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Delewi R, Piek JJ. Absorbing the Absorb experience-don't let the concept fade away. Neth Heart J 2019; 27:523-524. [PMID: 31628585 PMCID: PMC6823327 DOI: 10.1007/s12471-019-01334-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- R Delewi
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - J J Piek
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Danzi GB, Bernelli C, Cerrato E. Outcomes of Optimised Implantation Technique with Bioresorbable scaffolds: A Pooled Analysis of ABSORB-IV and COMPARE-ABSORB Trials. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:559-561. [PMID: 31422012 DOI: 10.1016/j.carrev.2019.07.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/17/2019] [Accepted: 07/16/2019] [Indexed: 11/30/2022]
Abstract
Randomised trials have demonstrated higher midterm rates of adverse events and device thrombosis with Absorb-BVS compared to contemporary drug-eluting-stents (DES). BVS failure was ascribed to the implantation technique and consequently two large randomised trials evaluated the clinical impact of an optimised scaffold-implant-procedure. However, pooling together data from ABSORB-IV and those of the COMPARE-ABSORB, the scaffold was still associated with a statistically significant increased risk of target-vessel myocardial-infarction (OR 1.5; 95% CI 1.04-2.17; P = 0.03) and thrombotic events (OR 2.85; 95% CI 1.33-6.11; P = 0.007) at 1-year. Such kind of results could be in part attributed to a lower radial force and the higher acute recoil of the BVS as observed in previous studies. Besides a painstaking implantation technique, future generations of bioresorbable stents should incorporate an excellent mechanical propriety in order to compete with the current-generation DES.
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Affiliation(s)
| | - Chiara Bernelli
- Division of Cardiology, Ospedale Santa Corona, Pietra Ligure, Italy.
| | - Enrico Cerrato
- Division of Cardiology, San Luigi Gonzaga University Hospital, Orbassano and Infermi Hospital, Rivoli, Turin, Italy
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Coronary Shear Stress after Implantation of Bioresorbable Scaffolds – a Modern Interdisciplinary Concept at the Border between Interventional Cardiology and Cardiac Imaging. JOURNAL OF INTERDISCIPLINARY MEDICINE 2019. [DOI: 10.2478/jim-2019-0007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Abstract
Bioresorbable scaffolds/stents offer new and exciting perspectives in the treatment of patients with acute coronary syndromes, especially after the recent development of invasive imaging techniques, such as optical coherence tomography, which allow complete assessment of vascu-lar segments. A particular advantage of bioresorbable scaffolds is that once the biosorption of the scaffold is complete, the vascular segment regains its normal physiological functions, thus eliminating the risk of late complications. New studies show the importance of shear stress in the progression of vascular atherosclerosis or in accelerating endothelial turnover. Based on the current knowledge in this field, a future standardized determination of shear stress may help in the long-term follow-up of patients that have suffered or are at risk of developing an acute coronary syndrome.
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Hybrid Coronary Percutaneous Treatment with Metallic Stents and Everolimus-Eluting Bioresorbable Vascular Scaffolds: 2-years Results from the GABI-R Registry. J Clin Med 2019; 8:jcm8060767. [PMID: 31151213 PMCID: PMC6617525 DOI: 10.3390/jcm8060767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 05/28/2019] [Accepted: 05/29/2019] [Indexed: 12/02/2022] Open
Abstract
The limitations of the first-generation everolimus-eluting coronary bioresorbable vascular scaffolds (BVS) have been demonstrated in several randomized controlled trials. Little data are available regarding the outcomes of patients receiving hybrid stenting with both BVS and drug-eluting stents (DES). Of 3144 patients prospectively enrolled in the GABI-Registry, 435 (age 62 ± 10, 19% females, 970 lesions) received at least one BVS and one metal stent (hybrid group). These patients were compared with the remaining 2709 (3308 lesions) who received BVS-only. Patients who had received hybrid stenting had more frequently a history of cardiovascular disease and revascularization (p < 0.05), had less frequently single-vessel disease (p < 0.0001), and the lesions treated in these patients were longer (p < 0.0001) and more frequently complex. Accordingly, the incidence of periprocedural myocardial infarction (p < 0.05) and that of cardiovascular death, target vessel and lesion failure and any PCI at 24 months was lower in the BVS-only group (all p < 0.05). The 24-months rate of definite and probable scaffold thrombosis was 2.7% in the hybrid group and 2.8% in the BVS-only group, that of stent thrombosis in the hybrid group was 1.86%. In multivariable analysis, only implantation in bifurcation lesions emerged as a predictor of device thrombosis, while the device type was not associated with this outcome (p = 0.21). The higher incidence of events in patients receiving hybrid stenting reflects the higher complexity of the lesions in these patients; in patients treated with a hybrid strategy, the type of device implanted did not influence patients´ outcomes.
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Okada K, Honda Y, Kitahara H, Otagiri K, Tanaka S, Hollak MB, Yock PG, Popma JJ, Kusano H, Cheong WF, Sudhir K, Fitzgerald PJ, Kimura T. Bioresorbable Scaffold for Treatment of Coronary Artery Lesions: Intravascular Ultrasound Results From the ABSORB Japan Trial. JACC Cardiovasc Interv 2019; 11:648-661. [PMID: 29622143 DOI: 10.1016/j.jcin.2017.11.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 11/26/2017] [Accepted: 11/28/2017] [Indexed: 10/17/2022]
Abstract
OBJECTIVES The aim of this study was to characterize post-procedural intravascular ultrasound (IVUS) findings in the ABSORB Japan trial, specifically stratified by the size of target coronary arteries. BACKGROUND Despite overall noninferiority confirmed in recent randomized trials comparing bioresorbable vascular scaffolds (BVS) (Absorb BVS) and cobalt-chromium everolimus-eluting metallic stents (CoCr-EES), higher event rates of Absorb BVS have been reported with suboptimal deployment, especially in small coronary arteries. METHODS In the ABSORB Japan trial, 150 patients (2:1 randomization) were scheduled in the IVUS cohort. Small vessel was defined as mean reference lumen diameter <2.75 mm. Tapered-vessel lesions were defined as tapering index (proximal/distal reference lumen diameter) ≥1.2. RESULTS Overall, IVUS revealed that the Absorb BVS arm had smaller device expansion than the CoCr-EES arm did, which was particularly prominent in small- and tapered-vessel lesions. Higher tapering index was also associated with higher rates of incomplete strut apposition in Absorb BVS, but not in CoCr-EES. With respect to procedural techniques, small-vessel lesions were treated more frequently with noncompliant balloons at post-dilatation but using significantly lower pressure in the Absorb BVS arm. In contrast, tapered-vessel lesions were post-dilated at equivalent pressure but with significantly smaller balloon catheters in the Absorb BVS arm, compared with the CoCr-EES arm. CONCLUSIONS The significantly smaller device expansion especially in small vessels may account for the poorer outcomes of Absorb BVS in this lesion type. Appropriate optimization strategy, possibly different between polymeric and metallic devices, needs to be established for bioresorbable scaffold technology. (AVJ-301 Clinical Trial: A Clinical Evaluation of AVJ-301 Absorb™ BVS) in Japanese Population [ABSORB JAPAN]; NCT01844284).
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Affiliation(s)
- Kozo Okada
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California
| | - Yasuhiro Honda
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California.
| | - Hideki Kitahara
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California
| | - Kyuhachi Otagiri
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California
| | - Shigemitsu Tanaka
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California
| | - M Brooke Hollak
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California
| | - Paul G Yock
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California
| | - Jeffrey J Popma
- Department of Internal Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Hajime Kusano
- Clinical Science and Medical Affairs, Abbott Vascular, Santa Clara, California
| | - Wai-Fung Cheong
- Clinical Science and Medical Affairs, Abbott Vascular, Santa Clara, California
| | - Krishnankutty Sudhir
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California; Clinical Science and Medical Affairs, Abbott Vascular, Santa Clara, California
| | - Peter J Fitzgerald
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Hospital, Kyoto, Japan
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Association between inflammatory biomarkers and neointimal response following elective implantation of the ABSORB bioresorbable vascular scaffold. Coron Artery Dis 2019; 30:183-187. [DOI: 10.1097/mca.0000000000000699] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Zhang H, Zhao J, Xu Y, Zhang W, Sui Y, Liu Q, Wang Y, Liu Z, Gao R, Wu Y. Three-year outcome of everolimus-eluting bioresorbable vascular scaffold versus everolimus-eluting metallic stents: a comprehensive updated meta-analysis of randomized controlled trials. Expert Rev Med Devices 2019; 16:421-427. [PMID: 31008654 DOI: 10.1080/17434440.2019.1610389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION In recent years, everolimus-eluting bioresorbable vascular scaffold stents (EE-BRS) were developed as alternative to everolimus-eluting metallic stents (EES) for coronary artery disease (CAD) treatments. Areas covered: Searches were conducted in MEDLINE, EMBASE, EBSCO, Springer, Ovid, TCTMD, Cardiosource, Clinical Trial Results and the Cochrane Library with combined key words such as bioresorbable vascular scaffold (BVS), everolimus-eluting metallic stents, EES, coronary artery disease, CAD and randomized-Controlled Trials.Finally, 5,474 patients were enrolled for comparison of device-induced thrombosis, ischemia-driven target lesion revascularization (ID-TLR), device-oriented composite endpoints (DOCE), patient-oriented composite endpoints (POCE), and target vessel failure (TVF) between EE-BRS and EES treatments. The primary literature search retrieved 200 records. Expert Opinion: There was no difference regarding DOCEs, POCEs and ID-TLRs for 1 or 2 years, whereas there were significant differences regarding thrombosis between EE-BRS and EES interventions in the 1-year (pooled HR, 2.15, 95%CI: 1.11, 4.18) and 2-year follow-ups (pooled HR, 2.02, 95%CI: 1.08, 3.78), but not in the 3-year follow-up (pooled HR, 1.57, 95%CI: 0.66, 3.75) anymore. The results of this study showed no inferiority of EE-BRS regarding TVF, DOCE, POCE and ID-TLR 1-year and 2-years after interventions, but enhanced risk of thrombosis in the EE-BRS patients, which disappeared in 3-year follow-ups.
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Affiliation(s)
- Hongliang Zhang
- a Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases , Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China
| | - Jie Zhao
- a Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases , Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China
| | - Yanlu Xu
- a Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases , Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China
| | - Wenjia Zhang
- a Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases , Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China
| | - Yonggang Sui
- a Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases , Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China
| | - Qingrong Liu
- b School of Basic Medical Sciences , Shanxi Medical University , Taiyuan , Shanxi Province , China
| | - Yubin Wang
- a Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases , Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China
| | - Zhihong Liu
- c Pulmonary Vascular Disease Center , Fuwai Hospital, National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China
| | - Runlin Gao
- a Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases , Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China
| | - Yongjian Wu
- a Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases , Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China
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Kang SH, Gogas BD, Jeon KH, Park JS, Lee W, Yoon CH, Suh JW, Hwang SS, Youn TJ, Chae IH, Kim HS. Long-term safety of bioresorbable scaffolds: insights from a network meta-analysis including 91 trials. EUROINTERVENTION 2019; 13:1904-1913. [PMID: 29278353 DOI: 10.4244/eij-d-17-00646] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AIMS The aim of this study was to investigate the long-term safety and efficacy of biodegradable scaffolds and metallic stents. METHODS AND RESULTS We analysed a total of 91 randomised controlled trials with a mean follow-up of 3.7 years in 105,842 patients which compared two or more coronary metallic stents or biodegradable scaffolds and reported the long-term clinical outcomes (≥2 years). Network meta-analysis showed that patients treated with the Absorb bioresorbable vascular scaffold (BVS) had a significantly higher risk of definite or probable scaffold thrombosis (ScT) compared to those treated with metallic DES. The risk of very late ScT was highest with the Absorb BVS among comparators. Pairwise conventional meta-analysis demonstrated that the elevated risk of ScT with Absorb BVS compared to cobalt-chromium everolimus-eluting stents was consistent across the time points of ≤30 days (early), 31 days - 1 year (late) and >1 year (very late) ScT. In addition, target lesion failure rates were significantly higher in the Absorb BVS cohort, driven by both increased risk of target vessel myocardial infarction and ischaemia-driven target lesion revascularisation. CONCLUSIONS Absorb BVS implantation was associated with increased risk of long-term and very late ScT compared to current-generation metallic DES. The risk of ScT occurred with a rising trend beyond one year.
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Affiliation(s)
- Si-Hyuck Kang
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
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Goel S, Pasam RT, Chava S, Sharma A, Malik BA, Ayzenberg S, Frankel R, Shani J, Gidwani U. Three to four years outcomes of the absorb bioresorbable vascular scaffold versus second‐generation drug‐eluting stent: A meta‐analysis. Catheter Cardiovasc Interv 2019; 95:216-223. [DOI: 10.1002/ccd.28290] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/07/2019] [Accepted: 04/04/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Sunny Goel
- Department of CardiologyMaimonides Medical Center Brooklyn New York
| | - Ravi Teja Pasam
- Department of CardiologyMaimonides Medical Center Brooklyn New York
| | - Srilekha Chava
- Department of CardiologyMaimonides Medical Center Brooklyn New York
| | - Abhishek Sharma
- Department of CardiologyRush University Medical Center Chicago Illinois
| | | | - Sergey Ayzenberg
- Department of CardiologyMaimonides Medical Center Brooklyn New York
| | - Robert Frankel
- Department of CardiologyMaimonides Medical Center Brooklyn New York
| | - Jacob Shani
- Department of CardiologyMaimonides Medical Center Brooklyn New York
| | - Umesh Gidwani
- Department of CardiologyIcahn School of Medicine at Mount Sinai New York New York
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Mahtta D, Elgendy IY. Everolimus-eluting bioresorbable vascular scaffolds: learning from the past to improve the future. Minerva Cardioangiol 2019; 67:288-305. [PMID: 30895764 DOI: 10.23736/s0026-4725.19.04900-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Bioresorbable vascular scaffolds (BVS) were developed to overcome the long-term limitations of metallic drug-eluting stents (DES). Shortcomings of DES include their permanent metallic cage which prevents normal coronary vasomotion, vascular remodeling, precludes future bypass grafting, and creates a nidus for very late stent thrombosis. With its transient scaffold which provides early mechanical support and subsequently resorbs thereby restoring physiologic properties and architecture of the vasculature, BVS offers a promising development within the field of interventional cardiology. Even though various BVS have been or are currently under development, the ABSORB BVS from Abbott Vascular was the first FDA approved device. In this review, we shed light on shortcomings of the current generation DES and theoretical advantages of BVS. In addition, we will discuss in detail clinical data from observational studies, meta-analyses, registries, and randomized controlled trials as it pertains to the efficacy and safety outcomes with everolimus-eluting BVS as compared to the current generation everolimus-eluting metallic stents (EES). We will summarize reasons behind the disappointing results from clinical trials and the failure of first generation BVS leading to its withdrawal from the market. Lastly, we will briefly review ongoing developments with the newer-generation BVS and future pre-clinical and clinical studies that are underway to evaluate the efficacy and safety of second-generation BVS.
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Affiliation(s)
- Dhruv Mahtta
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA -
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Predictors of bioresorbable scaffold failure in STEMI patients at 3 years follow-up. Int J Cardiol 2019; 268:68-74. [PMID: 30041805 DOI: 10.1016/j.ijcard.2018.04.081] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 04/10/2018] [Accepted: 04/18/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Little data are available on the long-term outcomes of bioresorbable scaffold (BRS) in the setting of ST-segment elevation myocardial infarction (STEMI). The aim of this study is to investigate three-years outcomes and predictors of BRS failure in patients presenting with STEMI. METHODS AND RESULTS Two prospective, single-arm registries were pooled. Incidence and predictors of clinical outcome were assessed with Kaplan-Meier and Cox regression analyses. From May-2012 to January-2015, 183 STEMI patients (58 ± 13 years, 77% males, 29% diabetics) who received a total of 256 BRS (1.4 ± 0.8 per patient) were included. 248 patients (65 ± 11 years, 74% males, 27% diabetics) treated for stable coronary artery disease (SCAD) served as control. 3-years follow-up was available in 386 (90%) patients. Device-oriented composite endpoint and scaffold thrombosis (ScT) rates were similar in the two groups (STEMI: 11.5% vs SCAD: 12.9%, P = 0.84; STEMI: 3.6% vs SCAD: 3.3%, P = 0.90). While early ScT was more frequent in SCAD patients, late/very late ScT was a feature of STEMI. While in STEMI patients the incidence of ScT was higher in vessels with RVD > 3.5 mm, a RVD < 2.5 mm was a predictor of events in stable patients. Similarly, BRS undersizing predicted events in STEMI patients, while oversizing was a predictor in stable ones. Finally, the incidence of ScT was reduced in both STEMI and stable patients (from 6.3% to 0% and from 5.80% to 0.9%) when an optimized implantation technique was used. CONCLUSIONS The incidence of events for three years follow-up was similar in STEMI and SCAD patients, although different timing and features underlie ScT in the two groups.
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Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, Byrne RA, Collet JP, Falk V, Head SJ, Jüni P, Kastrati A, Koller A, Kristensen SD, Niebauer J, Richter DJ, Seferović PM, Sibbing D, Stefanini GG, Windecker S, Yadav R, Zembala MO. 2018 ESC/EACTS Guidelines on myocardial revascularization. EUROINTERVENTION 2019; 14:1435-1534. [PMID: 30667361 DOI: 10.4244/eijy19m01_01] [Citation(s) in RCA: 310] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Franz-Josef Neumann
- Department of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
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Reichart C, Wöhrle J, Markovic S, Rottbauer W, Seeger J. Clinical results of bioresorbable drug-eluting scaffolds in short and long coronary artery lesions using the PSP technique. BMC Cardiovasc Disord 2019; 19:22. [PMID: 30658574 PMCID: PMC6339442 DOI: 10.1186/s12872-018-0994-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 12/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Data on bioresorbable vascular scaffolds (BVS) for the treatment of long lesions are limited. We studied the use of BVS-Absorb in routine clinical practice and compared the outcome of long lesions with short lesions. Implantation of drug-eluting scaffolds without PSP-technique (predilation, proper sizing and postdilation) is associated with an increased thrombotic risk. We compared the long-term outcome up to 36 months of patients with short (< 20 mm) and long (≥20 mm) coronary artery lesions after implantation of bioresorbable vascular scaffolds (BVS) via PSP-technique. METHODS Three hundred twenty-six patients with 424 lesions were enrolled in this prospective study and underwent percutaneous coronary intervention with the Absorb BVS. Clinical follow-up was scheduled after 12, 24 and 36 months. In all lesions the PSP-technique was used. The device oriented composite endpoint (DOCE) was defined as cardiac death, myocardial infarction (MI) not clearly related to a non-target vessel and target lesion revascularization (TLR). RESULTS Kaplan-Meier estimates for DOCE after 12 months were 2.63% for short lesions and 8.09% for long lesions (p = 0.0131), 5.51% vs. 11.35% (p = 0.0503) after 24 months and 8.00% vs. 18.00% (p = 0.0264) after 36 months of clinical follow-up. Kaplan-Meier estimates for TLR after 12 months were 1.46% for short and 7.69% for long lesions (p = 0.0012), 2.06% vs. 8.75% after 24 months (p = 0.0027) and 4.96% vs. 9.59% after 36 months of follow-up (p = 0.0109). Scaffold thrombosis rates were low. CONCLUSIONS In long lesions compared to short ones the bioresorbable scaffold Absorb implanted with the proper PSP technique Absorb has significant higher rates of DOCE. THE LEVEL OF EVIDENCE Is 3 (non-random sample).
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Affiliation(s)
- Christine Reichart
- Department of Internal Medicine II, University Hospital of Ulm, Ulm, Germany
| | - Jochen Wöhrle
- Head Interventional Cardiology Research Group, University Hospital of Ulm, Albert-Einstein-Allee, 23 89081, Ulm, Germany.
| | - Sinisa Markovic
- Department of Internal Medicine II, University Hospital of Ulm, Ulm, Germany
| | - Wolfgang Rottbauer
- Department of Internal Medicine II, University Hospital of Ulm, Ulm, Germany
| | - Julia Seeger
- Department of Internal Medicine II, University Hospital of Ulm, Ulm, Germany
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Vakkosov KM, Kochergin NA, Kozyrin KA, Ganjukov VI. Bioresorbable Vascular Scaffold Compared With Minimally Invasive Bypass Surgery for the Left Anterior Descending Coronary Artery Disease: 12-Month Follow up. ACTA ACUST UNITED AC 2018; 58:30-35. [PMID: 30625094 DOI: 10.18087/cardio.2018.12.10165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 12/25/2018] [Indexed: 11/18/2022]
Abstract
THE AIM Evaluates long-term clinical outcomes of percutaneous coronary intervention (PCI) with bioresorbable vascular scaffold (BVS) versus minimally invasive direct coronary artery bypass (MIDCAB) surgery for the treatment of left anterior descending (LAD) lesions. METHODS AND RESULTS In this single-center study were included 130 patients with stable angina and significant (≥ 70 %) LAD disease. Patients were randomly assigned in a 1:1 ratio to PCI with everolimus-eluting BVS (n=65) or MIDCAB (n=65). The primary end-point was major adverse cerebro-cardiovascular events (MACCE) and secondary was scaffold (graft) thrombosis at 1 year. The groups of patients were comparable for all baseline demographic, clinical and angiographic parameters. MACCE at 12 month occurred in 9.2 % of patients in the BVS group and in 4.6 % of patients in the MIDCAB group (p=0.3). There was no significant difference between the groups in rates of all cause death (1.5 % vs 1.5 %, p=1.0), myocardial infarction (3.1 % vs. 6.1 %, p=0.4), any revascularization (1.5 % vs. 6.1 %, p=0.1) and scaffold (graft) thrombosis (1.5 % vs. 1.5 %, p=1.00). CONCLUSION At 12-month follow up, there was no significant difference in the rate of MACCE between PCI by BVS and MIDCAB in patients with isolated LAD lesions.
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Affiliation(s)
- K M Vakkosov
- Research Institute for Complex Issues of Cardiovascular Diseases.
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Qiu TY, Zhao LG, Song M. A Computational Study of Mechanical Performance of Bioresorbable Polymeric Stents with Design Variations. Cardiovasc Eng Technol 2018; 10:46-60. [DOI: 10.1007/s13239-018-00397-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 11/30/2018] [Indexed: 10/27/2022]
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Colombo A, Giannini F. Encouraging data from ABSORB IV pave the way to new scaffolds. Lancet 2018; 392:1490-1491. [PMID: 30266413 DOI: 10.1016/s0140-6736(18)32319-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 09/14/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Antonio Colombo
- EMO-GVM Centro Cuore Columbus, 20145 Milan, Italy; Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.
| | - Francesco Giannini
- EMO-GVM Centro Cuore Columbus, 20145 Milan, Italy; Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
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Tanabe K, Popma JJ, Kozuma K, Saito S, Muramatsu T, Nakamura S, Namiki A, Morino Y, Hagiwara N, Uematsu M, Kawasaki T, Fujii K, Serruys PW, Onuma Y, Ying S, Kusano H, Stone GW, Kimura T. Multislice computed tomography assessment of everolimus-eluting Absorb bioresorbable scaffolds in comparison with metallic drug-eluting stents from the ABSORB Japan randomised trial. EUROINTERVENTION 2018; 14:e1020-e1028. [PMID: 29131799 DOI: 10.4244/eij-d-17-00716] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Blooming artefacts limit accurate coronary assessment by multislice computed tomography (MSCT) in metallic stents. We sought to investigate whether bioresorbable vascular scaffolds (BVS) could be better assessed by MSCT. METHODS AND RESULTS Among 400 patients in the randomised ABSORB Japan trial, a pre-specified MSCT substudy was performed in 98 patients (103 lesions) in the BVS arm and 49 patients (49 lesions) in the cobalt-chromium everolimus-eluting stent (CoCr-EES) arm at 13 months prior to follow-up angiography. The assessability of BVS by MSCT was superior to that of CoCr-EES (94% versus 67%, p<0.001). Blooming artefacts were the main reason CoCr-EES could not be analysed (29%), while marker artefacts precluded analysis in 1.1% of BVS. In the CoCr-EES arm, non-assessable lesions were more prevalent in segments with 2.5 mm stents compared to 3.0 or 3.5 mm stents (75.0% versus 23.5%, p=0.01), while in the BVS arm image quality was good regardless of the diameter. The in-device minimal lumen diameter by MSCT was smaller than that by QCA with a difference of 0.61 mm in the CoCr-EES arm, vs. only 0.026 mm in the BVS arm. CONCLUSIONS The feasibility of MSCT assessment of BVS-treated lesions was greater than that for lesions with CoCr-EES.
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Chen D, Su Z, Weng L, Cao L, Chen C, Zeng S, Zhang S, Wu T, Hu Q, Xiao J. Effect of inflammation on endothelial cells induced by poly-L-lactic acid degradation in vitro and in vivo. JOURNAL OF BIOMATERIALS SCIENCE-POLYMER EDITION 2018; 29:1909-1919. [PMID: 30173602 DOI: 10.1080/09205063.2018.1517858] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Dongping Chen
- Central Laboratory, The Dongguan Affiliated Hospital of Medical College of Jinan University, The Fifth People's Hospital of Dongguan, Dongguan, China
| | - Zhaobing Su
- Department of Cardiology, The Dongguan Affiliated Hospital of Medical College of Jinan University, The Fifth People's Hospital of Dongguan, Dongguan, China
| | - Linsheng Weng
- Department of Cardiology, The Dongguan Affiliated Hospital of Medical College of Jinan University, The Fifth People's Hospital of Dongguan, Dongguan, China
| | - Longbin Cao
- Central Laboratory, The Dongguan Affiliated Hospital of Medical College of Jinan University, The Fifth People's Hospital of Dongguan, Dongguan, China
| | - Can Chen
- Department of Pathology, The Dongguan Affiliated Hospital of Medical College of Jinan University, The Fifth People's Hospital of Dongguan, Dongguan, China
| | - Sufen Zeng
- Central Laboratory, The Dongguan Affiliated Hospital of Medical College of Jinan University, The Fifth People's Hospital of Dongguan, Dongguan, China
| | - Suzhen Zhang
- Central Laboratory, The Dongguan Affiliated Hospital of Medical College of Jinan University, The Fifth People's Hospital of Dongguan, Dongguan, China
| | - Tim Wu
- Dongguan TT Medical, Inc, Dongguan, China
- Vaso Tech, Inc. Lowell, MA, USA
| | - Qiang Hu
- Dongguan TT Medical, Inc, Dongguan, China
| | - Jianmin Xiao
- Central Laboratory, The Dongguan Affiliated Hospital of Medical College of Jinan University, The Fifth People's Hospital of Dongguan, Dongguan, China
- Department of Cardiology, The Dongguan Affiliated Hospital of Medical College of Jinan University, The Fifth People's Hospital of Dongguan, Dongguan, China
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Costa JR, Abizaid A, Whitbourn R, Serruys PW, Jepson N, Steinwender C, Stuteville M, Ediebah D, Sudhir K, Bartorelli AL. Three-year clinical outcomes of patients treated with everolimus-eluting bioresorbable vascular scaffolds: Final results of the ABSORB EXTEND trial. Catheter Cardiovasc Interv 2018; 93:E1-E7. [PMID: 30286520 DOI: 10.1002/ccd.27715] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 05/21/2018] [Accepted: 06/10/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND There is still limited data on the very long term clinical outcomes after ABSORB BRS in daily practice. We sought to evaluate the 3 year-performance of the Absorb bioresorbable vascular scaffolds for the treatment of low/moderate complexity patients enrolled in the ABSORB EXTEND trial. METHODS ABSORB EXTEND is a prospective, single-arm, open-label clinical study in which 812 patients were enrolled at 56 sites. This study allowed the treatment of lesions ≤28 mm in length and reference vessel diameter of 2.0-3.8 mm (as assessed by on-line QCA). To determine the independent predictors of MACE, a multivariable logistic regression model was built using a stepwise (forward/backward) procedure. RESULTS Average population age was 61 years and 26.5% had diabetes. Most patients had single target lesion (92.4%). Adequate scaffold deployment (PSP) was achieved in 14.2% of the cases. At three years, the composite endpoints of MACE and ischemia-driven target vessel failure were 9.2% and 10.6%, respectively. The cumulative rate of ARC definite/probable thrombosis was 2.2%, with 1.2% of the cases occurring after the 1st year. Independent predictors of MACE were hypertension and the need for "bail out" stent. CONCLUSION At three-year follow-up, the use of ABSORB in low/moderate complex PCI was associated with low and acceptable rates of major adverse clinical events, despite the infrequent use of the recommended contemporary scaffold deployment technique. However, scaffold thrombosis rate was higher than reported with current generation of metallic DES. The study is registered on clinicaltrials.gov (unique identifier NCT01023789).
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Affiliation(s)
| | | | | | - Patrick W Serruys
- Thoraxcenter Erasmus University Medical Center, Rotterdam, The Netherlands
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Al Nooryani A, Elabbassi WN, AlBaba B, Kerfes JA, Abudaqa LM, Bhatia A, Abdelrahman NA, Boskovic N, Beleslin B. Long-term outcome of first 300 implanted Absorb bioresorbable vascular scaffolds in an all-comers Middle East population. J Int Med Res 2018; 47:173-187. [PMID: 30235969 PMCID: PMC6384459 DOI: 10.1177/0300060518798994] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives To evaluate long-term clinical outcomes of the Absorb bioresorbable vascular scaffold (BVS) system (Abbott Vascular) in an all-comers Middle East population. Methods This prospective registry study included an initial set of patients with coronary lesions treated using Absorb BVS. Patients were followed for target vessel failure (TVF) including cardiac death, target vessel myocardial infarction (MI), and target lesion revascularization. Results A total of 217 patients (age, 55 ± 11 years; male, 169) with 300 treated lesions were included (median follow-up, 36 months [range, 26–41 months]; complete follow-up, 201 patients). Diabetes mellitus and acute coronary syndrome were present in 50% and 57% of patients, respectively. TVF rate was 32/201 (15.9%), including cardiac death in 10 (5%), target vessel MI in 13 (6.5%), and target lesion revascularization in 22 patients (10.9%). Definite or probable device thrombosis occurred in 11/201 patients (5.5%). TVF was associated with heart failure, worse ejection fraction, multi-vessel BVS, multi BVS in lesion, and total BVS length >50 mm. Conclusions Long-term outcome following Absorb BVS implantation in a population with high prevalence of high-risk and complex patients is acceptable, but heart failure, worse ejection fraction, and multi-vessel or long BVS implantation were associated with worse outcomes.
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Affiliation(s)
- Arif Al Nooryani
- 1 Cardiology Department, Al Qassimi Hospital, Sharjah, United Arab Emirates
| | - Wael N Elabbassi
- 1 Cardiology Department, Al Qassimi Hospital, Sharjah, United Arab Emirates
| | - Bassam AlBaba
- 1 Cardiology Department, Al Qassimi Hospital, Sharjah, United Arab Emirates
| | - Jalal A Kerfes
- 1 Cardiology Department, Al Qassimi Hospital, Sharjah, United Arab Emirates
| | - Loai M Abudaqa
- 1 Cardiology Department, Al Qassimi Hospital, Sharjah, United Arab Emirates
| | - Amit Bhatia
- 1 Cardiology Department, Al Qassimi Hospital, Sharjah, United Arab Emirates
| | | | - Nikola Boskovic
- 2 Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Branko Beleslin
- 2 Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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71
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Lüscher TF. Acute and chronic coronary syndromes: coronary dissection, intraplaque haemorrhage, and late lumen loss. Eur Heart J 2018; 39:3339-3342. [DOI: 10.1093/eurheartj/ehy589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Thomas F Lüscher
- Consultant and Director of Research, Education & Development, Royal Brompton and Harefield Hospital Trust and Imperial College, London, UK
- Chairman, Center for Molecular Cardiology, University of Zurich, Switzerland
- Editor-in-Chief, EHJ Editorial Office, Zurich Heart House, Hottingerstreet 14, Zurich, Switzerland
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Varcoe RL, Thomas SD, Lennox AF. Three-Year Results of the Absorb Everolimus-Eluting Bioresorbable Vascular Scaffold in Infrapopliteal Arteries. J Endovasc Ther 2018; 25:694-701. [DOI: 10.1177/1526602818799736] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To investigate the midterm performance of the everolimus-eluting Absorb bioresorbable vascular scaffold (BVS) for the treatment of symptomatic infrapopliteal atherosclerotic disease. Methods: A single-center study prospectively enrolled 48 symptomatic patients (mean age 82.1±8.0 years; 27 men) between September 2013 and February 2018 to evaluate the Absorb everolimus-eluting BVS system in distal popliteal and tibial lesions. Mean lesion length was 20.1±10.8 mm. Following predilation, up to 2 BVS were implanted in target lesions in 55 limbs. Clinical and duplex ultrasound follow-up was performed at 1, 3, 6, 12, 24, 36, and 48 months to determine 30-day morbidity and midterm Kaplan-Meier estimates of binary restenosis, clinically-driven target lesion revascularization (CD-TLR), amputation, and mortality. Results: Seventy-one scaffolds were implanted to treat 61 lesions. Technical success was achieved in all patients, with no amputation, death, or target limb bypass surgery within 30 days of the index procedure. There was 1 early thrombotic occlusion of 2 BVS in a previously anticoagulated patient not given antiplatelet medication after the procedure. During a mean follow-up of 24.0±15.3 months, 11 (23%) patients died; the remaining 37 were available for follow-up. Binary restenosis (50%–75%) was detected in 6 (8%) scaffolds. Primary patency estimates at 12, 24, and 36 months were 92.2%, 90.3%, and 81.1%; freedom from CD-TLR estimates were 97.2%, 97.2%, and 87.3% at the same time points. No late scaffold thrombosis has been observed. The majority of the 55 limbs (51, 93%) were clinically improved; 4 (7%) were unchanged. Thirty-six (92%) of 39 limbs treated for tissue loss achieved complete wound healing, with no major amputation (limb salvage 100%). Conclusion: Midterm follow-up demonstrates excellent safety, patency, and freedom from CD-TLR rates using the Absorb bioresorbable vascular scaffold below the knee.
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Affiliation(s)
- Ramon L. Varcoe
- Department of Surgery, Prince of Wales Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- The Vascular Institute, Prince of Wales, Sydney, New South Wales, Australia
| | - Shannon D. Thomas
- Department of Surgery, Prince of Wales Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- The Vascular Institute, Prince of Wales, Sydney, New South Wales, Australia
| | - Andrew F. Lennox
- Department of Surgery, Prince of Wales Hospital, Sydney, New South Wales, Australia
- The Vascular Institute, Prince of Wales, Sydney, New South Wales, Australia
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73
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DeRubertis BG, Kum S, Varcoe RL. The Demise of the Absorb BVS: Lessons Learned From the Discontinuation of a Disappearing Stent. J Endovasc Ther 2018; 25:706-709. [DOI: 10.1177/1526602818799735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Brian G. DeRubertis
- Division of Vascular and Endovascular Surgery, University of California Los Angeles, CA, USA
| | - Steven Kum
- Vascular Service, Department of Surgery, Changi General Hospital, Singapore
| | - Ramon L. Varcoe
- Department of Surgery, Prince of Wales Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- The Vascular Institute, Prince of Wales, Sydney, New South Wales, Australia
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Borhani S, Hassanajili S, Ahmadi Tafti SH, Rabbani S. Cardiovascular stents: overview, evolution, and next generation. Prog Biomater 2018; 7:175-205. [PMID: 30203125 PMCID: PMC6173682 DOI: 10.1007/s40204-018-0097-y] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 08/25/2018] [Indexed: 12/01/2022] Open
Abstract
Compared to bare-metal stents (BMSs), drug-eluting stents (DESs) have been regarded as a revolutionary change in coronary artery diseases (CADs). Releasing pharmaceutical agents from the stent surface was a promising progress in the realm of cardiovascular stents. Despite supreme advantages over BMSs, in-stent restenosis (ISR) and long-term safety of DESs are still deemed ongoing concerns over clinically application of DESs. The failure of DESs for long-term clinical use is associated with following factors including permanent polymeric coating materials, metallic stent platforms, non-optimal drug releasing condition, and factors that have recently been supposed as contributory factors such as degradation products of polymers, metal ions due to erosion and degradation of metals and their alloys utilizing in some stents as metal frameworks. Discovering the direct relation between stent materials and associating adverse effects is a complicated process, and yet it has not been resolved. For clinical success it is of significant importance to optimize DES design and explore novel strategies to overcome all problems including inflammatory response, delay endothelialization, and sub-acute stent thrombosis (ST) simultaneously. In this work, scientific reports are reviewed particularly focusing on recent advancements in DES design which covers both potential improvements of existing and recently novel prototype stent fabrications. Covering a wide range of information from the BMSs to recent advancement, this study mostly sheds light on DES's concepts, namely stent composition, drug release mechanism, and coating techniques. This review further reports different forms of DES including fully biodegradable DESs, shape-memory ones, and polymer-free DESs.
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Affiliation(s)
- Setareh Borhani
- Department of Chemical Engineering, School of Chemical and Petroleum Engineering, Shiraz University, Shiraz, Iran
| | - Shadi Hassanajili
- Department of Nanochemical Engineering, School of New Science and Technology, Shiraz University, Shiraz, Iran.
| | - Seyed Hossein Ahmadi Tafti
- Research Center for Advanced Technologies in Cardiovascular Medicine, Tehran Heart Center, Tehran University of Medical Sciences, North Kargar, Tehran, Iran
| | - Shahram Rabbani
- Research Center for Advanced Technologies in Cardiovascular Medicine, Tehran Heart Center, Tehran University of Medical Sciences, North Kargar, Tehran, Iran
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Kwon O, Ahn JM, Kang DY, Kang SH, Lee PH, Kang SJ, Lee SW, Kim YH, Lee CW, Park SW, Park DW, Park SJ. Early experience and favorable clinical outcomes of everolimus-eluting bioresorbable scaffolds for coronary artery disease in Korea. Korean J Intern Med 2018; 33:922-932. [PMID: 29108400 PMCID: PMC6129626 DOI: 10.3904/kjim.2016.368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 03/27/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND/AIMS Compared with metallic drug-eluting stents (DES), bioresorbable vascular scaffolds (BVS) may further improve long-term outcomes of percutaneous coronary intervention (PCI) in patients with coronary artery disease. We report our early experience with BVS in Korea. METHODS We evaluated 105 consecutive patients with BVS implanted at Asan Medical Center, Korea between October 21, 2015 and June 3, 2016. Angiographic results, and in-hospital and 6-month clinical outcomes were assessed. RESULTS A total of 134 BVS were implanted to treat 115 lesions. The mean age was 62 ± 10.5 years; 85 patients (81%) were males, 26 patients (25%) were presented with acute coronary syndrome. Among 115 lesions treated with BVS, 76 (66.1%) were B2/C type, 27 (23.5%) were bifurcation lesions, and four (3.5%) were chronic total occlusion. Pre-dilation and post-dilation using high-pressure non-compliant balloon was performed in 104 lesions (90.4%) and 113 lesions (98.2%), respectively. During the procedure, intravascular imaging was used for all patients (100%; intravascular ultrasound 89 and optical coherence tomography 40 patients). Device success rate was 100%. In-segment and in-scaffold acute again were 1.1 ± 0.6 and 1.3 ± 0.5 mm, respectively. Periprocedural myocardial infraction occurred in four patients (3.8%). No deaths, stent thrombosis, or urgent revascularizations occurred either during hospitalization or the follow-up period. CONCLUSION In this single-center experience, implantation of BVS with intravascular imaging support was feasible and early clinical outcomes were excellent. Evaluation of long-term efficacy and safety of BVS and its feasibility in clinical use for a broader range of lesions is warranted.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Duk-Woo Park
- Correspondence to Duk-Woo Park, M.D. Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea Tel: +82-2-3010-3995 Fax: +82-2-475-6898 E-mail:
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Sousa-Uva M, Neumann FJ, Ahlsson A, Alfonso F, Banning AP, Benedetto U, Byrne RA, Collet JP, Falk V, Head SJ, Jüni P, Kastrati A, Koller A, Kristensen SD, Niebauer J, Richter DJ, Seferovic PM, Sibbing D, Stefanini GG, Windecker S, Yadav R, Zembala MO. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur J Cardiothorac Surg 2018; 55:4-90. [PMID: 30165632 DOI: 10.1093/ejcts/ezy289] [Citation(s) in RCA: 347] [Impact Index Per Article: 57.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Grimfjärd P, James S, Persson J, Angerås O, Koul S, Omerovic E, Varenhorst C, Lagerqvist B, Erlinge D. Outcome of percutaneous coronary intervention with the Absorb bioresorbable scaffold: data from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). EUROINTERVENTION 2018; 13:1303-1310. [PMID: 28781242 DOI: 10.4244/eij-d-17-00458] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Randomised trials indicate higher rates of stent thrombosis (ST) and target lesion failure (TLF) after percutaneous coronary intervention (PCI) with the Absorb bioresorbable scaffold (BRS) compared with modern drug-eluting stents (DES). We aimed to investigate the outcome of all Swedish patients treated with the Absorb BRS. METHODS AND RESULTS The Absorb BRS (n=810) was compared with commonly used modern DES (n=67,909). The main outcome measure was definite ST; mean follow-up was two years. Despite being implanted in a younger, lower-risk population compared with modern DES, the Absorb BRS was associated with a higher crude incidence of definite ST at stent level: 1.5 vs. 0.6%, hazard ratio (HR) 2.38 (95% confidence interval [CI]: 1.34-4.23), adjusted HR 4.34 (95% CI: 2.37-7.94); p<0.001. The patient level adjusted HR was 4.44 (95% CI: 2.25-8.77). Rates of in-stent restenosis were similar for BRS and DES. Non-compliance with dual antiplatelet therapy (DAPT) guidelines was noted in six out of 12 BRS ST events. Three very late ST events occurred with the Absorb BRS. CONCLUSIONS In this real-world observational study, the Absorb BRS was associated with a significantly higher risk of definite ST compared with modern DES. Non-compliance with DAPT guideline recommendations was common among Absorb definite ST events.
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Affiliation(s)
- Per Grimfjärd
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
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Xu B, Yang Y, Han Y, Huo Y, Wang L, Qi X, Li J, Chen Y, Kuo HC, Ying SW, Cheong WF, Zhang Y, Su X, Popma JJ, Gao R, Stone GW. Comparison of everolimus-eluting bioresorbable vascular scaffolds and metallic stents: three-year clinical outcomes from the ABSORB China randomised trial. EUROINTERVENTION 2018; 14:e554-e561. [DOI: 10.4244/eij-d-17-00796] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Tijssen RYG, Kraak RP, Elias J, van Dongen IM, Kalkman DN, Nassif M, Sotomi Y, Asano T, Katagiri Y, Collet C, Piek JJ, Henriques JPS, de Winter RJ, Tijssen JGP, Onuma Y, Serruys PW, Wykrzykowska JJ. Implantation techniques (predilatation, sizing, and post-dilatation) and the incidence of scaffold thrombosis and revascularisation in lesions treated with an everolimus-eluting bioresorbable vascular scaffold: insights from the AIDA trial. EUROINTERVENTION 2018; 14:e434-e442. [PMID: 29688175 DOI: 10.4244/eij-d-17-01152] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Specific implantation strategies have been proposed for the Absorb bioresorbable vascular scaffold (Absorb BVS) to optimise outcomes. We aimed to analyse whether the occurrence of definite scaffold thrombosis (ScT) and target lesion revascularisation (TLR) in Absorb-treated AIDA patients was influenced by scaffold implantation techniques. METHODS AND RESULTS Absorb BVS implantation in 1,074 lesions was graded according to definitions of optimal implantation based on predilatation, sizing, and post-dilatation (PSP). Lesion-oriented outcomes (definite ScT and TLR) that occurred during a median follow-up of 707 days were related to the presence or absence of PSP. Of 1,074 lesions, 158 (14.7%) lesions met PSP criteria. The most prevalent reason for not meeting PSP criteria was inadequate sizing: 863 (94.2%). Definite ScT occurred in four of 158 PSP-treated lesions compared with 27 of 916 non PSP-treated lesions, with two-year KM estimates of 3.0% vs. 4.1% and an HR of 1.14 (p=0.811). TLR occurred in eight of 158 PSP-treated lesions compared with 61 of 916 non PSP-treated lesions, with KM estimates of 5.6% vs. 7.1% and an HR of 1.29 (p=0.492). CONCLUSIONS In AIDA, lesions that underwent scaffold implantation according to an optimised Absorb BVS implantation technique did not have lower rates of ScT and TLR compared to scaffold-treated lesions that did not meet PSP criteria.
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Affiliation(s)
- Ruben Yannick G Tijssen
- AMC Heartcenter, Academic Medical Center - University of Amsterdam, Amsterdam, the Netherlands
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Tijssen RYG, Kraak RP, Hofma SH, van der Schaaf RJ, Arkenbout EK, Weevers A, Elias J, van Dongen IM, Koch KT, Baan J, Vis M, de Winter RJ, Piek JJ, Tijssen JG, Henriques JP, Wykrzykowska JJ. Complete two-year follow-up with formal non-inferiority testing on primary outcomes of the AIDA trial comparing the Absorb bioresorbable scaffold with the XIENCE drug-eluting metallic stent in routine PCI. EUROINTERVENTION 2018; 14:e426-e433. [DOI: 10.4244/eij-d-18-00335] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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De Rosa R, Silverio A, Varricchio A, De Luca G, Di Maio M, Radano I, Belmonte M, De Angelis MC, Moscarella E, Citro R, Piscione F, Galasso G. Meta-Analysis Comparing Outcomes After Everolimus-Eluting Bioresorbable Vascular Scaffolds Versus Everolimus-Eluting Metallic Stents in Patients with Acute Coronary Syndromes. Am J Cardiol 2018; 122:61-68. [PMID: 29699747 DOI: 10.1016/j.amjcard.2018.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 03/06/2018] [Accepted: 03/13/2018] [Indexed: 11/24/2022]
Abstract
Acute coronary syndromes (ACS) may represent an intriguing clinical scenario for implantation of bioresorbable vascular scaffold (BRS). Nevertheless, the knowledge about the performance of these devices in patients with ACS is limited. Therefore, we performed a meta-analysis of clinical studies aiming to assess the safety and efficacy of everolimus-eluting-BRS versus everolimus-eluting-metallic stents (EES) in ACS patients undergoing percutaneous coronary intervention. Six studies enrolling 2,318 patients were included and analyzed for the risk of primary safety outcome (stent or scaffold thrombosis [ST/ScT]), primary efficacy outcome (target lesion revascularisation [TLR]), and secondary outcomes (myocardial infarction, cardiac death, all-cause death). Median follow-up was 9.5 (6 to 19.5) months. Patients treated with BRS had a significantly higher risk of definite ST/ScT compared with those receiving EES (2.3% vs 1.08%, odds ratio [OR] 2.22, 95% confidence interval [CI] 1.10 to 4.45, p = 0.03, I2 = 0%). Similarly, the risk of TLR was significantly higher in the BRS compared with EES group (3.5% vs 2.5%, OR 1.79, 95% CI 1.02 to 3.16, p = 0.04, I2 = 0%). When TLRs due to thrombosis were excluded, the difference in risk estimates between the 2 groups was no longer significant (OR 1.19, 95% CI 0.48 to 2.98, p = 0.71, I2 = 25%). Risk for secondary endpoints did not differ between the 2 groups. Results were confirmed when clinical and procedural variables were tested as potential effect modifiers in the meta-regression analysis for both primary endpoints. In conclusion, compared with those receiving EES, patients with ACS treated with BRS had increased risk of definite device thrombosis and TLR at mid-term follow-up.
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Yamaji K, Kimura T. COMBO dual-therapy stent: non-inferior to drug-eluting stents or stepping back to bare metal stents? Eur Heart J 2018; 39:2469-2471. [DOI: 10.1093/eurheartj/ehy351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kyohei Yamaji
- Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, Japan
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Orlik B, Milewski K, Derbisz K, Jelonek M, Chrząszcz P, Beil S, Młodziankowski A, Picheta W, Buszman PP, Buszman PE. Comparison of the Absorb bioresorbable vascular scaffold to the Xience durable polymer everolimus-eluting metallic stent in routine clinical practice: a propensity score-matched analysis from a multicenter registry. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2018; 14:149-156. [PMID: 30008767 PMCID: PMC6041836 DOI: 10.5114/aic.2018.76406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 03/15/2018] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Most clinical trials related to bioresorbable vascular scaffold (BVS) technology are limited to a highly selected patient population. AIM To evaluate early and long-term clinical outcomes of the Absorb everolimus-eluting BVS compared to the everolimus-eluting metallic XIENCE V stent in routine clinical practice. MATERIAL AND METHODS This is a multicenter, retrospective propensity score-matched comparative study, comprising 76 patients treated with a bare metal stents (BMS) and 501 with a XIENCE stent. Patients included in the study had stable and unstable angina and both types of myocardial infarction (STEMI and NSTEMI) as an indication for intervention and at least one significant de novo lesion in native coronary arteries. The primary endpoint was major adverse cardiovascular event (MACE), defined as death, myocardial infarction (MI), or target vessel revascularization (TVR). RESULTS Median follow-up was 400 days in both groups. After propensity score matching for patient baseline characteristics, only higher rate of predilatation, predominantly treated left anterior descending artery (LAD) and lower number of used stents in the BVS group remained statistically significant. After adjustment there was no difference in type of treated lesions. The MACE rate did not differ between BVS and drug-eluting stents (DES) groups (7.2% vs. 11.15%, respectively; p = 0.17). The TVR was 2.9% in both groups. Except in the periprocedural period, there were no deaths or MI in the BVS group. There was no stent thrombosis in either studied group. CONCLUSIONS In routine clinical practice throughout long-term follow-up, clinical outcomes of patients who successfully received the Absorb BVS did not differ from those of patients who received the Xience stent. Longer follow-up data are required to determine whether these findings will persist beyond one year.
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Affiliation(s)
- Bartłomiej Orlik
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
- 10 Department of Invasive Cardiology, Electrophysiology and Electrostimulation, Tychy, Poland
| | - Krzysztof Milewski
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
- 10 Department of Invasive Cardiology, Electrophysiology and Electrostimulation, Tychy, Poland
| | - Kamil Derbisz
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
| | - Michał Jelonek
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
| | - Patrycja Chrząszcz
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
| | - Sonia Beil
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
| | | | - Wojciech Picheta
- Department of Internal Medicine, District Hospital, Myszkow, Poland
| | - Piotr P. Buszman
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
| | - Paweł E. Buszman
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
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Yamaji K, Brugaletta S, Sabaté M, Iñiguez A, Jensen LO, Cequier A, Hofma SH, Christiansen EH, Suttorp M, van Es GA, Sotomi Y, Onuma Y, Serruys PW, Windecker S, Räber L. Effect of Post-Dilatation Following Primary PCI With Everolimus-Eluting Bioresorbable Scaffold Versus Everolimus-Eluting Metallic Stent Implantation: An Angiographic and Optical Coherence Tomography TROFI II Substudy. JACC Cardiovasc Interv 2018; 10:1867-1877. [PMID: 28935079 DOI: 10.1016/j.jcin.2017.07.035] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 07/26/2017] [Accepted: 07/26/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study sought to investigate the effect of post-dilatation on angiographic and intracoronary imaging parameters in the setting of primary percutaneous coronary intervention comparing the everolimus-eluting bioresorbable scaffold (BRS) with the everolimus-eluting metallic stent (EES). BACKGROUND Routine post-dilatation of BRS has been suggested to improve post-procedural angiographic and subsequent device-related clinical outcomes. METHODS In the ABSORB STEMI TROFI II trial, 191 patients with ST-segment elevation myocardial infarction were randomly assigned to treatment with BRS (n = 95) or EES (n = 96). Minimal lumen area and healing score as assessed by optical coherence tomography at 6 months were compared between BRS- and EES-treated patients stratified according to post-dilatation status. RESULTS Primary percutaneous coronary intervention with post-dilatation was performed in 48 (50.5%) BRS- and 25 (25.5%) EES-treated lesions. There were no differences in baseline characteristics and post-procedural minimal lumen diameter between groups. In the BRS group, lesions with post-dilatation were associated with a trend toward a smaller minimal lumen area at 6 months (5.07 ± 1.68 mm2 vs. 5.72 ± 1.77 mm2; p = 0.09) and significantly larger angiographic late lumen loss (0.28 ± 0.34 mm vs. 0.12 ± 0.25 mm; p = 0.02), whereas no difference was observed in the EES arm (5.46 ± 2.18 mm2 vs. 5.55 ± 1.77 mm2; p = 0.85). The neointimal healing score was low and comparable between groups with and without post-dilation (BRS: 1.55 ± 2.61 vs. 1.92 ± 2.17; p = 0.48; EES: 2.50 ± 3.33 vs. 2.90 ± 4.80; p = 0.72). CONCLUSIONS In the setting of selected patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention with BRS or EES, post-dilatation did not translate into larger lumen area or improved arterial healing at follow-up. (ABSORB STEMI: The TROFI II; NCT01986803).
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Affiliation(s)
- Kyohei Yamaji
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Salvatore Brugaletta
- Thorax Institute, University Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Manel Sabaté
- Thorax Institute, University Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | - Gerrit Anne van Es
- Cardialysis B.V., Rotterdam, the Netherlands; European Cardiovascular Research Institute, Rotterdam, the Netherlands
| | - Yohei Sotomi
- The Heart Center, Academic Medical Center, Amsterdam, the Netherlands
| | - Yoshinobu Onuma
- Cardialysis B.V., Rotterdam, the Netherlands; Thorax Centre, Erasmus MC, Rotterdam, the Netherlands
| | - Patrick W Serruys
- International Center for Circulatory Health, NHLI, Imperial College, London, United Kingdom
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Bern, Switzerland.
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
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Collet C, Asano T, Miyazaki Y, Tenekecioglu E, Katagiri Y, Sotomi Y, Cavalcante R, de Winter RJ, Kimura T, Gao R, Puricel S, Cook S, Capodanno D, Onuma Y, Serruys PW. Late thrombotic events after bioresorbable scaffold implantation: a systematic review and meta-analysis of randomized clinical trials. Eur Heart J 2018; 38:2559-2566. [PMID: 28430908 DOI: 10.1093/eurheartj/ehx155] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 03/09/2017] [Indexed: 12/25/2022] Open
Abstract
Aims To compare the long-term safety and efficacy of bioresorbable vascular scaffold (BVS) with everolimus-eluting stent (EES) after percutaneous coronary interventions. Methods and results A systematic review and meta-analysis of randomized clinical trials comparing clinical outcomes of patients treated with BVS and EES with at least 24 months follow-up was performed. Adjusted random-effect model by the Knapp-Hartung method was used to compute odds ratios (OR) and 95% confidence intervals (CI). The primary safety outcome of interest was the risk of definite/probable device thrombosis (DT). The primary efficacy outcome of interest was the risk of target lesion failure (TLF). Five randomized clinical trials (n = 1730) were included. Patients treated with Absorb BVS had a higher risk of definite/probable DT compared with patients treated with EES (OR 2.93, 95%CI 1.37-6.26, P = 0.01). Very late DT (VLDT) occurred in 13 patients [12/996 (1.4%, 95%CI: 0.08-2.5) Absorb BVS vs. 1/701 (0.5%, 95%CI: 0.2-1.6) EES; OR 3.04; 95%CI 1.2-7.68, P = 0.03], 92% of the VLDT in the BVS group occurred in the absence of dual antiplatelet therapy (DAPT). Patients treated with Absorb BVS had a trend towards higher risk of TLF (OR 1.48, 95%CI 0.90-2.42, P = 0.09), driven by a higher risk of target vessel myocardial infarction and ischaemia-driven target lesion revascularization. No difference was found in the risk of cardiac death. Conclusion Compared with EES, the use of Absorb BVS was associated with a higher rate of DT and a trend towards higher risk of TLF. VLDT occurred in 1.4% of the patients, the majority of these events occurred in the absence of DAPT.
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Affiliation(s)
- Carlos Collet
- Department of Cardiology, Academic Medical Center, Universiteit van Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam-Zuidoost, Netherlands
| | - Taku Asano
- Department of Cardiology, Academic Medical Center, Universiteit van Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam-Zuidoost, Netherlands
| | - Yosuke Miyazaki
- Department of Interventional Cardiology, 's-Gravendijkwal 230, 3015 CE Rotterdam, Netherlands
| | - Erhan Tenekecioglu
- Department of Interventional Cardiology, 's-Gravendijkwal 230, 3015 CE Rotterdam, Netherlands
| | - Yuki Katagiri
- Department of Cardiology, Academic Medical Center, Universiteit van Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam-Zuidoost, Netherlands
| | - Yohei Sotomi
- Department of Cardiology, Academic Medical Center, Universiteit van Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam-Zuidoost, Netherlands
| | - Rafael Cavalcante
- Department of Interventional Cardiology, 's-Gravendijkwal 230, 3015 CE Rotterdam, Netherlands
| | - Robbert J de Winter
- Department of Cardiology, Academic Medical Center, Universiteit van Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam-Zuidoost, Netherlands
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Hospital, Shogoin Kawaharacho, Sakyo Ward, Kyoto, Kyoto Prefecture 606-8507, Japan
| | - Runlin Gao
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, 10 Beijing, China
| | - Serban Puricel
- Department of Cardiology, Fribourg University and Hospital, Avenue de l'Europe 20, 1700 Fribourg, Switzerland
| | - Stéphane Cook
- Department of Cardiology, Fribourg University and Hospital, Avenue de l'Europe 20, 1700 Fribourg, Switzerland
| | - Davide Capodanno
- Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Via Salvatore Citelli, 6, 95124 Catania CT, Italy
| | - Yoshinobu Onuma
- Department of Interventional Cardiology, 's-Gravendijkwal 230, 3015 CE Rotterdam, Netherlands
| | - Patrick W Serruys
- Imperial Department of Medicine, Imperial College of London, Kensington, London SW7 2AZ, UK
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86
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Onuma Y, Grundeken MJ, Nakatani S, Asano T, Sotomi Y, Foin N, Ng J, Okamura T, Wykrzykowska JJ, de Winter RJ, van Geuns RJ, Koolen J, Christiansen EH, Whitbourn R, McClean D, Smits P, Windecker S, Ormiston JA, Serruys PW. Serial 5-Year Evaluation of Side Branches Jailed by Bioresorbable Vascular Scaffolds Using 3-Dimensional Optical Coherence Tomography: Insights From the ABSORB Cohort B Trial (A Clinical Evaluation of the Bioabsorbable Everolimus Eluting Coronary Stent System in the Treatment of Patients With De Novo Native Coronary Artery Lesions). Circ Cardiovasc Interv 2018; 10:CIRCINTERVENTIONS.116.004393. [PMID: 28893770 DOI: 10.1161/circinterventions.116.004393] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 07/28/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND The long-term fate of Absorb bioresorbable vascular scaffold (Abbott Vascular, Santa Clara, CA) struts jailing side branch ostia has not been clarified. We therefore evaluate serially (post-procedure and at 6 months, 1, 2, 3, and 5 years) the appearance and fate of jailed Absorb bioresorbable vascular scaffold struts. METHODS AND RESULTS We performed 3-dimensional optical coherence tomographic analysis of the ABSORB Cohort B trial (A Clinical Evaluation of the Bioabsorbable Everolimus Eluting Coronary Stent System in the Treatment of Patients With De Novo Native Coronary Artery Lesions) up to 5 years using a novel, validated cut-plane analysis method. We included 29 patients with a total of 85 side branch ostia. From the 12 ostia which could be assessed in true serial fashion, 7 showed a pattern of initial decrease in the ostial area free from struts, followed by an increase in strut-free ostial area toward the end of the 5 years of follow-up. In a repeated-measures analysis with time as fixed variable and ostial area free from struts as dependent variable, we showed a numeric decrease in the estimated ostial area free from struts from 0.75 mm2 (baseline) to 0.68 mm2 (first follow-up visit at 6 months or 1 year) and 0.63 mm2 (second follow-up visit at 2 or 3 years). However, from the second visit to the 5-year follow-up visit, there was a statistically significant increase from 0.63 to 0.89 mm2 (P=0.001). Struts overlying an ostium divided the ostium into compartments, and the number of these compartments decreased over time. CONCLUSIONS This study showed that in most cases, the side branch ostial area free from struts initially decreased. However, with full scaffold bioresorption, the ostial area free from scaffold increased between 2 to 3 years and 5 years in the vast majority of patients. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00856856.
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Affiliation(s)
- Yoshinobu Onuma
- From the Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands (Y.O., S.N., R.-J.v.G.); Cardialysis, Rotterdam, the Netherlands (Y.O.); Academic Medical Center, University of Amsterdam, the Netherlands (M.J.G., T.A., Y.S., J.J.W., R.J.d.W.); National Heart Centre Singapore (N.F., J.N.); National University of Singapore (J.N.); Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Yamaguchi-Ube, Japan (T.O.); Catharina Ziekenhuis, Eindhoven, the Netherlands (J.K.); Skejby Sygehus, Aarhus, Denmark (E.C.); The Cardiovascular Research Centre, St. Vincents Hospital, Fitzroy, Australia (R.W.); Cardiology Department, Christchurch Hospital, New Zealand (D.M.); Division of Cardiology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (P.S.); Division of Cardiology Swiss Cardiovascular Center, Bern, Switzerland (S.W.); Auckland City Hospital, New Zealand (J.A.O.); and International Center for Circulatory Health NHLI, Imperial College London, United Kingdom (P.W.S.)
| | - Maik J Grundeken
- From the Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands (Y.O., S.N., R.-J.v.G.); Cardialysis, Rotterdam, the Netherlands (Y.O.); Academic Medical Center, University of Amsterdam, the Netherlands (M.J.G., T.A., Y.S., J.J.W., R.J.d.W.); National Heart Centre Singapore (N.F., J.N.); National University of Singapore (J.N.); Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Yamaguchi-Ube, Japan (T.O.); Catharina Ziekenhuis, Eindhoven, the Netherlands (J.K.); Skejby Sygehus, Aarhus, Denmark (E.C.); The Cardiovascular Research Centre, St. Vincents Hospital, Fitzroy, Australia (R.W.); Cardiology Department, Christchurch Hospital, New Zealand (D.M.); Division of Cardiology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (P.S.); Division of Cardiology Swiss Cardiovascular Center, Bern, Switzerland (S.W.); Auckland City Hospital, New Zealand (J.A.O.); and International Center for Circulatory Health NHLI, Imperial College London, United Kingdom (P.W.S.)
| | - Shimpei Nakatani
- From the Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands (Y.O., S.N., R.-J.v.G.); Cardialysis, Rotterdam, the Netherlands (Y.O.); Academic Medical Center, University of Amsterdam, the Netherlands (M.J.G., T.A., Y.S., J.J.W., R.J.d.W.); National Heart Centre Singapore (N.F., J.N.); National University of Singapore (J.N.); Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Yamaguchi-Ube, Japan (T.O.); Catharina Ziekenhuis, Eindhoven, the Netherlands (J.K.); Skejby Sygehus, Aarhus, Denmark (E.C.); The Cardiovascular Research Centre, St. Vincents Hospital, Fitzroy, Australia (R.W.); Cardiology Department, Christchurch Hospital, New Zealand (D.M.); Division of Cardiology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (P.S.); Division of Cardiology Swiss Cardiovascular Center, Bern, Switzerland (S.W.); Auckland City Hospital, New Zealand (J.A.O.); and International Center for Circulatory Health NHLI, Imperial College London, United Kingdom (P.W.S.)
| | - Taku Asano
- From the Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands (Y.O., S.N., R.-J.v.G.); Cardialysis, Rotterdam, the Netherlands (Y.O.); Academic Medical Center, University of Amsterdam, the Netherlands (M.J.G., T.A., Y.S., J.J.W., R.J.d.W.); National Heart Centre Singapore (N.F., J.N.); National University of Singapore (J.N.); Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Yamaguchi-Ube, Japan (T.O.); Catharina Ziekenhuis, Eindhoven, the Netherlands (J.K.); Skejby Sygehus, Aarhus, Denmark (E.C.); The Cardiovascular Research Centre, St. Vincents Hospital, Fitzroy, Australia (R.W.); Cardiology Department, Christchurch Hospital, New Zealand (D.M.); Division of Cardiology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (P.S.); Division of Cardiology Swiss Cardiovascular Center, Bern, Switzerland (S.W.); Auckland City Hospital, New Zealand (J.A.O.); and International Center for Circulatory Health NHLI, Imperial College London, United Kingdom (P.W.S.)
| | - Yohei Sotomi
- From the Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands (Y.O., S.N., R.-J.v.G.); Cardialysis, Rotterdam, the Netherlands (Y.O.); Academic Medical Center, University of Amsterdam, the Netherlands (M.J.G., T.A., Y.S., J.J.W., R.J.d.W.); National Heart Centre Singapore (N.F., J.N.); National University of Singapore (J.N.); Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Yamaguchi-Ube, Japan (T.O.); Catharina Ziekenhuis, Eindhoven, the Netherlands (J.K.); Skejby Sygehus, Aarhus, Denmark (E.C.); The Cardiovascular Research Centre, St. Vincents Hospital, Fitzroy, Australia (R.W.); Cardiology Department, Christchurch Hospital, New Zealand (D.M.); Division of Cardiology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (P.S.); Division of Cardiology Swiss Cardiovascular Center, Bern, Switzerland (S.W.); Auckland City Hospital, New Zealand (J.A.O.); and International Center for Circulatory Health NHLI, Imperial College London, United Kingdom (P.W.S.)
| | - Nicolas Foin
- From the Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands (Y.O., S.N., R.-J.v.G.); Cardialysis, Rotterdam, the Netherlands (Y.O.); Academic Medical Center, University of Amsterdam, the Netherlands (M.J.G., T.A., Y.S., J.J.W., R.J.d.W.); National Heart Centre Singapore (N.F., J.N.); National University of Singapore (J.N.); Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Yamaguchi-Ube, Japan (T.O.); Catharina Ziekenhuis, Eindhoven, the Netherlands (J.K.); Skejby Sygehus, Aarhus, Denmark (E.C.); The Cardiovascular Research Centre, St. Vincents Hospital, Fitzroy, Australia (R.W.); Cardiology Department, Christchurch Hospital, New Zealand (D.M.); Division of Cardiology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (P.S.); Division of Cardiology Swiss Cardiovascular Center, Bern, Switzerland (S.W.); Auckland City Hospital, New Zealand (J.A.O.); and International Center for Circulatory Health NHLI, Imperial College London, United Kingdom (P.W.S.)
| | - Jaryl Ng
- From the Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands (Y.O., S.N., R.-J.v.G.); Cardialysis, Rotterdam, the Netherlands (Y.O.); Academic Medical Center, University of Amsterdam, the Netherlands (M.J.G., T.A., Y.S., J.J.W., R.J.d.W.); National Heart Centre Singapore (N.F., J.N.); National University of Singapore (J.N.); Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Yamaguchi-Ube, Japan (T.O.); Catharina Ziekenhuis, Eindhoven, the Netherlands (J.K.); Skejby Sygehus, Aarhus, Denmark (E.C.); The Cardiovascular Research Centre, St. Vincents Hospital, Fitzroy, Australia (R.W.); Cardiology Department, Christchurch Hospital, New Zealand (D.M.); Division of Cardiology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (P.S.); Division of Cardiology Swiss Cardiovascular Center, Bern, Switzerland (S.W.); Auckland City Hospital, New Zealand (J.A.O.); and International Center for Circulatory Health NHLI, Imperial College London, United Kingdom (P.W.S.)
| | - Takayuki Okamura
- From the Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands (Y.O., S.N., R.-J.v.G.); Cardialysis, Rotterdam, the Netherlands (Y.O.); Academic Medical Center, University of Amsterdam, the Netherlands (M.J.G., T.A., Y.S., J.J.W., R.J.d.W.); National Heart Centre Singapore (N.F., J.N.); National University of Singapore (J.N.); Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Yamaguchi-Ube, Japan (T.O.); Catharina Ziekenhuis, Eindhoven, the Netherlands (J.K.); Skejby Sygehus, Aarhus, Denmark (E.C.); The Cardiovascular Research Centre, St. Vincents Hospital, Fitzroy, Australia (R.W.); Cardiology Department, Christchurch Hospital, New Zealand (D.M.); Division of Cardiology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (P.S.); Division of Cardiology Swiss Cardiovascular Center, Bern, Switzerland (S.W.); Auckland City Hospital, New Zealand (J.A.O.); and International Center for Circulatory Health NHLI, Imperial College London, United Kingdom (P.W.S.)
| | - Joanna J Wykrzykowska
- From the Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands (Y.O., S.N., R.-J.v.G.); Cardialysis, Rotterdam, the Netherlands (Y.O.); Academic Medical Center, University of Amsterdam, the Netherlands (M.J.G., T.A., Y.S., J.J.W., R.J.d.W.); National Heart Centre Singapore (N.F., J.N.); National University of Singapore (J.N.); Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Yamaguchi-Ube, Japan (T.O.); Catharina Ziekenhuis, Eindhoven, the Netherlands (J.K.); Skejby Sygehus, Aarhus, Denmark (E.C.); The Cardiovascular Research Centre, St. Vincents Hospital, Fitzroy, Australia (R.W.); Cardiology Department, Christchurch Hospital, New Zealand (D.M.); Division of Cardiology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (P.S.); Division of Cardiology Swiss Cardiovascular Center, Bern, Switzerland (S.W.); Auckland City Hospital, New Zealand (J.A.O.); and International Center for Circulatory Health NHLI, Imperial College London, United Kingdom (P.W.S.)
| | - Robbert J de Winter
- From the Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands (Y.O., S.N., R.-J.v.G.); Cardialysis, Rotterdam, the Netherlands (Y.O.); Academic Medical Center, University of Amsterdam, the Netherlands (M.J.G., T.A., Y.S., J.J.W., R.J.d.W.); National Heart Centre Singapore (N.F., J.N.); National University of Singapore (J.N.); Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Yamaguchi-Ube, Japan (T.O.); Catharina Ziekenhuis, Eindhoven, the Netherlands (J.K.); Skejby Sygehus, Aarhus, Denmark (E.C.); The Cardiovascular Research Centre, St. Vincents Hospital, Fitzroy, Australia (R.W.); Cardiology Department, Christchurch Hospital, New Zealand (D.M.); Division of Cardiology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (P.S.); Division of Cardiology Swiss Cardiovascular Center, Bern, Switzerland (S.W.); Auckland City Hospital, New Zealand (J.A.O.); and International Center for Circulatory Health NHLI, Imperial College London, United Kingdom (P.W.S.)
| | - Robert-Jan van Geuns
- From the Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands (Y.O., S.N., R.-J.v.G.); Cardialysis, Rotterdam, the Netherlands (Y.O.); Academic Medical Center, University of Amsterdam, the Netherlands (M.J.G., T.A., Y.S., J.J.W., R.J.d.W.); National Heart Centre Singapore (N.F., J.N.); National University of Singapore (J.N.); Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Yamaguchi-Ube, Japan (T.O.); Catharina Ziekenhuis, Eindhoven, the Netherlands (J.K.); Skejby Sygehus, Aarhus, Denmark (E.C.); The Cardiovascular Research Centre, St. Vincents Hospital, Fitzroy, Australia (R.W.); Cardiology Department, Christchurch Hospital, New Zealand (D.M.); Division of Cardiology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (P.S.); Division of Cardiology Swiss Cardiovascular Center, Bern, Switzerland (S.W.); Auckland City Hospital, New Zealand (J.A.O.); and International Center for Circulatory Health NHLI, Imperial College London, United Kingdom (P.W.S.)
| | - Jacques Koolen
- From the Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands (Y.O., S.N., R.-J.v.G.); Cardialysis, Rotterdam, the Netherlands (Y.O.); Academic Medical Center, University of Amsterdam, the Netherlands (M.J.G., T.A., Y.S., J.J.W., R.J.d.W.); National Heart Centre Singapore (N.F., J.N.); National University of Singapore (J.N.); Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Yamaguchi-Ube, Japan (T.O.); Catharina Ziekenhuis, Eindhoven, the Netherlands (J.K.); Skejby Sygehus, Aarhus, Denmark (E.C.); The Cardiovascular Research Centre, St. Vincents Hospital, Fitzroy, Australia (R.W.); Cardiology Department, Christchurch Hospital, New Zealand (D.M.); Division of Cardiology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (P.S.); Division of Cardiology Swiss Cardiovascular Center, Bern, Switzerland (S.W.); Auckland City Hospital, New Zealand (J.A.O.); and International Center for Circulatory Health NHLI, Imperial College London, United Kingdom (P.W.S.)
| | - Evald H Christiansen
- From the Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands (Y.O., S.N., R.-J.v.G.); Cardialysis, Rotterdam, the Netherlands (Y.O.); Academic Medical Center, University of Amsterdam, the Netherlands (M.J.G., T.A., Y.S., J.J.W., R.J.d.W.); National Heart Centre Singapore (N.F., J.N.); National University of Singapore (J.N.); Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Yamaguchi-Ube, Japan (T.O.); Catharina Ziekenhuis, Eindhoven, the Netherlands (J.K.); Skejby Sygehus, Aarhus, Denmark (E.C.); The Cardiovascular Research Centre, St. Vincents Hospital, Fitzroy, Australia (R.W.); Cardiology Department, Christchurch Hospital, New Zealand (D.M.); Division of Cardiology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (P.S.); Division of Cardiology Swiss Cardiovascular Center, Bern, Switzerland (S.W.); Auckland City Hospital, New Zealand (J.A.O.); and International Center for Circulatory Health NHLI, Imperial College London, United Kingdom (P.W.S.)
| | - Robert Whitbourn
- From the Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands (Y.O., S.N., R.-J.v.G.); Cardialysis, Rotterdam, the Netherlands (Y.O.); Academic Medical Center, University of Amsterdam, the Netherlands (M.J.G., T.A., Y.S., J.J.W., R.J.d.W.); National Heart Centre Singapore (N.F., J.N.); National University of Singapore (J.N.); Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Yamaguchi-Ube, Japan (T.O.); Catharina Ziekenhuis, Eindhoven, the Netherlands (J.K.); Skejby Sygehus, Aarhus, Denmark (E.C.); The Cardiovascular Research Centre, St. Vincents Hospital, Fitzroy, Australia (R.W.); Cardiology Department, Christchurch Hospital, New Zealand (D.M.); Division of Cardiology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (P.S.); Division of Cardiology Swiss Cardiovascular Center, Bern, Switzerland (S.W.); Auckland City Hospital, New Zealand (J.A.O.); and International Center for Circulatory Health NHLI, Imperial College London, United Kingdom (P.W.S.)
| | - Dougal McClean
- From the Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands (Y.O., S.N., R.-J.v.G.); Cardialysis, Rotterdam, the Netherlands (Y.O.); Academic Medical Center, University of Amsterdam, the Netherlands (M.J.G., T.A., Y.S., J.J.W., R.J.d.W.); National Heart Centre Singapore (N.F., J.N.); National University of Singapore (J.N.); Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Yamaguchi-Ube, Japan (T.O.); Catharina Ziekenhuis, Eindhoven, the Netherlands (J.K.); Skejby Sygehus, Aarhus, Denmark (E.C.); The Cardiovascular Research Centre, St. Vincents Hospital, Fitzroy, Australia (R.W.); Cardiology Department, Christchurch Hospital, New Zealand (D.M.); Division of Cardiology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (P.S.); Division of Cardiology Swiss Cardiovascular Center, Bern, Switzerland (S.W.); Auckland City Hospital, New Zealand (J.A.O.); and International Center for Circulatory Health NHLI, Imperial College London, United Kingdom (P.W.S.)
| | - Pieter Smits
- From the Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands (Y.O., S.N., R.-J.v.G.); Cardialysis, Rotterdam, the Netherlands (Y.O.); Academic Medical Center, University of Amsterdam, the Netherlands (M.J.G., T.A., Y.S., J.J.W., R.J.d.W.); National Heart Centre Singapore (N.F., J.N.); National University of Singapore (J.N.); Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Yamaguchi-Ube, Japan (T.O.); Catharina Ziekenhuis, Eindhoven, the Netherlands (J.K.); Skejby Sygehus, Aarhus, Denmark (E.C.); The Cardiovascular Research Centre, St. Vincents Hospital, Fitzroy, Australia (R.W.); Cardiology Department, Christchurch Hospital, New Zealand (D.M.); Division of Cardiology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (P.S.); Division of Cardiology Swiss Cardiovascular Center, Bern, Switzerland (S.W.); Auckland City Hospital, New Zealand (J.A.O.); and International Center for Circulatory Health NHLI, Imperial College London, United Kingdom (P.W.S.)
| | - Stephan Windecker
- From the Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands (Y.O., S.N., R.-J.v.G.); Cardialysis, Rotterdam, the Netherlands (Y.O.); Academic Medical Center, University of Amsterdam, the Netherlands (M.J.G., T.A., Y.S., J.J.W., R.J.d.W.); National Heart Centre Singapore (N.F., J.N.); National University of Singapore (J.N.); Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Yamaguchi-Ube, Japan (T.O.); Catharina Ziekenhuis, Eindhoven, the Netherlands (J.K.); Skejby Sygehus, Aarhus, Denmark (E.C.); The Cardiovascular Research Centre, St. Vincents Hospital, Fitzroy, Australia (R.W.); Cardiology Department, Christchurch Hospital, New Zealand (D.M.); Division of Cardiology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (P.S.); Division of Cardiology Swiss Cardiovascular Center, Bern, Switzerland (S.W.); Auckland City Hospital, New Zealand (J.A.O.); and International Center for Circulatory Health NHLI, Imperial College London, United Kingdom (P.W.S.)
| | - John A Ormiston
- From the Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands (Y.O., S.N., R.-J.v.G.); Cardialysis, Rotterdam, the Netherlands (Y.O.); Academic Medical Center, University of Amsterdam, the Netherlands (M.J.G., T.A., Y.S., J.J.W., R.J.d.W.); National Heart Centre Singapore (N.F., J.N.); National University of Singapore (J.N.); Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Yamaguchi-Ube, Japan (T.O.); Catharina Ziekenhuis, Eindhoven, the Netherlands (J.K.); Skejby Sygehus, Aarhus, Denmark (E.C.); The Cardiovascular Research Centre, St. Vincents Hospital, Fitzroy, Australia (R.W.); Cardiology Department, Christchurch Hospital, New Zealand (D.M.); Division of Cardiology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (P.S.); Division of Cardiology Swiss Cardiovascular Center, Bern, Switzerland (S.W.); Auckland City Hospital, New Zealand (J.A.O.); and International Center for Circulatory Health NHLI, Imperial College London, United Kingdom (P.W.S.)
| | - Patrick W Serruys
- From the Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands (Y.O., S.N., R.-J.v.G.); Cardialysis, Rotterdam, the Netherlands (Y.O.); Academic Medical Center, University of Amsterdam, the Netherlands (M.J.G., T.A., Y.S., J.J.W., R.J.d.W.); National Heart Centre Singapore (N.F., J.N.); National University of Singapore (J.N.); Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Yamaguchi-Ube, Japan (T.O.); Catharina Ziekenhuis, Eindhoven, the Netherlands (J.K.); Skejby Sygehus, Aarhus, Denmark (E.C.); The Cardiovascular Research Centre, St. Vincents Hospital, Fitzroy, Australia (R.W.); Cardiology Department, Christchurch Hospital, New Zealand (D.M.); Division of Cardiology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (P.S.); Division of Cardiology Swiss Cardiovascular Center, Bern, Switzerland (S.W.); Auckland City Hospital, New Zealand (J.A.O.); and International Center for Circulatory Health NHLI, Imperial College London, United Kingdom (P.W.S.).
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Waksman R, Lipinski MJ, Acampado E, Cheng Q, Adams L, Torii S, Gai J, Torguson R, Hellinga DM, Westman PC, Joner M, Zumstein P, Kolodgie FD, Virmani R. Comparison of Acute Thrombogenicity for Metallic and Polymeric Bioabsorbable Scaffolds: Magmaris Versus Absorb in a Porcine Arteriovenous Shunt Model. Circ Cardiovasc Interv 2018; 10:CIRCINTERVENTIONS.116.004762. [PMID: 28801538 DOI: 10.1161/circinterventions.116.004762] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 06/19/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND A comparison in acute thrombogenicity between the Magmaris sirolimus-eluting bioabsorbable magnesium scaffold and the Absorb bioresorbable vascular scaffold has not been performed. This study assessed acute thrombogenicity of Magmaris compared with Absorb and the Orsiro hybrid drug-eluting stent in a porcine arteriovenous shunt model. METHODS AND RESULTS An ex vivo porcine carotid jugular arteriovenous shunt was established and connected to SYLGARD tubing containing the Magmaris, Absorb, and Orsiro scaffolds/stents and allowed to run in the shunt for a maximum of 1 hour. Twelve shunts (2 shunt runs per pig) were run comparing the 3 scaffolds in alternating order. Nested generalized linear mixed models were used to compare variables between scaffold groups while adjusting for variability between shunt runs. Confocal fluorescent microscopy costaining CD61/CD42b demonstrated that both Magmaris (3.0%) and Orsiro (4.6%) had less platelet coverage of the total scaffold compared with Absorb (21.8%). Scanning electron microscopy demonstrated significantly less thrombus deposition to Magmaris as a percentage of the total scaffold compared with Absorb (5.0% versus 16.1%, P=0.02). Magmaris had significantly less PM-1-positive neutrophil and CD14-positive monocyte adherence compared with both Orsiro and Absorb. Orsiro had significantly less monocyte deposition compared with Absorb. CONCLUSIONS Despite a similar scaffold strut thickness, the Magmaris sirolimus-eluting bioabsorbable magnesium scaffold was significantly less thrombogenic compared with the Absorb bioresorbable vascular scaffold in an ex vivo porcine arteriovenous shunt model. Further studies are needed to determine whether the reduced thrombogenicity of Magmaris will result in reductions in major cardiovascular events.
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Affiliation(s)
- Ron Waksman
- From the Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (R.W., M.J.L., J.G., R.T., D.M.H., P.C.W.); CVPath Institute, Inc, Gaithersburg, MD (E.A., Q.C., L.A., S.T., M.J., F.D.K., R.V.); and Biotronik AG, Bülach, Switzerland (P.Z.).
| | - Michael J Lipinski
- From the Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (R.W., M.J.L., J.G., R.T., D.M.H., P.C.W.); CVPath Institute, Inc, Gaithersburg, MD (E.A., Q.C., L.A., S.T., M.J., F.D.K., R.V.); and Biotronik AG, Bülach, Switzerland (P.Z.)
| | - Eduardo Acampado
- From the Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (R.W., M.J.L., J.G., R.T., D.M.H., P.C.W.); CVPath Institute, Inc, Gaithersburg, MD (E.A., Q.C., L.A., S.T., M.J., F.D.K., R.V.); and Biotronik AG, Bülach, Switzerland (P.Z.)
| | - Qi Cheng
- From the Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (R.W., M.J.L., J.G., R.T., D.M.H., P.C.W.); CVPath Institute, Inc, Gaithersburg, MD (E.A., Q.C., L.A., S.T., M.J., F.D.K., R.V.); and Biotronik AG, Bülach, Switzerland (P.Z.)
| | - Lila Adams
- From the Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (R.W., M.J.L., J.G., R.T., D.M.H., P.C.W.); CVPath Institute, Inc, Gaithersburg, MD (E.A., Q.C., L.A., S.T., M.J., F.D.K., R.V.); and Biotronik AG, Bülach, Switzerland (P.Z.)
| | - Sho Torii
- From the Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (R.W., M.J.L., J.G., R.T., D.M.H., P.C.W.); CVPath Institute, Inc, Gaithersburg, MD (E.A., Q.C., L.A., S.T., M.J., F.D.K., R.V.); and Biotronik AG, Bülach, Switzerland (P.Z.)
| | - Jiaxiang Gai
- From the Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (R.W., M.J.L., J.G., R.T., D.M.H., P.C.W.); CVPath Institute, Inc, Gaithersburg, MD (E.A., Q.C., L.A., S.T., M.J., F.D.K., R.V.); and Biotronik AG, Bülach, Switzerland (P.Z.)
| | - Rebecca Torguson
- From the Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (R.W., M.J.L., J.G., R.T., D.M.H., P.C.W.); CVPath Institute, Inc, Gaithersburg, MD (E.A., Q.C., L.A., S.T., M.J., F.D.K., R.V.); and Biotronik AG, Bülach, Switzerland (P.Z.)
| | - David M Hellinga
- From the Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (R.W., M.J.L., J.G., R.T., D.M.H., P.C.W.); CVPath Institute, Inc, Gaithersburg, MD (E.A., Q.C., L.A., S.T., M.J., F.D.K., R.V.); and Biotronik AG, Bülach, Switzerland (P.Z.)
| | - Peter C Westman
- From the Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (R.W., M.J.L., J.G., R.T., D.M.H., P.C.W.); CVPath Institute, Inc, Gaithersburg, MD (E.A., Q.C., L.A., S.T., M.J., F.D.K., R.V.); and Biotronik AG, Bülach, Switzerland (P.Z.)
| | - Michael Joner
- From the Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (R.W., M.J.L., J.G., R.T., D.M.H., P.C.W.); CVPath Institute, Inc, Gaithersburg, MD (E.A., Q.C., L.A., S.T., M.J., F.D.K., R.V.); and Biotronik AG, Bülach, Switzerland (P.Z.)
| | - Philine Zumstein
- From the Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (R.W., M.J.L., J.G., R.T., D.M.H., P.C.W.); CVPath Institute, Inc, Gaithersburg, MD (E.A., Q.C., L.A., S.T., M.J., F.D.K., R.V.); and Biotronik AG, Bülach, Switzerland (P.Z.)
| | - Frank D Kolodgie
- From the Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (R.W., M.J.L., J.G., R.T., D.M.H., P.C.W.); CVPath Institute, Inc, Gaithersburg, MD (E.A., Q.C., L.A., S.T., M.J., F.D.K., R.V.); and Biotronik AG, Bülach, Switzerland (P.Z.)
| | - Renu Virmani
- From the Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (R.W., M.J.L., J.G., R.T., D.M.H., P.C.W.); CVPath Institute, Inc, Gaithersburg, MD (E.A., Q.C., L.A., S.T., M.J., F.D.K., R.V.); and Biotronik AG, Bülach, Switzerland (P.Z.)
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Affiliation(s)
- Thomas F Lüscher
- Editorial Office, Zurich Heart House, 8032 Zurich, Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Switzerland and Royal Brompton and Harefield Hospital Trust and Imperial College, London, SW3 6NP, UK
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Clinical findings after bioresorbable vascular scaffold implantation in an unrestricted cohort of patients with ST-segment elevation myocardial infarction (from the RAI registry). Int J Cardiol 2018; 258:50-54. [DOI: 10.1016/j.ijcard.2018.01.135] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 01/11/2018] [Accepted: 01/31/2018] [Indexed: 11/21/2022]
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Nef H, Wiebe J, Boeder N, Dörr O, Bauer T, Hauptmann KE, Latib A, Colombo A, Fischer D, Rudolph T, Foin N, Richardt G, Hamm C. A multicenter post-marketing evaluation of the Elixir DESolve®
Novolimus-eluting bioresorbable coronary scaffold system: First results from the DESolve PMCF study. Catheter Cardiovasc Interv 2018; 92:1021-1027. [DOI: 10.1002/ccd.27550] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 12/25/2017] [Accepted: 01/28/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Holger Nef
- Department of Cardiology and Angiology; University of Giessen, Medizinische Klinik I; Giessen Germany
| | - Jens Wiebe
- Department of Cardiology; Deutsches Herzzentrum Muenchen; Munich Germany
| | - Niklas Boeder
- Department of Cardiology and Angiology; University of Giessen, Medizinische Klinik I; Giessen Germany
| | - Oliver Dörr
- Department of Cardiology and Angiology; University of Giessen, Medizinische Klinik I; Giessen Germany
| | - Timm Bauer
- Department of Cardiology and Angiology; University of Giessen, Medizinische Klinik I; Giessen Germany
| | | | | | | | - Dieter Fischer
- Department of Cardiology and Angiology; University of Münster; Münster Germany
| | - Tanja Rudolph
- Department of Cardiology; University of Cologne; Cologne Germany
| | - Nicolas Foin
- National Heart Centre Singapore, Duke-NUS Medical School; Singapore, Singapore
| | - Gert Richardt
- Department of Cardiology; Segeberger Kliniken; Bad Segeberg Germany
| | - Christian Hamm
- Department of Cardiology and Angiology; University of Giessen, Medizinische Klinik I; Giessen Germany
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Maes F, Costerousse O, Cieza T, Henry M, Déry JP, Barbeau G, Delarochellière R, Paradis JM, Larose E, Nguyen CM, Pirlet C, Mongrain R, Bertrand OF. Transradial experience with bioresorbable vascular scaffolds: A case-matched study with metallic drug-eluting stents. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:700-704. [PMID: 29398632 DOI: 10.1016/j.carrev.2018.01.002] [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: 11/23/2017] [Revised: 12/22/2017] [Accepted: 01/03/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Whether polymeric bioresorbable vascular scaffolds (BVS) implantation with transradial approach is feasible and safe is unknown. We compared the feasibility and safety of the transradial approach for BVS delivery with metallic drug-eluting stents (DES). METHODS We identified 118 consecutive patients who underwent BVS implantation and we compared 30-days and 1-year results with 118 matched patients with DES. Patients were matched for age, sex, risk factors and clinical indication. RESULTS Rates of transradial approach were 98% in the BVS group vs 95% in the DES group (P = 0.16) with 5Fr used in 38% and 32% (P = 0.34), respectively. The number of stents was similar in both groups, 2.6 ± 1.5 vs 2.4 ± 1.3 (P = 0.23). Although maximal pressure for stent deployment was identical in both groups (16 ± 3 atm), more lesions were pre-dilated (83% vs 52%, P < 0.001) and post-dilated (71% vs 33%, P < 0.001) in the BVS group. Contrast volume (217 ± 97 vs 175 ± 108 ml, P < 0.001), fluoroscopy time (16 [10-23] vs 13 [8-21] min, P = 0.04) and procedure duration (65 ± 31 vs 56 ± 47 min, P = 0.045) were significantly higher in the BVS group. Major adverse cardiac events, including death, myocardial infarction and target vessel revascularization remained similar in both groups, 1.7% vs 0.8% (P = 0.56) at 30 days and 10% vs 8.5% (P = 0.66) at 1 year. At 1 year, stent thrombosis occurred in 2 (1.7%) patients in the BVS group and 1 (0.8%) patient in the DES group (P = 0.56). CONCLUSION The use of transradial approach for BVS compared to DES implantation was feasible and safe in all-comers, although BVS implantation included more technical challenges. Outcomes up to 1-year remained comparable in both groups.
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Affiliation(s)
- Frédéric Maes
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Olivier Costerousse
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Tomas Cieza
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Mélaine Henry
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Jean-Pierre Déry
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Gérald Barbeau
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | | | - Jean-Michel Paradis
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Eric Larose
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Can M Nguyen
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Charles Pirlet
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Rosaire Mongrain
- Department of Mechanical Engineering, McGill University, Montréal, Canada
| | - Olivier F Bertrand
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada; Department of Mechanical Engineering, McGill University, Montréal, Canada.
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What Have We Learned From the ABSORB Trials? JACC Cardiovasc Interv 2018; 11:273-274. [DOI: 10.1016/j.jcin.2017.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 10/10/2017] [Indexed: 11/20/2022]
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Byrne R, Stefanini G, Capodanno D, Onuma Y, Baumbach A, Escaned J, Haude M, James S, Joner M, Jüni P, Kastrati A, Oktay S, Wijns W, Serruys P, Windecker S. Report of an ESC-EAPCI Task Force on the evaluation and use of bioresorbable scaffolds for percutaneous coronary intervention: executive summary. EUROINTERVENTION 2018; 13:1574-1586. [DOI: 10.4244/eij20170912-01] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Capodanno D. Bioresorbable Scaffolds in Coronary Intervention: Unmet Needs and Evolution. Korean Circ J 2018; 48:24-35. [PMID: 29322695 PMCID: PMC5764868 DOI: 10.4070/kcj.2017.0194] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 09/13/2017] [Accepted: 09/15/2017] [Indexed: 11/12/2022] Open
Abstract
Bioresorbable scaffolds (BRS) represent a novel paradigm in the 40-year history of interventional cardiology. Restoration of cyclic pulsatility and physiologic vasomotion, adaptive vascular remodeling, plaque regression, and removal of the trigger for late adverse events are expected BRS benefits over current metallic drug-eluting stents. However, first-generation BRS devices have significant manufacturing limitations and rely on optimal implantation technique to avoid experiencing an excess of clinical events. There are currently at least 22 BRS devices in different stages of development, including many trials of device iterations with thinner (<150 µm) struts than first-generation BRS. This article reviews the outcomes of commercially available and potentially upcoming BRS, focusing on the most recent stages of clinical development and future directions for each scaffold type.
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Affiliation(s)
- Davide Capodanno
- Division of Cardiology, Cardio-Thoracic-Vascular Department, Azienda Ospedaliero Universitaria "Policlinico-Vittorio Emanuele" and Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy.
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Jinnouchi H, Kuramitsu S, Shinozaki T, Hiromasa T, Kobayashi Y, Takeji Y, Miura M, Masuda H, Matsumura Y, Yamaji Y, Sakakura K, Domei T, Soga Y, Hyodo M, Shirai S, Ando K. Five-Year Clinical Outcomes After Drug-Eluting Stent Implantation Following Rotational Atherectomy for Heavily Calcified Lesions. Circ J 2018; 82:983-991. [DOI: 10.1253/circj.cj-17-0564] [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: 11/09/2022]
Affiliation(s)
| | | | - Tomohiro Shinozaki
- Department of Biostatistics, School of Public Health, the University of Tokyo
| | | | - Yohei Kobayashi
- Division of Cardiovascular Medicine, Kokura Memorial Hospital
| | - Yasuaki Takeji
- Division of Cardiovascular Medicine, Kokura Memorial Hospital
| | - Mizuki Miura
- Division of Cardiovascular Medicine, Kokura Memorial Hospital
| | - Hisaki Masuda
- Division of Cardiovascular Medicine, Kokura Memorial Hospital
| | | | - Yuhei Yamaji
- Division of Cardiovascular Medicine, Kokura Memorial Hospital
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Takenori Domei
- Division of Cardiovascular Medicine, Kokura Memorial Hospital
| | - Yoshimitsu Soga
- Division of Cardiovascular Medicine, Kokura Memorial Hospital
| | - Makoto Hyodo
- Division of Cardiovascular Medicine, Kokura Memorial Hospital
| | - Shinichi Shirai
- Division of Cardiovascular Medicine, Kokura Memorial Hospital
| | - Kenji Ando
- Division of Cardiovascular Medicine, Kokura Memorial Hospital
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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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Characteristics, Predictors, and Mechanisms of Thrombosis in Coronary Bioresorbable Scaffolds. JACC Cardiovasc Interv 2017; 10:2363-2371. [DOI: 10.1016/j.jcin.2017.08.020] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 08/11/2017] [Accepted: 08/14/2017] [Indexed: 11/20/2022]
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Lee WC, Wu CJ, Chen CJ, Yang CH, Hsueh SK, Yip HK, Hang CL, Fang CY, Fang HY. Thirty-Day and One-Year Clinical Outcomes of Bioresorbable Vascular Scaffold Implantation: A Single-Center Experience. ACTA CARDIOLOGICA SINICA 2017; 33:614-623. [PMID: 29167614 DOI: 10.6515/acs20170714a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Available data on the use of the Bioresorbable vascular scaffold (BVS) (Abbott Vascular, Santa Clara, CA) in real-world patients is limited, particularly in Asian populations. The aim of this study was to assess clinical outcomes of patients treated with a BVS in real-world practice in Taiwan. Methods This study focused on 156 patients with coronary artery disease and a total of 249 lesions who received BVS implantation from October 2012 to October 2015. The study's primary endpoint was major adverse cardiac event (MACE), such as a myocardial infarction (MI), target vessel revascularization (TVR), target lesion revascularization (TLR), definite or possible scaffold thrombosis, cardiovascular death, and all-cause mortality during the thirty-day follow-up period. The secondary endpoint was MACE during the one-year follow-up period. Additionally, the composite clinical secondary endpoint was target lesion failure (TLF), which was called device-oriented composite endpoint. Results The average age of the patients was 60.34 ± 10.15 years, and 81.4% were male. The average of Syntax score was 12.42 ± 8.77 points. 44.2 % lesions were type B2 or C. At 31 days, one patient experienced a MACE (1/156) the composite of two TLF (2/249) with ST elevation MI, which was related to scaffold thrombosis. At one-year, 5.1 % (8/156) of the patients experienced a MACE and 3.6% (9/249) of the lesions experienced a TLF. There was no cardiovascular or all-cause mortality in the 30-day follow-up. The one-year cardiovascular and all-cause mortality rates were each 1.3%, respectively. Diabetes, ostial lesion, bifurcation lesion, and non-standard dual anti-platelet therapy (DAPT) were the strong associations of one-year TLF. Conclusions Even with difficult and complex lesions of patients in this study, acceptable outcomes were achieved with low definite or possible scaffold thrombosis rates after BVS implantation. And despite anatomical issues, it is important to complete standard DAPT.
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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
| | - Chiung-Jen Wu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chien-Jen Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Hsu Yang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shu-Kai Hsueh
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hon-Kan Yip
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chi-Ling Hang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Yuan Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsiu-Yu Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Baquet M, Nef H, Gori T, Latib A, Capodanno D, Di Mario C, Sabate M, Colombo A, Tamburino C, Mehilli J. Restenosis patterns after bioresorbable vascular scaffold implantation: Angiographic substudy of the GHOST-EU registry. Catheter Cardiovasc Interv 2017; 92:276-282. [DOI: 10.1002/ccd.27350] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 08/09/2017] [Accepted: 08/30/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Moritz Baquet
- Department of Cardiology; Munich University Clinic, LMU; Munich Germany
- German Centre for Cardiovascular Research, partner site Munich Heart Alliance; Munich Germany
| | - Holger Nef
- Department of Cardiology; University of Giessen; Giessen Germany
| | - Tomasso Gori
- Department of Cardiology; University Medical Center; Mainz Germany
- German Centre for Cardiovascular Research, partner site Rhine Main; Mainz Germany
| | - Azeem Latib
- Centro Cuore and San Raffaele Hospitals; Milan Italy
| | | | | | - Manel Sabate
- Servicio de Cardiología, Hospital Clínic, Universitat de Barcelona; Barcelona Spain
| | | | | | - Julinda Mehilli
- Department of Cardiology; Munich University Clinic, LMU; Munich Germany
- German Centre for Cardiovascular Research, partner site Munich Heart Alliance; Munich Germany
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Testa L, Latib A, Montone RA, Colombo A, Bedogni F. Coronary Bioresorbable Vascular Scaffold Use in the Treatment of Coronary Artery Disease. Circ Cardiovasc Interv 2017; 9:CIRCINTERVENTIONS.116.003978. [PMID: 27412870 DOI: 10.1161/circinterventions.116.003978] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 06/20/2016] [Indexed: 11/16/2022]
Abstract
Bioresorbable vascular scaffolds (BVS) represent a promising novel approach for the treatment of coronary artery disease. BVS promise to address some of the well-known limitations of current drug-eluting stents, while providing a transient scaffolding of the vessel to prevent acute vessel closure/recoil. Drug elution by BVS prevents neointimal proliferation in a similar fashion to drug-eluting stents, and complete bioresorption is associated with late vessel lumen enlargement, plaque regression, and restoration of vasomotion. Based on the pathophysiological reasons and on the results derived from clinical studies, BVS are increasingly being used in clinical practice. The aim of this review is to provide an overview of the current evidence supporting the use of BVS in clinical practice. In particular, we will discuss the randomized controlled trials and registries evaluating the clinical outcome of these devices, with a special focus on their application in patients with acute coronary syndrome and in specific lesion subsets (bifurcations, chronic total occlusions, and in-stent restenosis).
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Affiliation(s)
- Luca Testa
- From the Department of Cardiology, IRCCS Pol. S. Donato, S.Donato Milanese, Milan, Italy (L.T., R.A.M., F.B.); and Interventional Cardiology Unit, San Raffaele Scientific Institute and EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A.C.).
| | - Azeem Latib
- From the Department of Cardiology, IRCCS Pol. S. Donato, S.Donato Milanese, Milan, Italy (L.T., R.A.M., F.B.); and Interventional Cardiology Unit, San Raffaele Scientific Institute and EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A.C.)
| | - Rocco A Montone
- From the Department of Cardiology, IRCCS Pol. S. Donato, S.Donato Milanese, Milan, Italy (L.T., R.A.M., F.B.); and Interventional Cardiology Unit, San Raffaele Scientific Institute and EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A.C.)
| | - Antonio Colombo
- From the Department of Cardiology, IRCCS Pol. S. Donato, S.Donato Milanese, Milan, Italy (L.T., R.A.M., F.B.); and Interventional Cardiology Unit, San Raffaele Scientific Institute and EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A.C.)
| | - Francesco Bedogni
- From the Department of Cardiology, IRCCS Pol. S. Donato, S.Donato Milanese, Milan, Italy (L.T., R.A.M., F.B.); and Interventional Cardiology Unit, San Raffaele Scientific Institute and EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A.C.)
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