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Zaman A, de Winter RJ, Kogame N, Chang CC, Modolo R, Spitzer E, Tonino P, Hofma S, Zurakowski A, Smits PC, Prokopczuk J, Moreno R, Choudhury A, Petrov I, Cequier A, Kukreja N, Hoye A, Iniguez A, Ungi I, Serra A, Gil RJ, Walsh S, Tonev G, Mathur A, Merkely B, Colombo A, Ijsselmuiden S, Soliman O, Kaul U, Onuma Y, Serruys PW. Safety and efficacy of a sirolimus-eluting coronary stent with ultra-thin strut for treatment of atherosclerotic lesions (TALENT): a prospective multicentre randomised controlled trial. Lancet 2019; 393:987-997. [PMID: 30827782 DOI: 10.1016/s0140-6736(18)32467-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 09/24/2018] [Accepted: 09/28/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND Supraflex is a sirolimus-eluting stent with a biodegradable polymer coating and ultra-thin struts. We aimed to compare Supraflex with the standard of care, Xience, an everolimus-eluting stent with a durable polymer coating, regarding clinical outcomes with a randomised trial in an all-comer population. METHODS We did a prospective, randomised, single-blind, multicentre study (TALENT) across 23 centres in Europe (the Netherlands, Poland, the UK, Spain, Bulgaria, Hungary, and Italy). Eligible participants were aged 18 years or older, had one or more coronary artery stenosis of 50% or greater in a native coronary artery, saphenous venous graft, or arterial bypass conduit, and had a reference vessel diameter of 2·25-4·50 mm. Patients underwent percutaneous coronary intervention in an all-comer manner. We randomly assigned patients (1:1) to implantation of either a sirolimus-eluting stent with a biodegradable polymer coating and ultra-thin struts (Supraflex) or an everolimus-eluting stent with a durable polymer coating (Xience). Randomisation was done by local investigators by use of a web-based software with random blocks according to centre. The primary endpoint was a non-inferiority comparison of a device-oriented composite endpoint-cardiac death, target-vessel myocardial infarction, or clinically indicated target lesion revascularisation-between groups at 12 months after the procedure, assessed in an intention-to-treat population. On assumption of 1-year composite endpoint prevalence of 8·3%, a margin of 4·0% was defined for non-inferiority of the Supraflex group compared with the Xience group. This trial is registered with ClinicalTrials.gov, number NCT02870140. FINDINGS Between Oct 21, 2016, and July 3, 2017, 1435 patients with 1046 lesions were randomly assigned to Supraflex, of whom 720 received the index procedure, and 715 patients with 1030 lesions were assigned to Xience, all receiving the index procedure. At 12 months, the primary endpoint had occurred in 35 patients (4·9 %) in the Supraflex group and in 37 patients (5·3%) in the Xience group (absolute difference -0·3% [one-sided 95% upper confidence bound 1·6%], pnon-inferiority<0·0001). Definite or probable stent thrombosis prevalence, a safety indicator, was low in both groups and did not differ between them. INTERPRETATION The Supraflex stent was non-inferior to the Xience stent for a device-oriented composite clinical endpoint at 12 months in an all-comer population. Supraflex seems a safe and effective alternative drug-eluting stent to other stents in clinical practice. FUNDING European Cardiovascular Research Institute.
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Affiliation(s)
- Azfar Zaman
- Freeman Hospital, Newcastle University, and Newcastle upon Tyne Hospitals NHS Trust, Newcastle, UK
| | - Robbert J de Winter
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Norihiro Kogame
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, Netherlands; Department of Cardiology, Toho University Medical Centre Ohashi Hospital, Tokyo, Japan
| | - Chun Chin Chang
- Thoraxcenter, Erasmus University Medical Centre, Rotterdam, Netherlands; Cardiology Division, Department of Internal Medicine, Taipei Veterans General Hospital, Taiwan
| | - Rodrigo Modolo
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, Netherlands; Cardiology Division, Department of Internal Medicine, University of Campinas, Campinas, SP, Brazil
| | - Ernest Spitzer
- Thoraxcenter, Erasmus University Medical Centre, Rotterdam, Netherlands; Cardialysis Clinical Trials Management and Core Laboratories, Rotterdam, Netherlands
| | - Pim Tonino
- Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands
| | - Sjoerd Hofma
- Medical Centre Leeuwarden, Leeuwarden, Netherlands
| | | | | | | | - Raul Moreno
- Cardiology Department, La Paz University Hospital, Madrid, Spain
| | | | - Ivo Petrov
- Acibadem City Clinic Cardiovascular Center, Sofia, Bulgaria
| | | | - Neville Kukreja
- Department of Cardiology, East and North Hertfordshire NHS Trust, Hertfordshire, UK
| | - Angela Hoye
- Department of Academic Cardiology, University of Hull, Castle Hill Hospital, UK
| | | | - Imre Ungi
- Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, University of Szeged, Szeged, Hungary
| | - Antonio Serra
- Unidad de Cardiología Intervencionista, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Robert J Gil
- Department of Invasive Cardiology, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland; Mossakowski Medical Research Centre, Polish Academy of Science, Warsaw, Poland
| | - Simon Walsh
- Department of Cardiology Belfast Health & Social Care Trust, Belfast, UK
| | - Gincho Tonev
- Multi-profile Hospital for Active Treatment, St George's University, Plovdiv, Bulgaria
| | - Anthony Mathur
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Bela Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Antonio Colombo
- Division of Interventional Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | | | - Osama Soliman
- Thoraxcenter, Erasmus University Medical Centre, Rotterdam, Netherlands; Cardialysis Clinical Trials Management and Core Laboratories, Rotterdam, Netherlands
| | - Upendra Kaul
- Academics and Research, Batra Hospital and Medical Research Center, New Delhi, India
| | - Yoshinobu Onuma
- Thoraxcenter, Erasmus University Medical Centre, Rotterdam, Netherlands; Cardialysis Clinical Trials Management and Core Laboratories, Rotterdam, Netherlands.
| | - Patrick W Serruys
- International Centre for Circulatory Health, Imperial College London, London, UK.
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Chichareon P, Katagiri Y, Asano T, Takahashi K, Kogame N, Modolo R, Tenekecioglu E, Chang CC, Tomaniak M, Kukreja N, Wykrzykowska JJ, Piek JJ, Serruys PW, Onuma Y. Mechanical properties and performances of contemporary drug-eluting stent: focus on the metallic backbone. Expert Rev Med Devices 2019; 16:211-228. [DOI: 10.1080/17434440.2019.1573142] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Ply Chichareon
- Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Division of Cardiovascular Medicine, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand
| | - Yuki Katagiri
- Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Taku Asano
- Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Kuniaki Takahashi
- Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Norihiro Kogame
- Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Rodrigo Modolo
- Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Department of Internal Medicine, Cardiology Division, University of Campinas (UNICAMP). Campinas, Sao Paulo, Brazil
| | | | - Chun-Chin Chang
- ThoraxCenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Mariusz Tomaniak
- ThoraxCenter, Erasmus Medical Center, Rotterdam, the Netherlands
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Neville Kukreja
- Department of Cardiology, East and North Hertfordshire NHS Trust, Hertfordshire, UK
| | | | - Jan J. Piek
- Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Patrick W. Serruys
- International Centre for Circulatory Health, NHLI, Imperial College London, London, UK
| | - Yoshinobu Onuma
- ThoraxCenter, Erasmus Medical Center, Rotterdam, the Netherlands
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53
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Wawrzyńska M, Duda M, Wysokińska E, Strządała L, Biały D, Ulatowska-Jarża A, Kałas W, Kraszewski S, Pasławski R, Biernat P, Pasławska U, Zielonka A, Podbielska H, Kopaczyńska M. Functionalized CD133 antibody coated stent surface simultaneously promotes EPCs adhesion and inhibits smooth muscle cell proliferation–A novel approach to prevent in-stent restenosis. Colloids Surf B Biointerfaces 2019; 174:587-597. [DOI: 10.1016/j.colsurfb.2018.11.061] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 11/09/2018] [Accepted: 11/24/2018] [Indexed: 01/12/2023]
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54
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Katagiri Y, De Maria GL, Kogame N, Chichareon P, Takahashi K, Chang CC, Modolo R, Walsh S, Sabate M, Davies J, Lesiak M, Moreno R, Cruz‐Gonzalez I, West NE, Piek JJ, Wykrzykowska JJ, Farooq V, Escaned J, Banning AP, Onuma Y, Serruys PW. Impact of post‐procedural minimal stent area on 2‐year clinical outcomes in the SYNTAX II trial. Catheter Cardiovasc Interv 2019; 93:E225-E234. [DOI: 10.1002/ccd.28105] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/11/2018] [Accepted: 01/02/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Yuki Katagiri
- Department of CardiologyAmsterdam UMC, University of Amsterdam Amsterdam The Netherlands
| | | | - Norihiro Kogame
- Department of CardiologyAmsterdam UMC, University of Amsterdam Amsterdam The Netherlands
| | - Ply Chichareon
- Department of CardiologyAmsterdam UMC, University of Amsterdam Amsterdam The Netherlands
| | - Kuniaki Takahashi
- Department of CardiologyAmsterdam UMC, University of Amsterdam Amsterdam The Netherlands
| | - Chun Chin Chang
- ThoraxCenterErasmus Medical Center Rotterdam The Netherlands
| | - Rodrigo Modolo
- Department of CardiologyAmsterdam UMC, University of Amsterdam Amsterdam The Netherlands
| | - Simon Walsh
- Department of CardiologyBelfast Health & Social Care Trust Belfast United Kingdom
| | - Manel Sabate
- Thorax InstituteHospital Clinic I Provincial de Barcelona Barcelona Spain
| | - Justin Davies
- Department of CardiologyImperial College London London United Kingdom
| | - Maciej Lesiak
- 1st Department of CardiologyUniversity of Medical Sciences Poznañ Poland
| | - Raul Moreno
- Department of CardiologyHospital Universitario la Paz Madrid Spain
| | | | - Nick E.J. West
- Department of Interventional CardiologyRoyal Papworth Hospital Cambridge United Kingdom
| | - Jan J. Piek
- Department of CardiologyAmsterdam UMC, University of Amsterdam Amsterdam The Netherlands
| | - Joanna J. Wykrzykowska
- Department of CardiologyAmsterdam UMC, University of Amsterdam Amsterdam The Netherlands
| | - Vasim Farooq
- Manchester Heart CentreManchester Royal Infirmary, Central Manchester University Hospitals Manchester United Kingdom
| | - Javier Escaned
- Hospital Cliinico San Carlos IDISSC and Universidad Complutense de Madrid Madrid Spain
| | - Adrian P. Banning
- Department of CardiologyJohn Radcliffe Hospital Oxford United Kingdom
| | - Yoshinobu Onuma
- ThoraxCenterErasmus Medical Center Rotterdam The Netherlands
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Dudek D, Dziewierz A, Stone G, Wijns W. The year in cardiology 2018: coronary interventions. Eur Heart J 2019; 40:195-203. [PMID: 30601991 PMCID: PMC6321963 DOI: 10.1093/eurheartj/ehy882] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 12/04/2018] [Accepted: 12/27/2018] [Indexed: 02/06/2023] Open
Affiliation(s)
- Dariusz Dudek
- Institute of Cardiology, Jagiellonian University Medical College, 17 Kopernika Street, Krakow, Poland
| | - Artur Dziewierz
- 2nd Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Gregg Stone
- New York Presbyterian Hospital and Columbia University Medical Center, New York, NY, USA
- The Cardiovascular Research Foundation, New York, NY, USA
| | - William Wijns
- The Lambe Institute for Translational Medicine and Curam, Saolta University Healthcare Group, National University of Ireland Galway, Galway, Ireland
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56
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Randomized All-Comers Evaluation of a Permanent Polymer Zotarolimus-Eluting Stent Versus a Polymer-Free Amphilimus-Eluting Stent. Circulation 2019; 139:67-77. [DOI: 10.1161/circulationaha.118.037707] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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57
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58
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Abizaid A, Kedev S, Kedhi E, Talwar S, Erglis A, Hlinomaz O, Masotti M, Fath-Ordoubadi F, Lemos PA, Milewski K, Botelho R, Costa R, Bangalore S. Randomised comparison of a biodegradable polymer ultra-thin sirolimus-eluting stent versus a durable polymer everolimus-eluting stent in patients with de novo native coronary artery lesions: the meriT-V trial. EUROINTERVENTION 2018; 14:e1207-e1214. [DOI: 10.4244/eij-d-18-00762] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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59
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Elia E, Montecucco F, Portincasa P, Sahebkar A, Mollazadeh H, Carbone F. Update on pathological platelet activation in coronary thrombosis. J Cell Physiol 2018; 234:2121-2133. [PMID: 30317596 DOI: 10.1002/jcp.27575] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 09/17/2018] [Indexed: 12/19/2022]
Abstract
Although coronary thrombosis (CT) is integral to cardiovascular outcomes, the underlying pathophysiological mechanisms remain unclear. CT may occur in case of atherosclerotic plaque erosion/rupture, or even after stenting implantation. Platelets (PLT) activation is the keystone of atherothrombosis and depends on many dysregulated elements, including endothelial dysfunction, oxidized lipoproteins, and immune response. Besides the classical view of PLT as an effector of hemostatic response, a new repertoire of PLT activities is emerging. PLT lipidome oxidation is a self-maintaining process which promotes PLT reactivity, coagulation cascade, and inflammatory cell activation. PLT-innate immune cell interaction is also sustained by neutrophil extracellular traps and NLRP3 inflammasome pathways. Other noteworthy emerging mechanisms are implicated in the crosstalk between PLT and surrounding cells. Especially, microvesicles (MVs) released from PLT may extend their signaling network far beyond the classical cell-cell interactions. Moreover, the recognition of noncoding RNA in PLT MVs introduce another layer of complexity in terms of intercellular signaling by a direct regulation of messenger RNA profile and gene expression in the recipient cells. The aim of this narrative review is to update the recent advance in CT and intracoronary stent thrombosis, including causal factors and potential translation of experimental evidence into the clinical setting.
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Affiliation(s)
- Edoardo Elia
- Department of Internal Medicine, First Clinic of Internal Medicine, University of Genoa, Genoa, Italy
| | - Fabrizio Montecucco
- Department of Internal Medicine, First Clinic of Internal Medicine, University of Genoa, Genoa, Italy.,Department of Internal Medicine, First Clinic of Internal Medicine, Ospedale Policlinico San Martino, 10 Largo Benzi, Genoa, Italy.,Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | - Piero Portincasa
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri," University of Bari Medical School, Bari, Italy
| | - Amirhossein Sahebkar
- Department of Pharmaceutical Biotechnology, Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.,Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamid Mollazadeh
- Department of Physiology and Pharmacology, School of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Federico Carbone
- Department of Internal Medicine, First Clinic of Internal Medicine, University of Genoa, Genoa, Italy
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60
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1-Year Clinical Outcomes of All-Comer Patients Treated With the Dual-Therapy COMBO Stent. JACC Cardiovasc Interv 2018; 11:1969-1978. [DOI: 10.1016/j.jcin.2018.04.038] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 03/21/2018] [Accepted: 04/21/2018] [Indexed: 11/23/2022]
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61
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Modolo R, Miyazaki Y, Chichareon P, Asano T, Collet C, Tenekecioglu E, Katagiri Y, Soliman O, Garg S, Onuma Y, Serruys PW. Interventional cardiology: review of the year 2017. EUROINTERVENTION 2018; 13:2083-2096. [PMID: 29437035 DOI: 10.4244/eij-d-18-00066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Rodrigo Modolo
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Winther AK, Fejerskov B, ter Meer M, Jensen NB, Dillion R, Schaffer JE, Chandrawati R, Stevens MM, Schultze Kool LJ, Simonsen U, Zelikin AN. Enzyme Prodrug Therapy Achieves Site-Specific, Personalized Physiological Responses to the Locally Produced Nitric Oxide. ACS APPLIED MATERIALS & INTERFACES 2018; 10:10741-10751. [PMID: 29570264 PMCID: PMC5887086 DOI: 10.1021/acsami.8b01658] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 03/15/2018] [Indexed: 05/23/2023]
Abstract
Nitric oxide (NO) is a highly potent but short-lived endogenous radical with a wide spectrum of physiological activities. In this work, we developed an enzymatic approach to the site-specific synthesis of NO mediated by biocatalytic surface coatings. Multilayered polyelectrolyte films were optimized as host compartments for the immobilized β-galactosidase (β-Gal) enzyme through a screen of eight polycations and eight polyanions. The lead composition was used to achieve localized production of NO through the addition of β-Gal-NONOate, a prodrug that releases NO following enzymatic bioconversion. The resulting coatings afforded physiologically relevant flux of NO matching that of the healthy human endothelium. The antiproliferative effect due to the synthesized NO in cell culture was site-specific: within a multiwell dish with freely shared media and nutrients, a 10-fold inhibition of cell growth was achieved on top of the biocatalytic coatings compared to the immediately adjacent enzyme-free microwells. The physiological effect of NO produced via the enzyme prodrug therapy was validated ex vivo in isolated arteries through the measurement of vasodilation. Biocatalytic coatings were deposited on wires produced using alloys used in clinical practice and successfully mediated a NONOate concentration-dependent vasodilation in the small arteries of rats. The results of this study present an exciting opportunity to manufacture implantable biomaterials with physiological responses controlled to the desired level for personalized treatment.
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Affiliation(s)
- Anna K. Winther
- Department
of Chemistry, Department of Biomedicine, and iNano Interdisciplinary Nanoscience Centre, Aarhus University, Aarhus 8000, Denmark
| | - Betina Fejerskov
- Department
of Chemistry, Department of Biomedicine, and iNano Interdisciplinary Nanoscience Centre, Aarhus University, Aarhus 8000, Denmark
| | - Marja ter Meer
- Department of Radiology and Nuclear Medicine 766, Radboud University Medical Center, Nijmegen 6525, The Netherlands
| | - Najah B.S. Jensen
- Department
of Chemistry, Department of Biomedicine, and iNano Interdisciplinary Nanoscience Centre, Aarhus University, Aarhus 8000, Denmark
| | - Ross Dillion
- Fort Wayne Metals, Research and Development, Fort Wayne 46809, Indiana, United States
| | - Jeremy E. Schaffer
- Fort Wayne Metals, Research and Development, Fort Wayne 46809, Indiana, United States
| | - Rona Chandrawati
- Department
of Materials, Department of Bioengineering, and Institute of Biomedical
Engineering, Imperial College London, London SW7 2AZ, U.K.
| | - Molly M. Stevens
- Department
of Materials, Department of Bioengineering, and Institute of Biomedical
Engineering, Imperial College London, London SW7 2AZ, U.K.
| | - Leo J. Schultze Kool
- Department of Radiology and Nuclear Medicine 766, Radboud University Medical Center, Nijmegen 6525, The Netherlands
| | - Ulf Simonsen
- Department
of Chemistry, Department of Biomedicine, and iNano Interdisciplinary Nanoscience Centre, Aarhus University, Aarhus 8000, Denmark
| | - Alexander N. Zelikin
- Department
of Chemistry, Department of Biomedicine, and iNano Interdisciplinary Nanoscience Centre, Aarhus University, Aarhus 8000, Denmark
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Wijns W, Vrolix M, Verheye S, Schoors D, Slagboom T, Gosselink M, Benit E, Kandzari D, Donohoe D, Ormiston JA. Long-term clinical outcomes of a crystalline sirolimus-eluting coronary stent with a fully bioabsorbable polymer coating: five-year outcomes from the DESSOLVE I and II trials. EUROINTERVENTION 2018; 13:e2147-e2151. [DOI: 10.4244/eij-d-17-00230] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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64
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Tzafriri AR, Garcia-Polite F, Li X, Keating J, Balaguer JM, Zani B, Bailey L, Markham P, Kiorpes TC, Carlyle W, Edelman ER. Defining drug and target protein distributions after stent-based drug release: Durable versus deployable coatings. J Control Release 2018; 274:102-108. [PMID: 29421608 DOI: 10.1016/j.jconrel.2018.02.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 12/31/2017] [Accepted: 02/04/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Innovations in drug eluting stent designs make it increasingly important to develop models for differentiating performance through spatial definition of drug, receptor binding and cell state. METHODS Two designs of sirolimus analog eluting stents were implanted into porcine coronary arteries for 28, 60 or 90 days (n = 9/time point), durable coating (Xience) and deployable absorbable coating (MiStent). Explanted arteries were evaluated for drug content (n = 3/time point) by LC-MS/MS and for drug and target protein (mTOR) distributions by immunofluorescence (IF, n = 6/time point). A computational model was developed to predict drug release and arterial distribution maps. RESULTS Both stents released the majority of drug load by 28 days, with different tissue retention efficiencies (91.4 ± 4.9% MiStent versus 21.5 ± 1.9% Xience, P < 0.001). Computational modeling of MiStent coating deployment and microcrystal dissolution recapitulated in vivo drug release and net tissue content and predicted that >98.5% of deployed drug remains crystalline through 90 days. Immunofluorescence and computational modeling showed peristrut drug localization for both stents, with similar peaks, but high interstrut levels only at sites of coating deployment from the absorbable coating. Co-localization of mTOR-IF with drug-IF for both devices showed persistent drug effects, though with differential drug-receptor pharmacokinetics. CONCLUSIONS Immunofluorescence and computational modeling provide insights into drug distribution and binding status that can help differentiate drug delivery technologies. Herein we found that tissue deployment of slow dissolving crystalline drug particles results in temporally and spatially more uniform drug delivery to interstrut zones that might otherwise be under-dosed without excess peristrut drug.
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Affiliation(s)
| | | | - Xiaojian Li
- CBSET Inc., 500 Shire Way, Lexington, MA, USA
| | | | | | - Brett Zani
- CBSET Inc., 500 Shire Way, Lexington, MA, USA
| | - Lynn Bailey
- CBSET Inc., 500 Shire Way, Lexington, MA, USA
| | | | | | | | - Elazer R Edelman
- IMES, MIT, 77 Massachusetts Avenue, Cambridge, MA, USA; Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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