vascular scaffolds (BRS) are associated with changes in wall shear stress and contribute to neointimal proliferation. We aimed to evaluate the relationship between the BRS strut distribution and the neointimal proliferation. 50 lesions underwent optical coherence tomography, 12 months after BRS implantation. Scaffold area and neointimal thickness were evaluated in each cross-sectional area (CSA). Scaffold eccentricity was defined as follows: (maximum diameter - minimum diameter) × 100/maximum diameter. CSAs of BRS were divided into four quadrants. The maximal neointimal thickness (Maximal-NIT), Minimal-NIT and the number of struts in each quadrant were measured. The number of struts were classified as 1, 2, 3 and ≥ 4. Furthermore, the mean-NIT acquired in each quadrant was divided by the average-NIT of all struts in the same CSA, which was defined as the unevenness score. In addition, Maximal-NIT minus Minimal-NIT was divided by the average-NIT of all struts in the same CSA, which was defined as heterogenicity of neointimal proliferation. There was a significant difference in the association between the number of struts and not only the unevenness score (no. of strut = 1 (N = 440), unevenness score 1.04 ± 0.34; 2 (N = 696), 0.98 ± 0.27; 3 (N = 994), 0.96 ± 0.23; ≥4 (N = 1202), 1.04 ± 0.22, P < 0.01) but also Maximal-NIT and Minimal-NIT. Furthermore, a significant correlation was observed between scaffold eccentricity in each CSA and the heterogeneity of neointimal proliferation in the same CSA (N = 892, R = 0.38, p = 0.01). Crowding of struts is associated with increased neointimal proliferation after BRS implantation. The scaffold eccentricity causes heterogeneity of neointimal proliferation.
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The fate of incomplete scaffold apposition of everolimus-eluting bioresorble scaffolds: A serial optical coherence tomography analysis. J Cardiol 2017; 70:454-460. [PMID: 28476635 DOI: 10.1016/j.jjcc.2017.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 02/22/2017] [Accepted: 03/07/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Incomplete stent apposition (ISA) can be divided into acute and late forms. Late ISA may be due to persistent ISA or late-acquired ISA (LAISA). This study evaluated the natural course of ISA after bioresorbable vascular scaffold (BRS) implantation using optical coherence tomography (OCT). METHODS Thirty-two patients (45 BRS) were assessed immediately after BRS implantation and 1 year thereafter using OCT. Acute ISA identified after BRS implantation but absent at follow-up was defined as resolved; otherwise, it was considered persistent. LAISA was defined as newly developed ISA that was identified at follow-up despite complete apposition immediately after BRS implantation. Intra-BRS fibrin-like material (IBF) was identified as an irregular intraluminal mass. ISA percentage was expressed as follows: (number of ISA/total number of BRS struts)×100. RESULTS Among 45 BRS and 15,894 analyzed BRS struts, 34 and 882 had acute ISA post-procedure, respectively. At follow-up, 92 of 15,364 analyzed struts exhibited late ISA (64 persistent ISA and 28 LAISA). In 15 of 28 struts with LAISA, LAISA occurred at the sites adjacent to post-interventional dissection. Uncovered struts were more frequently observed in late ISA compared to apposed struts (3.7±4.8 vs. 0.58±2.2%, p=0.09). IBF was significantly more common in BRS with late ISA (62.5 vs. 8.1%, p=0.02). Receiver-operating characteristic curve analysis identified a cut-off value of 280μm for acute ISA distance predicting persistent ISA. CONCLUSION Resolution of acute ISA after BRS is common. The occurrence of LAISA may be infrequent and may be a nidus of stent thrombosis.
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Sotomi Y, Onuma Y, Collet C, Tenekecioglu E, Virmani R, Kleiman NS, Serruys PW. Bioresorbable Scaffold: The Emerging Reality and Future Directions. Circ Res 2017; 120:1341-1352. [PMID: 28408454 DOI: 10.1161/circresaha.117.310275] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
In the era of drug-eluting stents, large-scale randomized trials and all-comer registries have shown excellent clinical results. However, even the latest-generation drug-eluting stent has not managed to address all the limitations of permanent metallic coronary stents, such as the risks of target lesion revascularization, neoatherosclerosis, preclusion of late lumen enlargement, and the lack of reactive vasomotion. Furthermore, the risk of very late stent, although substantially reduced with newer-generation drug-eluting stent, still remains. These problems were anticipated to be solved with the advent of fully biodegradable devices. Fully bioresorbable coronary scaffolds have been designed to function transiently to prevent acute recoil, but have retained the capability to inhibit neointimal proliferation by eluting immunosuppressive drugs. Nevertheless, long-term follow-up data of the leading bioresorbable scaffold (Absorb) are becoming available and have raised a concern about the relatively higher incidence of scaffold thrombosis. To reduce the rate of clinical events, improvements in the device, as well as implantation procedure, are being evaluated. This review will focus on the current CE-mark approved bioresorbable scaffolds, their basic characteristics, and clinical results. In addition, we summarize the current limitations of bioresorbable scaffold and their possible solutions.
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Affiliation(s)
- Yohei Sotomi
- From the Department of Cardiology, Academic Medical Center, University of Amsterdam, the Netherlands (Y.S., C.C.); ThoraxCenter, Erasmus Medical Center, Rotterdam, the Netherlands (Y.O., E.T.); Cardialysis, Rotterdam, the Netherlands (Y.O.); CVPath, Institute Inc, Gaithersburg, MD (R.V.); Department of Cardiology (NSK), Houston Methodist DeBakey Heart and Vascular Center, Texas (N.S.K.); and NHLI, Imperial College London, United Kingdom (P.W.S.)
| | - Yoshinobu Onuma
- From the Department of Cardiology, Academic Medical Center, University of Amsterdam, the Netherlands (Y.S., C.C.); ThoraxCenter, Erasmus Medical Center, Rotterdam, the Netherlands (Y.O., E.T.); Cardialysis, Rotterdam, the Netherlands (Y.O.); CVPath, Institute Inc, Gaithersburg, MD (R.V.); Department of Cardiology (NSK), Houston Methodist DeBakey Heart and Vascular Center, Texas (N.S.K.); and NHLI, Imperial College London, United Kingdom (P.W.S.)
| | - Carlos Collet
- From the Department of Cardiology, Academic Medical Center, University of Amsterdam, the Netherlands (Y.S., C.C.); ThoraxCenter, Erasmus Medical Center, Rotterdam, the Netherlands (Y.O., E.T.); Cardialysis, Rotterdam, the Netherlands (Y.O.); CVPath, Institute Inc, Gaithersburg, MD (R.V.); Department of Cardiology (NSK), Houston Methodist DeBakey Heart and Vascular Center, Texas (N.S.K.); and NHLI, Imperial College London, United Kingdom (P.W.S.)
| | - Erhan Tenekecioglu
- From the Department of Cardiology, Academic Medical Center, University of Amsterdam, the Netherlands (Y.S., C.C.); ThoraxCenter, Erasmus Medical Center, Rotterdam, the Netherlands (Y.O., E.T.); Cardialysis, Rotterdam, the Netherlands (Y.O.); CVPath, Institute Inc, Gaithersburg, MD (R.V.); Department of Cardiology (NSK), Houston Methodist DeBakey Heart and Vascular Center, Texas (N.S.K.); and NHLI, Imperial College London, United Kingdom (P.W.S.)
| | - Renu Virmani
- From the Department of Cardiology, Academic Medical Center, University of Amsterdam, the Netherlands (Y.S., C.C.); ThoraxCenter, Erasmus Medical Center, Rotterdam, the Netherlands (Y.O., E.T.); Cardialysis, Rotterdam, the Netherlands (Y.O.); CVPath, Institute Inc, Gaithersburg, MD (R.V.); Department of Cardiology (NSK), Houston Methodist DeBakey Heart and Vascular Center, Texas (N.S.K.); and NHLI, Imperial College London, United Kingdom (P.W.S.)
| | - Neal S Kleiman
- From the Department of Cardiology, Academic Medical Center, University of Amsterdam, the Netherlands (Y.S., C.C.); ThoraxCenter, Erasmus Medical Center, Rotterdam, the Netherlands (Y.O., E.T.); Cardialysis, Rotterdam, the Netherlands (Y.O.); CVPath, Institute Inc, Gaithersburg, MD (R.V.); Department of Cardiology (NSK), Houston Methodist DeBakey Heart and Vascular Center, Texas (N.S.K.); and NHLI, Imperial College London, United Kingdom (P.W.S.)
| | - Patrick W Serruys
- From the Department of Cardiology, Academic Medical Center, University of Amsterdam, the Netherlands (Y.S., C.C.); ThoraxCenter, Erasmus Medical Center, Rotterdam, the Netherlands (Y.O., E.T.); Cardialysis, Rotterdam, the Netherlands (Y.O.); CVPath, Institute Inc, Gaithersburg, MD (R.V.); Department of Cardiology (NSK), Houston Methodist DeBakey Heart and Vascular Center, Texas (N.S.K.); and NHLI, Imperial College London, United Kingdom (P.W.S.).
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63
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Baron SJ, Lei Y, Chinnakondepalli K, Vilain K, Magnuson EA, Kereiakes DJ, Ellis SG, Stone GW, Cohen DJ. Economic Outcomes of Bioresorbable Vascular Scaffolds Versus Everolimus-Eluting Stents in Patients Undergoing Percutaneous Coronary Intervention: 1-Year Results From the ABSORB III Trial. JACC Cardiovasc Interv 2017; 10:774-782. [PMID: 28427593 DOI: 10.1016/j.jcin.2017.01.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 01/04/2017] [Accepted: 01/05/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the economic impact of the Absorb bioresorbable vascular scaffold compared with the Xience everolimus-eluting stent in patients undergoing percutaneous coronary intervention. BACKGROUND The ABSORB III trial (Everolimus-Eluting Bioresorbable Scaffolds for Coronary Artery Disease) demonstrated that the Absorb scaffold was noninferior to the Xience stent with respect to target lesion failure at 1 year. Whether health care costs differ between the Absorb scaffold and the Xience stent is unknown. METHODS We performed a prospective health economic study alongside the ABSORB III trial, in which patients undergoing percutaneous coronary intervention for stable or unstable angina were randomized to receive the Absorb scaffold (n = 1,322) or Xience stent (n = 686). Resource use data were collected through 1 year of follow-up. Costs were assessed using resource-based accounting (for procedures), MedPAR data (for other index hospitalization costs), and Medicare reimbursements (for follow-up costs and physician fees). RESULTS Initial procedural costs were higher with the Absorb scaffold than the Xience stent ($6,316 ± 1,892 vs. $6,103 ± 1,895; p = 0.02), driven mainly by greater balloon catheter use and the higher cost of the scaffold in the Absorb group. Nonetheless, index hospitalization costs ($15,035 ± 2,992 for Absorb vs. $14,903 ± 3,449 for Xience; p = 0.37) and total 1-year costs ($17,848 ± 6,110 for Absorb vs. $17,498 ± 7,411 for Xience; p = 0.29) were similar between the 2 groups. CONCLUSIONS Although initial procedural costs were higher with the Absorb scaffold, there were no differences in total 1-year health care costs between the 2 cohorts. Longer term follow-up is needed to determine whether meaningful cost savings emerge after scaffold resorption. (A Clinical Evaluation of Absorb™ BVS, the Everolimus-Eluting Bioresorbable Vascular Scaffold in the Treatment of Subjects With de Novo Native Coronary Artery Lesions; NCT01751906).
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Affiliation(s)
- Suzanne J Baron
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Yang Lei
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Khaja Chinnakondepalli
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Katherine Vilain
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Elizabeth A Magnuson
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Dean J Kereiakes
- Christ Hospital Heart and Vascular Center and The Lindner Research Center, Cincinnati, Ohio
| | | | - Gregg W Stone
- New York-Presbyterian Hospital, Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York
| | - David J Cohen
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.
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Suwannasom P, Sotomi Y, Asano T, Koon JNC, Tateishi H, Zeng Y, Tenekecioglu E, Wykrzykowska J, Foin N, de Winter R, Ormiston J, Serruys P, Onuma Y. Change in lumen eccentricity and asymmetry after treatment with Absorb bioresorbable vascular scaffolds in the ABSORB cohort B trial: a five-year serial optical coherence tomography imaging study. EUROINTERVENTION 2017; 12:e2244-e2252. [DOI: 10.4244/eij-d-16-00740] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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65
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Visualizing polymeric bioresorbable scaffolds with three-dimensional image reconstruction using contrast-enhanced micro-computed tomography. Int J Cardiovasc Imaging 2016; 33:731-737. [PMID: 28039591 PMCID: PMC5383680 DOI: 10.1007/s10554-016-1049-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 12/20/2016] [Indexed: 11/02/2022]
Abstract
There are no previous studies showing how to visualize polymeric bioresorbable scaffolds (BRSs) by micro-computed tomography (mCT). There are no previous studies showing how to visualize polymeric bioresorbable scaffolds (BRSs) by micro-computed tomography (mCT). This study aimed to explore the feasibility of detecting polymeric BRS with 3-dimensional reconstruction of BRS images by contrast-enhanced mCT and to determine the optimal imaging settings. BRSs, made of poly-L-lactic acid (PLLA), were implanted in coronary bifurcation models. Five treatments were conducted to examine an optimal condition for imaging BRSs: Baseline treatment, samples were filled with normal saline and scanned with mCT immediately; Treatment-1, -2, -3 and -4, samples were filled with contrast medium and scanned with mCT immediately and 1, 2 and 3 h thereafter, corresponding to soaking time of contrast medium of 0, 1, 2 and 3 h. Compared to Baseline, mCT scanning completely discriminate the scaffold struts from the vascular lumen immediately after filling the samples with contrast agent but not from the vascular wall until the contrast agent soaking time was more than 2 h (Treatment-3 and -4). By setting 10-15 HU as a cut-point of CT values, the scaffold strut detectable rate at Baseline and Teatment-1, -2, -3 and -4 were 1.23 ± 0.31%, 1.65 ± 0.26%, 58.14 ± 12.84%, 97.97 ± 1.43% and 98.90 ± 0.38%, respectively (Treatment-3 vs. Treatment-2, p < 0.01); meanwhile, the success rate of 3D BRS reconstruction with high quality images at Baseline and Teatment-1, -2, -3 and -4 were 1.23%, 1.65%, 58.14%, 97.97% and 98.90%, respectively (Treatment-3 vs. Treatment-2, p < 0.01). In conclusions, reconstruction of 3D BRS images is technically feasible by contrast-enhanced mCT and soaking time of contrast agent for more than 2 h is necessary for complete separation of scaffold struts from the surrounding structures in the phantom samples.
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Baquet M, Brenner C, Wenzler M, Eickhoff M, David J, Brunner S, Theiss H, Massberg S, Guagliumi G, Mehilli J. Impact of Clinical Presentation on Early Vascular Healing After Bioresorbable Vascular Scaffold Implantation. J Interv Cardiol 2016; 30:16-23. [DOI: 10.1111/joic.12359] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Moritz Baquet
- Department of Cardiology; Munich University Clinic; Ludwig-Maximilian University; Munich Germany
| | - Christoph Brenner
- Department of Internal Medicine III; Medical University of Innsbruck; Innsbruck Austria
| | - Maximilian Wenzler
- Department of Cardiology; Munich University Clinic; Ludwig-Maximilian University; Munich Germany
| | - Madeleine Eickhoff
- Department of Cardiology; Munich University Clinic; Ludwig-Maximilian University; Munich Germany
| | - Jochheim David
- Department of Cardiology; Munich University Clinic; Ludwig-Maximilian University; Munich Germany
| | - Stefan Brunner
- Department of Cardiology; Munich University Clinic; Ludwig-Maximilian University; Munich Germany
| | - Hans Theiss
- Department of Cardiology; Munich University Clinic; Ludwig-Maximilian University; Munich Germany
| | - Steffen Massberg
- Department of Cardiology; Munich University Clinic; Ludwig-Maximilian University; Munich Germany
- Munich Heart Alliance at DZHK; Munich Germany
| | - Giulio Guagliumi
- Interventional Cardiology Unit; Azienda Ospedaliera Papa Giovanni XXIII; Bergamo Italy
| | - Julinda Mehilli
- Department of Cardiology; Munich University Clinic; Ludwig-Maximilian University; Munich Germany
- Munich Heart Alliance at DZHK; Munich Germany
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Serruys PW, Chevalier B, Sotomi Y, Cequier A, Carrié D, Piek JJ, Van Boven AJ, Dominici M, Dudek D, McClean D, Helqvist S, Haude M, Reith S, de Sousa Almeida M, Campo G, Iñiguez A, Sabaté M, Windecker S, Onuma Y. Comparison of an everolimus-eluting bioresorbable scaffold with an everolimus-eluting metallic stent for the treatment of coronary artery stenosis (ABSORB II): a 3 year, randomised, controlled, single-blind, multicentre clinical trial. Lancet 2016; 388:2479-2491. [PMID: 27806897 DOI: 10.1016/s0140-6736(16)32050-5] [Citation(s) in RCA: 403] [Impact Index Per Article: 50.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 10/13/2016] [Accepted: 10/19/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND No medium-term data are available on the random comparison between everolimus-eluting bioresorbable vascular scaffolds and everolimus-eluting metallic stents. The study aims to demonstrate two mechanistic properties of the bioresorbable scaffold: increase in luminal dimensions as a result of recovered vasomotion of the scaffolded vessel. METHODS The ABSORB II trial is a prospective, randomised, active-controlled, single-blind, parallel two-group, multicentre clinical trial. We enrolled eligible patients aged 18-85 years with evidence of myocardial ischaemia and one or two de-novo native lesions in different epicardial vessels. We randomly assigned patients (2:1) to receive treatment with an everolimus-eluting bioresorbable scaffold (Absorb; Abbott Vascular, Santa Clara, CA, USA) or treatment with an everolimus-eluting metallic stent (Xience; Abbott Vascular, Santa Clara, CA, USA). Randomisation was stratified by diabetes status and number of planned target lesions. At 3 year follow-up, the primary endpoint was superiority of the Absorb bioresorbable scaffold versus the Xience metallic stent in angiographic vasomotor reactivity after administration of intracoronary nitrate. The co-primary endpoint is the non-inferiority of angiographic late luminal loss. For the endpoint of vasomotion, the comparison was tested using a two-sided t test. For the endpoint of late luminal loss, non-inferiority was tested using a one-sided asymptotic test, against a non-inferiority margin of 0·14 mm. The trial is registered at ClinicalTrials.gov, number NCT01425281. FINDINGS Between Nov 28, 2011, and June 4, 2013, we enrolled 501 patients and randomly assigned them to the Absorb group (335 patients, 364 lesions) or the Xience group (166 patients, 182 lesions). The vasomotor reactivity at 3 years was not statistically different (Absorb group 0·047 mm [SD 0·109] vs Xience group 0·056 mm [0·117]; psuperiority=0·49), whereas the late luminal loss was larger in the Absorb group than in the Xience group (0·37 mm [0·45] vs 0·25 mm [0·25]; pnon-inferiority=0·78). This difference in luminal dimension was confirmed by intravascular ultrasound assessment of the minimum lumen area (4·32 mm2 [SD 1·48] vs 5·38 mm2 [1·51]; p<0·0001). The secondary endpoints of patient-oriented composite endpoint, Seattle Angina Questionnaire score, and exercise testing were not statistically different in both groups. However, a device-oriented composite endpoint was significantly different between the Absorb group and the Xience group (10% vs 5%, hazard ratio 2·17 [95% CI 1·01-4·70]; log-rank test p=0·0425), mainly driven by target vessel myocardial infarction (6% vs 1%; p=0·0108), including peri-procedural myocardial infarction (4% vs 1%; p=0·16). INTERPRETATION The trial did not meet its co-primary endpoints of superior vasomotor reactivity and non-inferior late luminal loss for the Absorb bioresorbable scaffold with respect to the metallic stent, which was found to have significantly lower late luminal loss than the Absorb scaffold. A higher rate of device-oriented composite endpoint due to target vessel myocardial infarction, including peri-procedural myocardial infarction, was observed in the Absorb group. The patient-oriented composite endpoint, anginal status, and exercise testing, were not statistically different between both devices at 3 years. Future studies should investigate the clinical impact of accurate intravascular imaging in sizing the device and in optimising the scaffold implantation. The benefit and need for prolonged dual antiplatelet therapy after bioresorbable scaffold implantation could also become a topic for future clinical research. FUNDING Abbott Vascular.
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Affiliation(s)
- Patrick W Serruys
- The National Heart and Lung Institute, Imperial College London, London, UK.
| | | | - Yohei Sotomi
- Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | | | | | - Jan J Piek
- Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | | | | | - Dariusz Dudek
- Department of Interventional Cardiology, Jagiellonian University, Krakow, Poland
| | | | | | - Michael Haude
- Medical Clinic I, Städtische Klinken Neuss, Lukaskrankenhaus GmbH, Neuss, Germany
| | | | | | - Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria S Anna, Cona, FE, Italy
| | - Andrés Iñiguez
- Interventional Cardiology Unit, Cardiology Department, Hospital Alvaro Cunqueiro, University Hospital of Vigo, Vigo, Spain
| | - Manel Sabaté
- Thorax Institute, University Hospital Clinic, Institut d'Investigacions Biome'diques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | | | - Yoshinobu Onuma
- ThoraxCenter, Erasmus Medical Center, Rotterdam, Netherlands; Cardialysis, Rotterdam, Netherlands
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Chamié D, Garcia-Garcia H, Costa RA, Onuma Y, Abizaid A, Serruys PW. Role of invasive imaging in acute and long-term assessment of bioresorbable scaffold technology. Catheter Cardiovasc Interv 2016; 88:38-53. [PMID: 27797463 DOI: 10.1002/ccd.26815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 10/01/2016] [Indexed: 11/11/2022]
Abstract
Fully bioresorbable scaffolds (BRS) represent a novel approach for the percutaneous treatment of coronary artery stenosis, providing temporary vessel scaffolding with drug-eluting capability during the restenosis-prone phase of the vascular healing. Beyond this initial critical period, when mechanical scaffolding support is no longer necessary, the device is bioresorbed, restoring the normal vascular physiology with the aim to eliminate the long-term safety concerns related to permanent metallic implants. Nonetheless, current BRS technology suffers from limited mechanical properties as compared to available metallic platforms, requiring careful attention to lesion preparation, accurate vessel sizing, and implantation technique. Intravascular imaging has played an important role in providing knowledge on the acute effects after BRS deployment, and it helped refine the current technique of BRS implantation. In addition, extensive work with multiple intravascular imaging modalities have also contributed to the understanding of the unique dynamic vascular changes that are experienced in the treated segment from post-implantation up to complete device bioresorption. In this manuscript, we review the role of invasive imaging modalities-from angiography to sound- and light-based techniques-to guide BRS implantation procedures, to assess its acute results postimplantation, and the changes experienced in the long-term until complete bioresorption has ensued. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Daniel Chamié
- Department of Interventional Cardiology, Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil. .,Cardiovascular Research Center, Sao Paulo, Brazil.
| | - Hector Garcia-Garcia
- Department of Interventional Cardiology, MedStar Heart and Vascular Institute, Washington, DC
| | - Ricardo A Costa
- Department of Interventional Cardiology, Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil.,Cardiovascular Research Center, Sao Paulo, Brazil
| | - Yoshinobu Onuma
- Department of Interventional Cardiology, Erasmus University Medical Center, Thoraxcenter, Rotterdam, The Netherlands.,Cardialysis BV, Rotterdam, The Netherlands
| | - Alexandre Abizaid
- Department of Interventional Cardiology, Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil.,Cardiovascular Research Center, Sao Paulo, Brazil.,Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Patrick W Serruys
- NHLI, Imperial College London, International Centre for Circulatory Health, London, United Kingdom
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Blachutzik F, Boeder N, Wiebe J, Mattesini A, Dörr O, Most A, Bauer T, Röther J, Tröbs M, Schlundt C, Achenbach S, Hamm CW, Nef HM. Post-dilatation after implantation of bioresorbable everolimus- and novolimus-eluting scaffolds: an observational optical coherence tomography study of acute mechanical effects. Clin Res Cardiol 2016; 106:271-279. [PMID: 27757522 DOI: 10.1007/s00392-016-1048-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 10/12/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The objective was to investigate the acute mechanical effects of post-dilatation on bioresorbable scaffolds (BRS) as determined by optical coherence tomography (OCT). BACKGROUND Post-dilatation with high-pressure balloons is regarded as a key component of BRS implantation for treatment of coronary artery stenoses. However, the impact of post-dilatation on BRS in vivo has not been thoroughly investigated. METHODS OCT was performed after the implantation procedure of 51 everolimus-eluting or novolimus-eluting polylactic acid-based BRS with (n = 27) or without non-compliant balloon post-dilatation (n = 24). The number of malapposed struts, strut fractures, edge dissections, residual in-scaffold area stenosis, and incomplete scaffold apposition area was analyzed over the complete length of each BRS with a spacing of 1 mm. RESULTS OCT revealed a significantly lower incomplete scaffold apposition area if post-dilatation was performed (0.16 ± 0.49 mm2 with post-dilatation vs. 2.65 ± 2.78 mm2 without post-dilatation, p < 0.001), as well as a significantly lower absolute number of malapposed struts (1 ± 2 with post-dilatation vs. 13 ± 13 without post-dilatation, p < 0.001). No significant differences regarding residual in-scaffold area stenosis, strut fracture, edge dissection, symmetry index, or eccentricity index were observed in patients with vs. without post-dilatation. CONCLUSION Post-dilatation of BRS with non-compliant balloons significantly reduces the number of malapposed struts and incomplete scaffold apposition area without inducing higher rates of edge dissection or strut fracture.
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Affiliation(s)
- Florian Blachutzik
- Department of Cardiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.
| | - Niklas Boeder
- Department of Cardiology and Angiology, University of Giessen, Giessen, Germany
| | - Jens Wiebe
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Alessio Mattesini
- Department of Heart and Vessels, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Oliver Dörr
- Department of Cardiology and Angiology, University of Giessen, Giessen, Germany
| | - Astrid Most
- Department of Cardiology and Angiology, University of Giessen, Giessen, Germany
| | - Timm Bauer
- Department of Cardiology and Angiology, University of Giessen, Giessen, Germany
| | - Jens Röther
- Department of Cardiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Monique Tröbs
- Department of Cardiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Christian Schlundt
- Department of Cardiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Christian W Hamm
- Department of Cardiology and Angiology, University of Giessen, Giessen, Germany
| | - Holger M Nef
- Department of Cardiology and Angiology, University of Giessen, Giessen, Germany
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Sotomi Y, Onuma Y, Dijkstra J, Eggermont J, Liu S, Tenekecioglu E, Zeng Y, Asano T, de Winter RJ, Popma JJ, Kozuma K, Tanabe K, Serruys PW, Kimura T. Impact of Implantation Technique and Plaque Morphology on Strut Embedment and Scaffold Expansion of Polylactide Bioresorbable Scaffold - Insights From ABSORB Japan Trial. Circ J 2016; 80:2317-2326. [PMID: 27725525 DOI: 10.1253/circj.cj-16-0818] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The optimal implantation technique for the bioresorbable scaffold (Absorb, Abbott Vascular) is still a matter of debate. The purpose of the present study was to evaluate the effect of implantation technique on strut embedment and scaffold expansion.Methods and Results:Strut embedment depth and scaffold expansion index assessed by optical coherence tomography (OCT) (minimum scaffold area/reference vessel area) were evaluated in the ABSORB Japan trial (OCT subgroup: 87 lesions) with respect to implantation technique using either quantitative coronary angiography (QCA) or OCT. Strut embedment was assessed at the strut level (n=667), while scaffold expansion was assessed at the lesion level (n=81). The mean embedment depth was 63±59 µm. Balloon sizing and inflation pressure had no direct effect on strut embedment. Plaque morphology affected strut embedment [nonatherosclerotic (58.9±54.3 µm), fibroatheroma (73.3±59.6 µm), fibrous plaque (59.7±51.1 µm), and fibrocalcific plaque (-3.1±61.6 µm, negative value means malapposition), P <0.001]. The balloon-artery ratio positively correlated with the expansion index. This relationship was stronger when the OCT-derived reference vessel diameter (RVD) was used as a reference for balloon selection rather than the QCA-derived one [predilatation (Pearson correlation r: QCA: 0.167 vs. OCT: 0.552), postdilatation (QCA: 0.316 vs. OCT: 0.717)]. CONCLUSIONS Underlying plaque morphology influenced strut embedment, whereas implantation technique had no direct effect on it. Optimal balloon sizing based on OCT-derived RVD might be recommended. However, the safety of such a strategy should be investigated in a prospective trial. (Circ J 2016; 80: 2317-2326).
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Affiliation(s)
- Yohei Sotomi
- Academic Medical Center, University of Amsterdam
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Caiazzo G, Di Mario C. Predictors of Bioresorbable Everolimus-Eluting Scaffold Failure at Intravascular Ultrasound Examination. JACC Cardiovasc Interv 2016; 9:1970-1. [DOI: 10.1016/j.jcin.2016.07.010] [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: 06/27/2016] [Accepted: 06/29/2016] [Indexed: 10/21/2022]
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Hong MK, Kim JS. Does Asymmetric Expansion of Bioresorbable Vascular Scaffolds Cause Stent Failure? JACC Cardiovasc Interv 2016; 9:1243-1245. [PMID: 27262864 DOI: 10.1016/j.jcin.2016.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 04/20/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Myeong-Ki Hong
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea; Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea.
| | - Jung-Sun Kim
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
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