51
|
Florin Ferent I, Mester A, Hlinomaz O, Groch L, Rezek M, Sitar J, Semenka J, Novak M, Benedek I. Intracoronary Imaging for Assessment of Vascular Healing and Stent Follow-up in Bioresorbable Vascular Scaffolds. Curr Med Imaging 2020; 16:123-134. [PMID: 32003312 DOI: 10.2174/1573405614666180604093621] [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: 12/15/2016] [Revised: 08/10/2017] [Accepted: 03/19/2018] [Indexed: 11/22/2022]
Abstract
Bioresorbable Vascular Scaffolds (BVS) are polymer-based materials implanted in the coronary arteries in order to treat atherosclerotic lesions, based on the concept that once the lesion has been treated, the material of the implanted stent will undergo a process of gradual resorption that will leave, in several years, the vessel wall smooth, free of any foreign material and with its vasomotion restored. However, after the first enthusiastic reports on the efficacy of BVSs, the recently published trials demonstrated disappointing results regarding long-term patency following BVS implantation, which were mainly attributed to technical deficiencies during the stenting procedure. Intracoronary imaging could play a crucial role for helping the operator to correctly implant a BVS into the coronary artery, as well as providing relevant information in the follow-up period. This review aims to summarize the role of intracoronary imaging in the follow-up of coronary stents, with a particular emphasis on the role of intravascular ultrasound and optical coherence tomography for procedural guidance during stent implantation and also for follow-up of bioabsorbable scaffolds.
Collapse
Affiliation(s)
- Ioan Florin Ferent
- Department of Cardiology, Laboratory of Advanced Research in Multimodality Cardiac Imaging, University of Medicine and Pharmacy of Targu Mures, Targu Mures, Romania
| | - Andras Mester
- Department of Cardiology, Laboratory of Advanced Research in Multimodality Cardiac Imaging, University of Medicine and Pharmacy of Targu Mures, Targu Mures, Romania
| | - Ota Hlinomaz
- International Clinical Research Center, St. Anne´s Hospital and Masaryk University, Brno, Czech Republic
| | - Ladislav Groch
- International Clinical Research Center, St. Anne´s Hospital and Masaryk University, Brno, Czech Republic
| | - Michal Rezek
- International Clinical Research Center, St. Anne´s Hospital and Masaryk University, Brno, Czech Republic
| | - Jan Sitar
- International Clinical Research Center, St. Anne´s Hospital and Masaryk University, Brno, Czech Republic
| | - Jiri Semenka
- International Clinical Research Center, St. Anne´s Hospital and Masaryk University, Brno, Czech Republic
| | - Martin Novak
- International Clinical Research Center, St. Anne´s Hospital and Masaryk University, Brno, Czech Republic
| | - Imre Benedek
- Department of Cardiology, Laboratory of Advanced Research in Multimodality Cardiac Imaging, University of Medicine and Pharmacy of Targu Mures, Targu Mures, Romania
| |
Collapse
|
52
|
Abstract
Fully bioresorbable scaffolds (BRS) were designed to overcome the limitations of metallic drug-eluting stents, which permanently cage the vessel wall, thereby preventing normal coronary vasomotion, preclude bypass grafting and can provoke long-term foreign-body responses. Although multiple scaffolds have been or are in development, the Absorb Bioresorbable Vascular Scaffold (BVS; Abbott Vascular) was the first FDA-approved device and was widely expected to fulfil the dream of interventional cardiologists of a transient scaffold that would disappear 'when the job was done' and would not hamper further treatment options. Although early, small studies and even large, randomized trials showed beneficial outcomes up to 1 year of follow-up, longer-term results have been disappointing, with increased rates of device thrombosis and target-lesion revascularization. The Absorb BVS device was withdrawn from the market because of low demand. In this Review, we summarize the preclinical and clinical data available for BRS to understand how the vascular biological reactions to these devices differ from biological reactions to metallic drug-eluting stents and how these responses translate into clinical outcomes. We also discuss next-generation BRS and outline modifications that are needed to improve the long-term outcomes with these devices so that they eventually become a viable option for patients with symptomatic obstructive coronary artery disease.
Collapse
|
53
|
Coronary Stents and Metal Allergy. Contact Dermatitis 2020. [DOI: 10.1007/978-3-319-72451-5_81-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
54
|
Elwany M, Zaki A, Latib A, Testa L, Ielasi A, Piraino D, Geraci S, El Zawawy T, Cortese B. The impact of the use of bioresorbable vascular scaffolds and drug-coated balloons in coronary bifurcation lesions. Egypt Heart J 2019; 71:31. [PMID: 31845098 PMCID: PMC6914751 DOI: 10.1186/s43044-019-0033-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 11/19/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the improvement in techniques and tools, coronary lesions involving a bifurcation are still challenging and the outcome with drug-eluting stents is not always optimal. The role of bioresorbable vascular scaffolds (BVS) and drug-coated balloons (DCB) in this setting has not been adequately investigated yet. RESULTS From the databases of 6 italian centers with high proficiencies in newer technologies, we retrospectively collected all consecutive cases of coronary bifurcations managed or attempted with the implantation of at least one BVS in the main vessel and the use of one DCB in the side branch (SB). Primary study endpoint was the occurrence of major adverse cardiovascular events (MACE) at the longest available follow-up. Fourty patients fulfilled the enrollment criterion, 22.5% had diabetes and 50% an acute coronary syndrome. Average syntax score was 15.04 ± 7.18, all lesions were de novo, and 27 patients (67.5%) had a type 1,1,1 Medina lesion. Twenty-three lesions (57.5%) involved the proximal left anterior-descending artery/first diagonal branch. Only 32.5% of patients underwent an intravascular imaging-guided angioplasty. Average lesion length was 21.4 mm in the main vessel and 11.49 mm in the SB. MV was always predilated and BVS received a postdilation in 100% of the cases. In 42.5% of the cases, the DCB was used during final kissing balloon inflation, and in no cases, a stent/BVS was required in the SB. Procedural success was achieved in 100% of the cases. After an average follow-up of 15.5 (± 11.5) months, we observed no MACE with only one case of target vessel revasularization (2.5%). CONCLUSIONS Management of coronary bifurcation lesions with the use of newer technologies including BVS and DCB seems feasible and effective at mid-term and long-term clinical follow-up.
Collapse
Affiliation(s)
- Mostafa Elwany
- Interventional Cardiology, San Carlo Clinic, Milano, Italy
- Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Amr Zaki
- Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | | | | | | | | | | | - Tarek El Zawawy
- Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Bernardo Cortese
- Interventional Cardiology, San Carlo Clinic, Milano, Italy
- Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Massa, Italy
| |
Collapse
|
55
|
Jeżewski MP, Kubisa MJ, Eyileten C, De Rosa S, Christ G, Lesiak M, Indolfi C, Toma A, Siller-Matula JM, Postuła M. Bioresorbable Vascular Scaffolds-Dead End or Still a Rough Diamond? J Clin Med 2019; 8:E2167. [PMID: 31817876 PMCID: PMC6947479 DOI: 10.3390/jcm8122167] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/02/2019] [Accepted: 12/04/2019] [Indexed: 02/06/2023] Open
Abstract
Percutaneous coronary interventions with stent-based restorations of vessel patency have become the gold standard in the treatment of acute coronary states. Bioresorbable vascular scaffolds (BVS) have been designed to combine the efficiency of drug-eluting stents (DES) at the time of implantation and the advantages of a lack of foreign body afterwards. Complete resolution of the scaffold was intended to enable the restoration of vasomotor function and reduce the risk of device thrombosis. While early reports demonstrated superiority of BVS over DES, larger-scale application and longer observation exposed major concerns about their use, including lower radial strength and higher risk of thrombosis resulting in higher rate of major adverse cardiac events. Further focus on procedural details and research on the second generation of BVS with novel properties did not allow to unequivocally challenge position of DES. Nevertheless, BVS still have a chance to present superiority in distinctive indications. This review presents an outlook on the available first and second generation BVS and a summary of results of clinical trials on their use. It discusses explanations for unfavorable outcomes, proposed enhancement techniques and a potential niche for the use of BVS.
Collapse
Affiliation(s)
- Mateusz P. Jeżewski
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology, Medical University of Warsaw, 02091 Warsaw, Poland; (M.P.J.); (M.J.K.); (C.E.); (M.P.)
| | - Michał J. Kubisa
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology, Medical University of Warsaw, 02091 Warsaw, Poland; (M.P.J.); (M.J.K.); (C.E.); (M.P.)
| | - Ceren Eyileten
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology, Medical University of Warsaw, 02091 Warsaw, Poland; (M.P.J.); (M.J.K.); (C.E.); (M.P.)
| | - Salvatore De Rosa
- Department of Medical and Surgical Sciences, Division of Cardiology, “Magna Graecia” University, 88100 Catanzaro, Italy; (S.D.R.); (C.I.)
| | - Günter Christ
- Department of Cardiology, 5th Medical Department with Cardiology, Kaiser Franz Josef Hospital, 31100 Vienna, Austria;
| | - Maciej Lesiak
- 1st Department of Cardiology, Poznan University of Medical Sciences, 1061701 Poznań, Poland;
| | - Ciro Indolfi
- Department of Medical and Surgical Sciences, Division of Cardiology, “Magna Graecia” University, 88100 Catanzaro, Italy; (S.D.R.); (C.I.)
| | - Aurel Toma
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 231090 Vienna, Austria;
| | - Jolanta M. Siller-Matula
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology, Medical University of Warsaw, 02091 Warsaw, Poland; (M.P.J.); (M.J.K.); (C.E.); (M.P.)
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 231090 Vienna, Austria;
| | - Marek Postuła
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology, Medical University of Warsaw, 02091 Warsaw, Poland; (M.P.J.); (M.J.K.); (C.E.); (M.P.)
| |
Collapse
|
56
|
Stiehm M, Wüstenhagen C, Siewert S, Ince H, Grabow N, Schmitz KP. Impact of strut dimensions and vessel caliber on thrombosis risk of bioresorbable scaffolds using hemodynamic metrics. ACTA ACUST UNITED AC 2019; 64:251-262. [PMID: 29933242 DOI: 10.1515/bmt-2017-0101] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 05/18/2018] [Indexed: 11/15/2022]
Abstract
Bioresorbable scaffolds (BRS) promise to be the treatment of choice for stenosed coronary vessels. But higher thrombosis risk found in current clinical studies limits the expectations. Three hemodynamic metrics are introduced to evaluate the thrombosis risk of coronary stents/scaffolds using transient computational fluid dynamics (CFD). The principal phenomena are platelet activation and effective diffusion (platelet shear number, PSN), convective platelet transport (platelet convection number, PCN) and platelet aggregation (platelet aggregation number, PAN) were taken into consideration. In the present study, two different stent designs (thick-strut vs. thin-strut design) positioned in small- and medium-sized vessels (reference vessel diameter, RVD=2.25 mm vs. 2.70 mm) were analyzed. In both vessel models, the thick-strut design induced higher PSN, PCN and PAN values than the thin-strut design (thick-strut vs. thin-strut: PSN=2.92/2.19 and 0.54/0.30; PCN=3.14/1.15 and 2.08/0.43; PAN: 14.76/8.19 and 20.03/10.18 for RVD=2.25 mm and 2.70 mm). PSN and PCN are increased by the reduction of the vessel size (PSN: RVD=2.25 mm vs. 2.70 mm=5.41 and 7.30; PCN: RVD=2.25 mm vs. 2.70 mm=1.51 and 2.67 for thick-strut and thin-strut designs). The results suggest that bulky stents implanted in small caliber vessels may substantially increase the thrombosis risk. Moreover, sensitivity analyses imply that PSN is mostly influenced by vessel size (lesion-related factor), whereas PCN and PAN sensitively respond to strut-thickness (device-related factor).
Collapse
Affiliation(s)
- Michael Stiehm
- Institute for ImplantatTechnology and Biomaterials e.V., Friedrich-Barnewitz-Str. 4, 18119 Rostock-Warnemünde, Germany
| | - Carolin Wüstenhagen
- Institute for ImplantatTechnology and Biomaterials e.V., Friedrich-Barnewitz-Str. 4, 18119 Rostock-Warnemünde, Germany
| | - Stefan Siewert
- Institute for ImplantatTechnology and Biomaterials e.V., Friedrich-Barnewitz-Str. 4, 18119 Rostock-Warnemünde, Germany
| | - Hüseyin Ince
- Center for Internal Medicine, Department of Cardiology, Rostock University Medical Center, Ernst-Heydemann-Straße 6, 18057 Rostock, Germany
| | - Niels Grabow
- Institute for Biomedical Engineering, Rostock University Medical Center, Friedrich-Barnewitz-Str. 4, 18119 Rostock-Warnemünde, Germany
| | - Klaus-Peter Schmitz
- Institute for ImplantatTechnology and Biomaterials e.V., Friedrich-Barnewitz-Str. 4, 18119 Rostock-Warnemünde, Germany.,Institute for Biomedical Engineering, Rostock University Medical Center, Friedrich-Barnewitz-Str. 4, 18119 Rostock-Warnemünde, Germany
| |
Collapse
|
57
|
Tanaka A, Jabbour RJ, Colombo A. What are the remaining lessons to be learnt from 1st-generation bioresorbable scaffolds? Int J Cardiol 2019; 293:103-104. [DOI: 10.1016/j.ijcard.2019.07.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 07/10/2019] [Indexed: 11/27/2022]
|
58
|
Dinh Nguyen T, Feng G, Yi X, Lyu Y, Lan Z, Xia J, Wu T, Jiang X. Six-month evaluation of novel bioabsorbable scaffolds composed of poly-L-lactic acid and amorphous calcium phosphate nanoparticles in porcine coronary arteries. J Biomater Appl 2019; 33:227-233. [PMID: 30096995 DOI: 10.1177/0885328218790332] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Using coronary angiography and intravascular ultrasound methods to evaluate the performance of the novel fully bioabsorbable scaffold (NFBS) composed of poly-L-lactic acid/amorphous calcium phosphate (PLLA/ACP) at six-month follow-up by comparing with PLLA scaffolds Methods Twelve PLLA/ACP scaffolds and 12 PLLA scaffolds were implanted into the coronary arteries of 12 miniature pigs. Quantitative coronary angiography (QCA) was used to measure the reference vessel diameter (RVD), mean lumen diameter (MLD) and late lumen loss (LLL). According to IVUS images, we calculated the strut malapposition rate (SMR) at post implantation, strut overlap rate (SOR), reference vessel area (RVA), mean stent area (MSA), mean lumen area (MLA) and luminal patency rate (LPR) at six-month follow-up. The radial strength of the scaffold was evaluated using a catheter tensile testing machine. Results QCA results indicated that, at six month, MLD of PLLA/ACP scaffolds was greater than those of PLLA scaffolds (2.47 ± 0.22 mm vs. 2.08 ± 0.25 mm, P < 0.05); LLL of PLLA/ACP scaffolds was less than those of PLLA scaffolds (0.42 ± 0.20 mm vs. 0.75 ± 0.22 mm, P < 0.05). IVUS results showed the SMR and SOR were all significantly less with the PLLA/ACP scaffolds than the PLLA scaffolds (5.84% ± 3.56% vs. 17.72% ± 4.86%, P < 0.05) (6.17% ± 4.63% vs. 17.65% ± 4.29%, P < 0.05). MSA, MLA and LPR of the PLLA/ACP scaffolds were all greater than those of PLLA scaffolds (6.35 ± 0.45 mm2 vs. 5.35 ± 0.51 mm2, P < 0.05) (4.76 ± 0.46 mm2 vs. 3.77 ± 0.46 mm2, P < 0.05) (78.01% ± 12.29% vs. 61.69% ± 9.76%, P < 0.05). Radial strength of PLLA/ACP scaffold at six month was greater than that of PLLA scaffold (76.33 ± 3.14 N vs. 67.67 ± 3.63 N). Conclusion The NFBS had less stent recoil, better lumen patency rate and greater radial strength than PLLA scaffolds. The results suggest the NFBS scaffolds can maintain the structural strength and functional performance, which are effective for up to six months when implanted in porcine coronary arteries.
Collapse
Affiliation(s)
- Thanh Dinh Nguyen
- 1 Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Gaoke Feng
- 1 Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xin Yi
- 1 Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yongnan Lyu
- 1 Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhiyuan Lan
- 2 VasoTech Inc., Lowell, MA, USA.,3 Department of Plastic Engineering, University of Massachusetts Lowell, Lowell, MA, USA.,5 Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | | | - Tim Wu
- 2 VasoTech Inc., Lowell, MA, USA.,3 Department of Plastic Engineering, University of Massachusetts Lowell, Lowell, MA, USA.,5 Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xuejun Jiang
- 1 Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| |
Collapse
|
59
|
Effects of mean platelet volume and platelet counts on peripheral biodegradable stent restenosis. JOURNAL OF SURGERY AND MEDICINE 2019. [DOI: 10.28982/josam.569158] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
60
|
Preparation of nanocellulose and lignin-carbohydrate complex composite biological carriers and culture of heart coronary artery endothelial cells. Int J Biol Macromol 2019; 137:1161-1168. [DOI: 10.1016/j.ijbiomac.2019.07.062] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/08/2019] [Accepted: 07/08/2019] [Indexed: 12/17/2022]
|
61
|
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.
Collapse
|
62
|
Early-Stage Vascular Response between Bare Metal Stent and Drug-Free Bioresorbable Vascular Scaffold in the Small-Sized Peripheral Artery: A Preclinical Study in Porcine Femoral Arteries. Ann Vasc Surg 2019; 60:388-396. [PMID: 31200063 DOI: 10.1016/j.avsg.2019.03.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 03/11/2019] [Accepted: 03/14/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND The clinical benefits and outcomes of the interventional treatment of small-sized infrapopliteal arteries using stent implantation remain uncertain. The aim of this study was to compare the safety and efficacy of drug-free bioresorbable vascular scaffold (BVS) with that of bare metal stent (BMS) in endovascular treatment of small-sized peripheral arteries. METHODS In this study, drug-free BVS and BMS were used in eight porcine models. We compared the angiographic and histomorphometric findings in the two groups at 4 weeks. In each pig, BVS and BMS of adequate sizes were implanted in the small branch (<3 mm) of the femoral artery. Angiography, intravascular ultrasound (IVUS), and histomorphometric analysis were performed at 4 weeks. RESULTS In the 4-week follow-up angiography and IVUS examination, the minimal luminal diameter was smaller and diameter stenosis was more severe in the BVS group. Histomorphometric findings indicated that the lumen area in the BVS group was smaller (0.34 ± 0.28 mm2 vs. 1.40 ± 0.52 mm2, P < 0.001), whereas the neointimal area (2.70 ± 1.28 mm2 vs. 1.76 ± 0.66 mm2, P = 0.013), area stenosis (85.18 ± 13.14 % vs. 54.99 ± 16.13 %, P < 0.001), inflammatory score (2.07 ± 0.861 vs. 28 ± 0.39, P = 0.003), and fibrin scores (1.24 ± 0.70 vs. 0.79 ± 0.72, P = 0.043) were significantly higher in the BVS group. The injury score was higher in the BMS group. In histopathologic findings, restenosis was mainly due to recoil and distortion of the scaffold in the BVS group. CONCLUSIONS Compared with BMS, drug-free BVS was not feasible for small-sized peripheral arteries based on the angiographic, IVUS, and histomorphometric results primarily due to insufficient mechanical support.
Collapse
|
63
|
Zhao G, Thompson MR, Zhu Z. Effect of poly(2‐ethyl‐2‐oxazoline) and UV irradiation on the melt rheology and mechanical properties of poly(lactic acid). J Appl Polym Sci 2019. [DOI: 10.1002/app.48023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Guoqing Zhao
- Shanghai Key Lab of Chemical Assessment and Sustainability, School of Chemical Science and EngineeringTongji University Shanghai 200092 China
| | - Michael R. Thompson
- Department of Chemical EngineeringMcMaster University Hamilton Ontario Canada
| | - Zhirong Zhu
- Shanghai Key Lab of Chemical Assessment and Sustainability, School of Chemical Science and EngineeringTongji University Shanghai 200092 China
| |
Collapse
|
64
|
Zhang Y, Zhao J, Yang G, Zhou Y, Gao W, Wu G, Li X, Mao C, Sheng T, Zhou M. Mechanical properties and degradation of drug eluted bioresorbable vascular scaffolds prepared by three-dimensional printing technology. JOURNAL OF BIOMATERIALS SCIENCE-POLYMER EDITION 2019; 30:547-560. [PMID: 30897033 DOI: 10.1080/09205063.2019.1586303] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Bioresorbable vascular scaffolds are expected to replace the traditional metal stent, avoiding the long-term complications of metal stents. However, it is hard for the traditional scaffold manufacturing process to meet the requirements of individualized treatment for vascular lesions, which requires different morphologies. Here, we used a new method of scaffold manufacturing, three-dimensional printing technology, to prepare bioresorbable vascular scaffolds. The fabricated scaffold was loaded with sirolimus mixed with scaffold preparation material for slow drug release. The engineered, drug- loaded, bioresorbable vascular scaffold (BVS) was analyzed and tested in vivo. The scaffolds produced by three-dimensional printing technology exhibited good mechanical properties and in vitro degradation performance. The results also suggested that these scaffolds could maintain effective radial strength after long-term degradation and sustained release of the drug. As a new scaffold preparation method, it may provide a promising idea for developing bioresorbable vascular scaffold technology.
Collapse
Affiliation(s)
- Yepeng Zhang
- a Department of Vascular Surgery , Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School , Nanjing , People's Republic of China
| | - Jie Zhao
- a Department of Vascular Surgery , Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School , Nanjing , People's Republic of China
| | - Guangmin Yang
- a Department of Vascular Surgery , Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School , Nanjing , People's Republic of China
| | - Yu Zhou
- a Department of Vascular Surgery , Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School , Nanjing , People's Republic of China
| | - Wentao Gao
- a Department of Vascular Surgery , Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School , Nanjing , People's Republic of China
| | - Guangyan Wu
- a Department of Vascular Surgery , Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School , Nanjing , People's Republic of China
| | - Xiaoqiang Li
- a Department of Vascular Surgery , Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School , Nanjing , People's Republic of China
| | - Chun Mao
- b School of Chemistry and National and Local Joint Engineering Research Center of Biomedical Functional Materials, Jiangsu Key Laboratory of Biofunctional Materials Materials Science , Nanjing Normal University , Nanjing , People's Republic of China
| | - Tao Sheng
- c Department of Vascular and Interventional Radiology , Wujin People's Hospital Affilicated to Jiangsu University , Changzhou , People's Republic of China
| | - Min Zhou
- a Department of Vascular Surgery , Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School , Nanjing , People's Republic of China
| |
Collapse
|
65
|
Asano T, Hytönen J, Chichareon P, Taavitsainen J, Kogame N, Katagiri Y, Miyazaki Y, Takahashi K, Modolo R, Komiyama H, Tenekecioglu E, Sotomi Y, Wykrzykowska JJ, Piek JJ, Martin J, Baumbach A, Mathur A, Onuma Y, Ylä-Herttuala S, Serruys PW. Serial Optical Coherence Tomography at Baseline, 7 Days, and 1, 3, 6 and 12 Months After Bioresorbable Scaffold Implantation in a Growing Porcine Model. Circ J 2019; 83:556-566. [PMID: 30700665 DOI: 10.1253/circj.cj-18-0855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Little is known about serial changes in lumen and device dimensions after bioresorbable scaffold implantation in a growing animal model. Methods and Results: ABSORB (n=14) or bare metal stents (ICROS amg [Abbott Vascular, Santa Clara, CA, USA], Winsen-Luhe, Germany; n=15) were implanted in the coronary arteries of domestic swine (a hybrid of Finnish-Norwegian Landrace swine) weighing 30-35 kg. Angiography and optical coherence tomography (OCT) were performed immediately after implantation and repeated at 7 days, 1, 3, 6 and 12 months after the index procedure. One month after implantation, mean lumen area decreased relative to baseline in both groups (relative area change from baseline, -41.4±15.6% for ABSORB vs. -20.9±18.6% for ICROS) while mean device area decreased only in the ABSORB group (relative area change: -11.1±9.4% vs. +0.14±7.95%, respectively). At 12 months, mean lumen area increased relative to baseline in both groups (relative area change from baseline, +55.6±22.4% vs. +32.3±83.6%, respectively) in accordance with the swine growth weighing up to 260-300 kg. Mean device area in the ICROS group remained stable whereas that in the ABSORB group began to increase between 3 and 6 months along with the vessel growth (relative area change: +107.8±25.7% vs. +0.14±7.95%). CONCLUSIONS In the growing porcine model, ABSORB was associated with greater extent of recoil 1 month after implantation compared with ICROS but demonstrated substantial adaptability to vessel growth in late phase.
Collapse
Affiliation(s)
- Taku Asano
- Department of Cardiology, Academic Medical Center, University of Amsterdam.,Department of Cardiology, St. Luke's International Hospital
| | - Jarkko Hytönen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland
| | - Ply Chichareon
- Department of Cardiology, Academic Medical Center, University of Amsterdam
| | - Jouni Taavitsainen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland
| | - Norihiro Kogame
- Department of Cardiology, Academic Medical Center, University of Amsterdam
| | - Yuki Katagiri
- Department of Cardiology, Academic Medical Center, University of Amsterdam
| | | | - Kuniaki Takahashi
- Department of Cardiology, Academic Medical Center, University of Amsterdam
| | - Rodrigo Modolo
- Department of Cardiology, Academic Medical Center, University of Amsterdam
| | - Hidenori Komiyama
- Department of Cardiology, Academic Medical Center, University of Amsterdam
| | | | - Yohei Sotomi
- Department of Cardiology, Academic Medical Center, University of Amsterdam
| | | | - Jan J Piek
- Department of Cardiology, Academic Medical Center, University of Amsterdam
| | - John Martin
- Division of Medicine, University College London
| | - Andreas Baumbach
- Department of Cardiology, Barts Health NHS Trust.,Department of Cardiology, Queen Mary University of London
| | - Anthony Mathur
- Department of Cardiology, Barts Health NHS Trust.,Department of Cardiology, Queen Mary University of London
| | | | - Seppo Ylä-Herttuala
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland
| | | |
Collapse
|
66
|
Chichareon P, Katagiri Y, Asano T, Takahashi K, Kogame N, Modolo R, Tenekecioglu E, Chang CC, Tomaniak M, Kukreja N, Wykrzykowska JJ, Piek JJ, Serruys PW, Onuma Y. Mechanical properties and performances of contemporary drug-eluting stent: focus on the metallic backbone. Expert Rev Med Devices 2019; 16:211-228. [DOI: 10.1080/17434440.2019.1573142] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Ply Chichareon
- Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Division of Cardiovascular Medicine, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand
| | - Yuki Katagiri
- Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Taku Asano
- Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Kuniaki Takahashi
- Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Norihiro Kogame
- Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Rodrigo Modolo
- Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Department of Internal Medicine, Cardiology Division, University of Campinas (UNICAMP). Campinas, Sao Paulo, Brazil
| | | | - Chun-Chin Chang
- ThoraxCenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Mariusz Tomaniak
- ThoraxCenter, Erasmus Medical Center, Rotterdam, the Netherlands
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Neville Kukreja
- Department of Cardiology, East and North Hertfordshire NHS Trust, Hertfordshire, UK
| | | | - Jan J. Piek
- Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Patrick W. Serruys
- International Centre for Circulatory Health, NHLI, Imperial College London, London, UK
| | - Yoshinobu Onuma
- ThoraxCenter, Erasmus Medical Center, Rotterdam, the Netherlands
| |
Collapse
|
67
|
Nagaraja V, Moss S, Jepson NS, Pitney MR. Saphenous vein graft intervention with a bioresorbable vascular scaffold: a follow-up optical coherence tomography study at 40 months. ASIAINTERVENTION 2019; 5:27-31. [PMID: 36483936 PMCID: PMC9706773 DOI: 10.4244/aij-d-18-00020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 11/19/2018] [Indexed: 06/17/2023]
Affiliation(s)
- Vinayak Nagaraja
- Department of Cardiology, Prince of Wales Hospital, Sydney, Australia
| | | | - Nigel S Jepson
- Department of Cardiology, Prince of Wales Hospital, Sydney, Australia
| | - Mark R Pitney
- Sutherland Heart Clinic, Sutherland Hospital, Sydney, Australia
| |
Collapse
|
68
|
Qi Y, Li X, He Y, Zhang D, Ding J. Mechanism of Acceleration of Iron Corrosion by a Polylactide Coating. ACS APPLIED MATERIALS & INTERFACES 2019; 11:202-218. [PMID: 30511850 DOI: 10.1021/acsami.8b17125] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Strong and biodegradable materials are key to the development of next-generation medical devices for interventional treatment. Biodegradable polymers such as polylactide (PLA) have controllable degradation profiles, but their mechanical strength is much weaker than some metallic materials such as iron; on the other hand, tuning the corrosion rate of iron to a proper time range for biomedical applications has always been a challenge. Very recently, we have achieved a complete corrosion of iron stent in vivo within the clinically required time frame by combining a PLA coating, which provides a new biomaterial type for the next-generation biodegradable coronary stents termed as a metal-polymer composite stent. The underlying mechanism of accelerating iron corrosion by a PLA coating remains an open fundamental topic. Herein, we investigated the corrosion mechanism of an iron sheet under a PLA coating in the biomimetic in vitro condition. The Pourbaix diagram (potential vs pH) was calculated to present the thermodynamic driving force of iron corrosion in the biomimetic aqueous medium. Electrochemical methods were applied to track the dynamic corrosion process and inspect various potential cues influencing iron corrosion. The present work reveals that acceleration of iron corrosion by the PLA coating arises mainly from decreasing the local pH owing to PLA hydrolysis and from alleviating the deposition of the passivation layer by the polymer coating.
Collapse
Affiliation(s)
- Yongli Qi
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science , Fudan University , Shanghai 200438 , China
| | - Xin Li
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science , Fudan University , Shanghai 200438 , China
| | - Yao He
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science , Fudan University , Shanghai 200438 , China
| | - Deyuan Zhang
- R&D Center, Lifetech Scientific (Shenzhen) Co., Ltd. , Shenzhen 518057 , China
| | - Jiandong Ding
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science , Fudan University , Shanghai 200438 , China
| |
Collapse
|
69
|
Brugaletta S, Cequier A, Alfonso F, Iñiguez A, Romaní S, Serra A, Salinas P, Goicolea J, Bordes P, del Blanco BG, Hernández-Antolín R, Pernigotti A, Gómez-Lara J, Sabaté M. MAGnesium-based bioresorbable scaffold and vasomotor function in patients with acute ST segment elevation myocardial infarction: The MAGSTEMI trial: Rationale and design. Catheter Cardiovasc Interv 2019; 93:64-70. [DOI: 10.1002/ccd.27825] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Salvatore Brugaletta
- Department of Cardiology, Institut Clínic Cardiovascular, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Barcelona Spain
| | - Angel Cequier
- Department of Cardiology, Hospital de Bellvitge; Barcelona Spain
| | | | - Andrés Iñiguez
- Department of Cardiology, Hospital Alvaro Cunqueiro; Vigo Spain
| | - Sebastian Romaní
- Department of Cardiology, Hospital San Pedro de Alcántara; Cáceres Spain
| | - Antonio Serra
- Department of Cardiology, Hospital de Sant Pau; Barcelona Spain
| | - Pablo Salinas
- Department of Cardiology, Hospital Clínico San Carlos; Madrid Spain
| | - Javier Goicolea
- Department of Cardiology, Hospital Puerta de Hierro-Majadahonda; Madrid Spain
| | - Pascual Bordes
- Department of Cardiology, Hospital General de Alicante; Alicante Spain
| | | | | | - Alberto Pernigotti
- Department of Cardiology, Institut Clínic Cardiovascular, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Barcelona Spain
| | - Josep Gómez-Lara
- Department of Cardiology, Hospital de Bellvitge; Barcelona Spain
| | - Manel Sabaté
- Department of Cardiology, Institut Clínic Cardiovascular, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Barcelona Spain
| |
Collapse
|
70
|
Letter by Dérimay et al. regarding the article, “A randomized trial comparing two stent sizing strategies in coronary bifurcation treatment with bioresorbable vascular scaffolds – The Absorb Bifurcation Coronary (ABC) trial” by Rampat et al. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:85-86. [DOI: 10.1016/j.carrev.2018.08.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 08/30/2018] [Indexed: 11/22/2022]
|
71
|
|
72
|
CTA Assessment of Coronary Atherosclerotic Plaque Evolution after BVS Implantation – a Follow-up Study. JOURNAL OF INTERDISCIPLINARY MEDICINE 2018. [DOI: 10.2478/jim-2018-0035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background: Computed tomography angiography (CTA) occupies an important place in the evaluation of coronary atherosclerotic lesions, both before and after the implantation of bioresorbable stents (BVS), providing an accurate assessment of the treated lesions.
Aim of the study: This study aims the prospective follow-up of atherosclerotic plaques electively treated with BVS implantation via CTA evaluation in terms of morphological and virtual histology aspects.
Material and methods: This is a prospective observational study which enrolled 30 patients electively treated with BVS implantation, in whom CTA was performed after PTCA in order to assess the morphological and virtual histology aspects of coronary plaques. In order to evaluate the impact determined by pre- and post-implantation procedures, statistical analysis was performed among 6 subgroups.
Results: After BVS implantation, a significant reduction was observed in terms of stenosis % (61.63 ± 12.63% in subgroup 1A vs. 24.41 ± 12.48% in subgroup 1B, p <0.0001) and eccentricity index (0.46 ± 0.24 in subgroup 1A vs. 0.43 ± 0.24 in subgroup 1B, p <0.0001). In terms of plaque components, there were significant differences with regard to lipid volume and lipid % (20.07 ± 15.67 mm3 in subgroup 1A vs. 11.05 ± 10.83 mm3 in subgroup 1B, p = 0.01), which presented a significant reduction after BVS implantation. The calcium score evaluated locally (82.97 ± 107.5 in subgroup 1A vs. 96.54 ± 85.73 in subgroup 1B, p = 0.25) and on the target coronary artery (148.2 ± 222.3 in subgroup 1A vs. 206.6 ± 224.0 in subgroup 1B, p = 0.10), as well as the total calcium score (377.6 ± 459.5 in subgroup 1A vs. 529.5 ± 512.9 in subgroup 1B, p = 0.32), presented no significant differences when compared with and without post-dilatation lesions. As far as CT vulnerability markers are concerned, the study groups presented significant differences only in terms of spotty calcifications (66.66% in subgroup 1A vs. 79.16% in subgroup 1B, p = 0.05) and low attenuation (37.5% in subgroup 1A vs. 20.83% in subgroup 1B, p = 0.01).
Conclusions: Following the analysis of coronary artery plaques after the implantation of BVS, significant changes were noted both in the morphology of the atherosclerotic plaques treated with these devices and in the lumen and coronary wall.
Collapse
|
73
|
Li H, Liu K, Zhao D, Wang M, Li Q, Hou J. Multi-Objective Optimizations for Microinjection Molding Process Parameters of Biodegradable Polymer Stent. MATERIALS (BASEL, SWITZERLAND) 2018; 11:E2322. [PMID: 30463214 PMCID: PMC6267175 DOI: 10.3390/ma11112322] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 11/11/2018] [Accepted: 11/15/2018] [Indexed: 12/22/2022]
Abstract
Microinjection molding technology for degradable polymer stents has good development potential. However, there is a very complicated relationship between molding quality and process parameters of microinjection, and it is hard to determine the best combination of process parameters to optimize the molding quality of polymer stent. In this study, an adaptive optimization method based on the kriging surrogate model is proposed to reduce the residual stress and warpage of stent during its injection molding. Integrating design of experiment (DOE) methods with the kriging surrogate model can approximate the functional relationship between design goals and design variables, replacing the expensive reanalysis of the stent residual stress and warpage during the optimization process. In this proposed optimization algorithm, expected improvement (EI) is used to balance local and global search. The finite element method (FEM) is used to simulate the micro-injection molding process of polymer stent. As an example, a typical polymer vascular stent ART18Z was studied, where four key process parameters are selected to be the design variables. Numerical results demonstrate that the proposed adaptive optimization method can effectively decrease the residual stress and warpage during the stent injection molding process.
Collapse
Affiliation(s)
- Hongxia Li
- School of Mechanical Engineering, Dalian University of Technology, Dalian 116023, China.
| | - Kui Liu
- School of Mechanical Engineering, Dalian University of Technology, Dalian 116023, China.
| | - Danyang Zhao
- School of Mechanical Engineering, Dalian University of Technology, Dalian 116023, China.
| | - Minjie Wang
- School of Mechanical Engineering, Dalian University of Technology, Dalian 116023, China.
| | - Qian Li
- National Center for International Joint Research of Micro-Nano Molding Technology, Zhengzhou University, Zhengzhou 450000, China.
| | - Jianhua Hou
- National Center for International Joint Research of Micro-Nano Molding Technology, Zhengzhou University, Zhengzhou 450000, China.
| |
Collapse
|
74
|
Balocco S, Ciompi F, Rigla J, Carrillo X, Mauri J, Radeva P. Assessment of intracoronary stent location and extension in intravascular ultrasound sequences. Med Phys 2018; 46:484-493. [PMID: 30383304 DOI: 10.1002/mp.13273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 10/11/2018] [Accepted: 10/12/2018] [Indexed: 11/06/2022] Open
Abstract
PURPOSE An intraluminal coronary stent is a metal scaffold deployed in a stenotic artery during percutaneous coronary intervention (PCI). In order to have an effective deployment, a stent should be optimally placed with regard to anatomical structures such as bifurcations and stenoses. Intravascular ultrasound (IVUS) is a catheter-based imaging technique generally used for PCI guiding and assessing the correct placement of the stent. A novel approach that automatically detects the boundaries and the position of the stent along the IVUS pullback is presented. Such a technique aims at optimizing the stent deployment. METHODS The method requires the identification of the stable frames of the sequence and the reliable detection of stent struts. Using these data, a measure of likelihood for a frame to contain a stent is computed. Then, a robust binary representation of the presence of the stent in the pullback is obtained applying an iterative and multiscale quantization of the signal to symbols using the Symbolic Aggregate approXimation algorithm. RESULTS The technique was extensively validated on a set of 103 IVUS of sequences of in vivo coronary arteries containing metallic and bioabsorbable stents acquired through an international multicentric collaboration across five clinical centers. The method was able to detect the stent position with an overall F-measure of 86.4%, a Jaccard index score of 75% and a mean distance of 2.5 mm from manually annotated stent boundaries, and in bioabsorbable stents with an overall F-measure of 88.6%, a Jaccard score of 77.7 and a mean distance of 1.5 mm from manually annotated stent boundaries. Additionally, a map indicating the distance between the lumen and the stent along the pullback is created in order to show the angular sectors of the sequence in which the malapposition is present. CONCLUSIONS Results obtained comparing the automatic results vs the manual annotation of two observers shows that the method approaches the interobserver variability. Similar performances are obtained on both metallic and bioabsorbable stents, showing the flexibility and robustness of the method.
Collapse
Affiliation(s)
- Simone Balocco
- Department of Matematics and Informatics, University of Barcelona, Gran Via 585, 08007, Barcelona, Spain.,Computer Vision Center, 08193, Bellaterra, Spain
| | - Francesco Ciompi
- Department of Pathology University Medical Center, Nijmegen, The Netherlands.,Diagnostic Image Analysis Group, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Xavier Carrillo
- University Hospital Germans Trias i Pujol, 08916, Badalona, Spain
| | - Josepa Mauri
- University Hospital Germans Trias i Pujol, 08916, Badalona, Spain
| | - Petia Radeva
- Department of Matematics and Informatics, University of Barcelona, Gran Via 585, 08007, Barcelona, Spain.,Computer Vision Center, 08193, Bellaterra, Spain
| |
Collapse
|
75
|
Regazzoli D, Latib A, Ezhumalai B, Tanaka A, Leone PP, Khan S, Kumar V, Rastogi V, Ancona MB, Mangieri A, Giannini F, Mitomo S, Seth A, Colombo A. Long-term follow-up of BVS from a prospective multicenter registry: Impact of a dedicated implantation technique on clinical outcomes. Int J Cardiol 2018; 270:113-117. [PMID: 29983253 DOI: 10.1016/j.ijcard.2018.06.094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 06/03/2018] [Accepted: 06/21/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the impact of a consistent and dedicated implantation strategy on long-term outcomes after implantation of bioresorbable vascular scaffold (BVS) in a real-world cohort of patients with a high prevalence of complex lesions. BACKGROUND Bioresorbable vascular scaffolds may result in a reduced incidence of late and very-late scaffold thrombosis (ScT) after the complete reabsorption of the scaffold, but this hypothesis is hampered by data from RCTs that showed a higher than expected incidence of late events. However, these studies did not adopt a dedicated implantation technique, that proved to be fundamental in reducing the incidence of adverse events. METHODS 573 consecutive patients (912 lesions) treated with bioresorbable scaffolds between May 2012 and December 2014 were enrolled in 3 high-volume centers that used a dedicated implantation strategy from the beginning. Primary endpoints were target-lesion failure (TLF) and definite and probable ScT. Secondary endpoints included myocardial infarction, target-lesion and target-vessel revascularization. RESULTS The registry enrolled a high complexity subset of lesions (69.4% of type B2 or C lesions; 10.3% of severe calcific lesions; 26.1% of bifurcations). Predilatation was performed in almost all cases (99.2%); intracoronary imaging was liberally adopted (37.3%). Mean scaffold length was 42.9 ± 27.4 mm per patient, and post-dilation with a 1:1 high-pressure (22 ± 3.5 atm) balloon was performed in 99.9% of lesions. Median follow-up (available for 98.6% of patients) was 981 days (IQR 802-1133). Overall incidence of ScT was reassuringly low: three thrombotic events occurred during the first year (0.5%), while only one event ensued in the second year of follow-up, and ScT rate remained stable thereafter up to the fourth year (0.7%). Cumulative TLF rates at 1, 2, 3 and 4 years were 3.0%, 6.0%, 7.8% and 12.2%. CONCLUSIONS These long-term results from a complex "real-world" population appear to be reassuring as regards to the incidence of ScT and TLF when BVS are implanted by experienced operators with a dedicated implantation technique.
Collapse
Affiliation(s)
- Damiano Regazzoli
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Azeem Latib
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Unit of Cardiovascular Interventions, EMO-GVM Centro Cuore Columbus, Milan, Italy.
| | - Babu Ezhumalai
- Unit of Cardiovascular Interventions, Fortis Escorts Heart Institute, New Delhi, India
| | - Akihito Tanaka
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Pier Pasquale Leone
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sara Khan
- Unit of Cardiovascular Interventions, Fortis Escorts Heart Institute, New Delhi, India
| | - Vijay Kumar
- Unit of Cardiovascular Interventions, Fortis Escorts Heart Institute, New Delhi, India
| | - Vishal Rastogi
- Unit of Cardiovascular Interventions, Fortis Escorts Heart Institute, New Delhi, India
| | - Marco Bruno Ancona
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Mangieri
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Giannini
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Unit of Cardiovascular Interventions, EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Satoru Mitomo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ashok Seth
- Unit of Cardiovascular Interventions, Fortis Escorts Heart Institute, New Delhi, India
| | - Antonio Colombo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Unit of Cardiovascular Interventions, EMO-GVM Centro Cuore Columbus, Milan, Italy
| |
Collapse
|
76
|
Abstract
The quest for an ideal biodegradable stent for both adult coronary and pediatric congenital heart disease applications continues. Over the past few years, a lot of progress has been made toward development of a dedicated pediatric biodegradable stent that can be used for congenital heart disease applications. At present, there are no biodegradable stents available for use in congenital heart disease. In this article, the authors review the different biodegradable materials and their limitations and provide an overview of the current biodegradable stents being evaluated for congenital heart disease applications.
Collapse
Affiliation(s)
- Tre R Welch
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Alan W Nugent
- Division of Cardiology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 21, Chicago, IL 60611, USA
| | - Surendranath R Veeram Reddy
- Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Children's Health System of Texas, Childrens Medical Center, 1935 Medical District Drive, Dallas, TX 75235, USA.
| |
Collapse
|
77
|
Vascular Intervention: From Angioplasty to Bioresorbable Vascular Scaffold. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018. [PMID: 30315545 DOI: 10.1007/978-3-319-96445-4_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
Coronary artery disease (CAD) is the leading cause of mortality and morbidity worldwide. Clinically, CAD can be potentially managed through surgical artery bypass. However, due to the highly invasive nature, surgical intervention has been gradually replaced by percutaneous transluminal coronary angioplasty and recently by percutaneous coronary revascularization using metallic stents. However, the permanent presence of metallic scaffolds inevitably impairs arterial physiology and may induce a variety of adverse effects, such as inflammation, restenosis, thrombosis, and neoatherosclerosis. To address these limitations, revascularization using bioresorbable vascular scaffolds (BVSs) has emerged as the most promising approach. After angioplasty, BVSs provide temporarily mechanical support and are completely resorbed over defined time. This transient nature allows favorable arterial remodeling and avoids thrombosis and in-stent restenosis. However, the theoretical advantages of BVSs have yet to be demonstrated. In this chapter, we first review the evolution of nonsurgical vascular intervention approaches over the past few decades. Next, we discuss the current status of BVS development and propose potential approaches to addressing the limitations associated with the current BVSs.
Collapse
|
78
|
Biodegradable stents for coronary artery disease treatment: Recent advances and future perspectives. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2018; 91:163-178. [DOI: 10.1016/j.msec.2018.04.100] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 04/11/2018] [Accepted: 04/28/2018] [Indexed: 12/24/2022]
|
79
|
Serruys PW, Onuma Y. Dmax for sizing, PSP-1, PSP-2, PSP-3 or OCT guidance: interventionalist's jargon or indispensable implantation techniques for short- and long-term outcomes of Absorb BRS? EUROINTERVENTION 2018; 12:2047-2056. [PMID: 28246059 DOI: 10.4244/eijy17m02_01] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
80
|
Understanding the Impact of Stent and Scaffold Material and Strut Design on Coronary Artery Thrombosis from the Basic and Clinical Points of View. Bioengineering (Basel) 2018; 5:bioengineering5030071. [PMID: 30181463 PMCID: PMC6164756 DOI: 10.3390/bioengineering5030071] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 08/23/2018] [Accepted: 08/30/2018] [Indexed: 01/09/2023] Open
Abstract
The technology of percutaneous coronary intervention (PCI) is constantly being refined in order to overcome the shortcomings of present day technologies. Even though current generation metallic drug-eluting stents (DES) perform very well in the short-term, concerns still exist about their long-term efficacy. Late clinical complications including late stent thrombosis (ST), restenosis, and neoatherosclerosis still exist and many of these events may be attributed to either the metallic platform and/or the drug and polymer left behind in the arterial wall. To overcome this limitation, the concept of totally bioresorbable vascular scaffolds (BRS) was invented with the idea that by eliminating long-term exposure of the vessel wall to the metal backbone, drug, and polymer, late outcomes would improve. The Absorb-bioabsorbable vascular scaffold (Absorb-BVS) represented the most advanced attempt to make such a device, with thicker struts, greater vessel surface area coverage and less radial force versus contemporary DES. Unfortunately, almost one year after its initial approval by the U.S. Food and Drug Administration, this scaffold was withdrawn from the market due to declining devise utilization driven by the concerns about scaffold thrombosis (ScT) seen in both early and late time points. Additionally, the specific causes of ScT have not yet been fully elucidated. In this review, we discuss the platform, vascular response, and clinical data of past and current metallic coronary stents with the Absorb-BVS and newer generation BRS, concentrating on their material/design and the mechanisms of thrombotic complications from the pre-clinical, pathologic, and clinical viewpoints.
Collapse
|
81
|
Jelonek K, Jaworska J, Pastusiak M, Sobota M, Włodarczyk J, Karpeta-Jarzabek P, Kaczmarczyk B, Kasperczyk J, Dobrzyński P. Effect of vascular scaffold composition on release of sirolimus. Eur J Pharm Biopharm 2018; 132:41-49. [PMID: 30179737 DOI: 10.1016/j.ejpb.2018.08.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 08/31/2018] [Accepted: 08/31/2018] [Indexed: 11/25/2022]
Abstract
Despite extensive development of bioresorbable drug-eluting vascular scaffolds it is still challenging to achieve controlled drug delivery. The lack of capacity for adjusting the drug dose and inadequate release behavior are one of the main reasons of the side effects. However, so far, mainly biodegradable drug-eluting coatings of metallic stents have been studied in regard to explain drug release mechanisms. The objective of this study was to develop degradable polymer coatings applicable to bioresorbable polymer-based scaffolds. Moreover, a detailed analysis of sirolimus release and scaffold degradation has been conducted. Coating layers of the same composition were applied by the same method on the surface of two different kinds of scaffolds in order to explain the effect of scaffold structure on release process. The developed coatings showed controlled release of antiproliferative agent with elimination of burst effect. However, differences in drug release profile from two kinds of scaffolds were observed. Scaffold composed of polymer with higher lactide content showed slower and bi-phasic, erosion-controlled release of sirolimus. On the contrary, sirolimus release from scaffold composed of polymer with lower content of lactide was mainly controlled by diffusion. These results demonstrate that characteristics of scaffold is another crucial factor that must be considered in further development of bioresorbable vascular scaffolds (BRS) with controlled release of antiproliferative agent.
Collapse
Affiliation(s)
- Katarzyna Jelonek
- Centre of Polymer and Carbon Materials, Polish Academy of Sciences, Curie-Sklodowska 34 St., 41-819 Zabrze, Poland.
| | - Joanna Jaworska
- Centre of Polymer and Carbon Materials, Polish Academy of Sciences, Curie-Sklodowska 34 St., 41-819 Zabrze, Poland
| | - Małgorzata Pastusiak
- Centre of Polymer and Carbon Materials, Polish Academy of Sciences, Curie-Sklodowska 34 St., 41-819 Zabrze, Poland
| | - Michał Sobota
- Centre of Polymer and Carbon Materials, Polish Academy of Sciences, Curie-Sklodowska 34 St., 41-819 Zabrze, Poland
| | - Jakub Włodarczyk
- Centre of Polymer and Carbon Materials, Polish Academy of Sciences, Curie-Sklodowska 34 St., 41-819 Zabrze, Poland
| | - Paulina Karpeta-Jarzabek
- Centre of Polymer and Carbon Materials, Polish Academy of Sciences, Curie-Sklodowska 34 St., 41-819 Zabrze, Poland
| | - Bożena Kaczmarczyk
- Centre of Polymer and Carbon Materials, Polish Academy of Sciences, Curie-Sklodowska 34 St., 41-819 Zabrze, Poland
| | - Janusz Kasperczyk
- Centre of Polymer and Carbon Materials, Polish Academy of Sciences, Curie-Sklodowska 34 St., 41-819 Zabrze, Poland; School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia, Katowice, Poland, Chair and Department of Biopharmacy, Jedności 8, Sosnowiec, Poland
| | - Piotr Dobrzyński
- Centre of Polymer and Carbon Materials, Polish Academy of Sciences, Curie-Sklodowska 34 St., 41-819 Zabrze, Poland; Faculty of Mathematics and Natural Sciences, Jan Dlugosz University, Armii Krajowej 13/15, 42-218 Czestochowa, Poland
| |
Collapse
|
82
|
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.
Collapse
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
| |
Collapse
|
83
|
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.
Collapse
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:
| | | |
Collapse
|
84
|
Two-year clinical outcomes after implantation of an everolimus-eluting bioresorbable scaffold (Absorb) in stable angina and acute coronary syndrome patients. Single-centre real-life registry data. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2018; 14:144-148. [PMID: 30008766 PMCID: PMC6041844 DOI: 10.5114/aic.2018.76405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 03/05/2018] [Indexed: 11/27/2022] Open
Abstract
Aim The aim of this long-term registry data was to evaluate 2-year clinical and angiographic outcomes after implantation of everolimus-eluting bioresorbable scaffolds (Absorb) from the Latvian Centre of Cardiology Real-life Registry. Material and methods Between November 2012 and December 2014 in the Centre of Cardiology Real-life Bioresorbable Vascular Scaffold Registry, 187 patients with stable angina or acute coronary syndrome and available 2-year follow-up were selected. All patients had percutaneous coronary intervention (PCI) following bioresorbable scaffold (Absorb) implantation. At 2 years, clinical parameters were analysed in stable angina and acute coronary syndrome subgroups: all-cause death, cardiac death, non-cardiac death, myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), scaffold thrombosis (ST), cerebral infarction, in-scaffold restenosis and bleeding. Results The clinical follow-up rate at 2 years was 96.2%. In-hospital death occurred in 2 (1.1%) patients, and 1 (0.5%) patient had in-hospital MI. At 2 years, the rate of all-cause death was 3.9% (n = 7), MI 1.6% (n = 3), TLR 3.9% (n = 7), and TVR 8.4% (n = 15). Between hospital discharge and 2-year follow-up scaffold thrombosis occurred in 2 (1.1%) patients. In-hospital scaffold thrombosis occurred in 1 (0.5%) patient due to clopidogrel resistance, and 1 additional case of scaffold thrombosis occurred at 5 days after implantation (0.5%). Conclusions Bioresorbable scaffolds showed acceptable efficacy (target lesion revascularization) and safety (cardiac death, myocardial infarction, and scaffold thrombosis) results at mid-term follow-up in stable angina and acute coronary syndrome patients.
Collapse
|
85
|
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.
Collapse
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
| |
Collapse
|
86
|
Shamimi-Noori SM, Clark TW. Venous Stents: Current Status and Future Directions. Tech Vasc Interv Radiol 2018; 21:113-116. [DOI: 10.1053/j.tvir.2018.03.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
87
|
Nikoubashman O, Heringer S, Feher K, Brockmann MA, Sellhaus B, Dreser A, Kurtenbach K, Pjontek R, Jockenhövel S, Weis J, Kießling F, Gries T, Wiesmann M. Development of a Polymer-Based Biodegradable Neurovascular Stent Prototype: A Preliminary In Vitro and In Vivo Study. Macromol Biosci 2018; 18:e1700292. [PMID: 29855168 DOI: 10.1002/mabi.201700292] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 01/10/2018] [Indexed: 11/10/2022]
Abstract
Biodegradable stents are not established in neurovascular interventions. In this study, mechanical, radiological, and histological characteristics of a stent prototype developed for neurovascular use are presented. The elasticity and brittleness of PLA 96/4, PLDL 70/30, PCL, and PLGA 85/15 and 10/90 polymers in in vitro experiments are first analyzed. After excluding the inapt polymers, degradability and mechanical characteristics of 78 PLGA 85/15 and PLGA 10/90 stent prototypes are analyzed. After excluding PLGA 10/90 stents because of rapid loss of mass PLGA 85/15 stents in porcine in vivo experiments are analyzed. Angiographic occlusion rates 7 d, 1 month, 3 months, and 6 months after stent implantation are assessed. Histological outcome measures are the presence of signs of inflammation, endothelialization, and the homogeneity of degradation after six months. One case of stent occlusion occurs within the first 7 d. There is a prominent foreign-body reaction with considerable mononuclear and minor granulocytic inflammation combined with incomplete fragmental degradation of the struts. It is possible to produce a stent prototype with dimensions that fit the typical size of carotid arteries. Major improvements concerning thrombogenicity, degradation, and inflammatory response are required to produce biodegradable stents that are suitable for neurovascular interventions.
Collapse
Affiliation(s)
- Omid Nikoubashman
- Department of Diagnostic and Interventional Neuroradiology, University Hospital, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Sarah Heringer
- Department of Diagnostic and Interventional Neuroradiology, University Hospital, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Katalin Feher
- Institute of Tissue Engineering and Textile Implants, RWTH Aachen University, Otto-Blumenthal-Str. 1, 52074, Aachen, Germany
| | - Marc-Alexander Brockmann
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Mainz, 55131, Mainz, Germany
| | - Bernd Sellhaus
- Institute of Neuropathology, University Hospital, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Alice Dreser
- Institute of Neuropathology, University Hospital, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Kathrin Kurtenbach
- Institute of Tissue Engineering and Textile Implants, RWTH Aachen University, Otto-Blumenthal-Str. 1, 52074, Aachen, Germany.,Institute of Neuropathology, University Hospital, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Rastislav Pjontek
- Department of Diagnostic and Interventional Neuroradiology, University Hospital, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany.,Institute of Neuropathology, University Hospital, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Stefan Jockenhövel
- Institute of Tissue Engineering and Textile Implants, RWTH Aachen University, Otto-Blumenthal-Str. 1, 52074, Aachen, Germany.,Institute of Neuropathology, University Hospital, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany.,Institute of Applied Medical Engineering, University Hospital, RWTH Aachen University, Pauwelsstr. 20, 52074, Aachen, Germany
| | - Joachim Weis
- Institute of Neuropathology, University Hospital, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Fabian Kießling
- Institute of Experimental Molecular Imaging, University Hospital, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Thomas Gries
- Institute of Tissue Engineering and Textile Implants, RWTH Aachen University, Otto-Blumenthal-Str. 1, 52074, Aachen, Germany
| | - Martin Wiesmann
- Department of Diagnostic and Interventional Neuroradiology, University Hospital, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
| |
Collapse
|
88
|
Torrado J, Buckley L, Durán A, Trujillo P, Toldo S, Valle Raleigh J, Abbate A, Biondi-Zoccai G, Guzmán LA. Restenosis, Stent Thrombosis, and Bleeding Complications. J Am Coll Cardiol 2018; 71:1676-1695. [PMID: 29650125 DOI: 10.1016/j.jacc.2018.02.023] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 01/17/2018] [Accepted: 02/11/2018] [Indexed: 02/08/2023]
|
89
|
Lee JH, Kim ED, Jun EJ, Yoo HS, Lee JW. Analysis of trends and prospects regarding stents for human blood vessels. Biomater Res 2018; 22:8. [PMID: 29564151 PMCID: PMC5851094 DOI: 10.1186/s40824-018-0114-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 02/12/2018] [Indexed: 11/18/2022] Open
Abstract
Background The purpose of this paper is to provide technology trends and information regarding market and prospects in stents used for human blood vessels in Korea and the world. A stent is a medical device in the form of a cylindrical metal net used to normalize flow when blood or other bodily fluids such as biliary fluids are obstructed in blood vessels, gastrointestinal tracts, etc. by inserting the stent into a narrowed or clogged area. Stents are classified into vascular and non-vascular stents. The coronary artery stent is avascular stent that is used for coronary atherosclerosis. The demand is increasing for stents to treat diseases such as those affecting the heart and blood vessels of elderly and middle-aged patients. Due to the current shift in the demographic structure caused by an aging society, the prospect for stents seems to be very bright. The use of a stent designed to prevent acute vascular occlusion and restenosis, which is a side effect of conventional balloon angioplasty, has rapidly become popular because it can prevent acute complications and improve clinical outcomes. Since the initial release of this stent, there have been significant developments in its design, the most notable of which has been the introduction of drug-eluting stents (DES). Bioresorbable scaffolds (BRS) have the potential to introduce a paradigm shift in interventional cardiology, a true anatomical and functional “vascular restoration” instead of an artificial stiff tube encased by a persistent metallic foreign body. Methods Data for this research were gathered from primary and secondary sources as well as the databases of the Korea Institute of Science Technology Information (KISTI) located in Seoul, Korea like KISTI Market Report. The sources used for primary research included the databases available from the Korea Institute of Science Technology Information, past industry research services/studies, economic and demographic data, and trade and industry journals. Secondary research was used to supplement and complement the primary research. Interviews were conducted with physicians and surgeons from the key hospitals and senior sale/marketing managers from stent product suppliers in South Korea. Results The global stent market is estimated at US $ 7.98 billion in 2016 and is expected to grow at a Compound Annual Growth Rate (CAGR) of 3.8% over the next 5 years. As of 2016, the global market for vascular stents is estimated at $ 7.22 billion, with coronary artery stents accounting for 67.3% of the vascular stent market. Among the coronary artery stents, BRS is notably expected to grow at an annual average rate of 8.8% by 2020, but the global adoption rate of BRS remains low at present. In the Korean market, stents for blood vessels account for most of the market, and the market size of stents for blood vessels in Korea was estimated to be 145 billion won as of 2016. Conclusions In comparison to the sales growth rate of other medical devices, the future stent technology market is judged to be higher in growth potential.
Collapse
Affiliation(s)
- Jeong Hee Lee
- 1Graduate School of Health Science Business Convergence, College of Medicine, Chungbuk National University, Chungdae-ro 1, Seowon-Gu, Cheongju, Chungbuk 28644 Korea
| | - Eung Do Kim
- 1Graduate School of Health Science Business Convergence, College of Medicine, Chungbuk National University, Chungdae-ro 1, Seowon-Gu, Cheongju, Chungbuk 28644 Korea
| | - Eun Jung Jun
- Aurios Medical, M-2503, 32 569 Songdogwahak-ro, Yeonsu-gu, Incheon, 21984 Korea
| | - Hyoung Sun Yoo
- 3Korea Institute of Science and Technology Information, 66 Heogi-ro, 570 Dongdeamoon-gu, Seoul, 02456 Korea
| | - Joon Woo Lee
- 3Korea Institute of Science and Technology Information, 66 Heogi-ro, 570 Dongdeamoon-gu, Seoul, 02456 Korea
| |
Collapse
|
90
|
Han Y, Xu B, Fu G, Wang X, Xu K, Jin C, Tao L, Li L, Hou Y, Su X, Fang Q, Chen L, Liu H, Wang B, Yuan Z, Gao C, Zhou S, Sun Z, Zhao Y, Guan C, Stone GW. A Randomized Trial Comparing the NeoVas Sirolimus-Eluting Bioresorbable Scaffold and Metallic Everolimus-Eluting Stents. JACC Cardiovasc Interv 2018; 11:260-272. [DOI: 10.1016/j.jcin.2017.09.037] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 09/19/2017] [Accepted: 09/26/2017] [Indexed: 01/25/2023]
|
91
|
Moncada M, Delgado JA, Colombo A, Gasior P, Ramzipoor K, Estrada A, Lee C, Dokko D, Granada JF. First in human evaluation of the vascular biocompatibility and biomechanical performance of a novel ultra high molecular weight amorphous PLLA bioresorbable scaffold in the absence of anti-proliferative drugs: Two-year imaging results in humans. Catheter Cardiovasc Interv 2017; 92:E246-E253. [DOI: 10.1002/ccd.27444] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 11/07/2017] [Accepted: 11/12/2017] [Indexed: 11/08/2022]
Affiliation(s)
| | - Juan A. Delgado
- San Vicente Fundacion and Hospital Manuel Uribe Angel; Medellin Colombia
| | | | - Pawel Gasior
- 3rd Department of Cardiology; Medical University of Silesia; Katowice Poland
- CRF-Skirball Center for Innovation; New York New York
| | | | | | - Chang Lee
- Amaranth Medical, Inc; Mountain View California
| | - Danny Dokko
- Amaranth Medical, Inc; Mountain View California
| | | |
Collapse
|
92
|
Naganuma T, Kawamoto H, Panoulas VF, Latib A, Tanaka A, Mitomo S, Ruparelia N, Jabbour RJ, Chieffo A, Carlino M, Montorfano M, Colombo A. Mid-term clinical outcomes of ABSORB bioresorbable vascular scaffold versus everolimus-eluting stent for coronary bifurcation lesions. Int J Cardiol 2017; 246:26-31. [DOI: 10.1016/j.ijcard.2017.03.123] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 02/21/2017] [Accepted: 03/24/2017] [Indexed: 10/18/2022]
|
93
|
Maeremans J, Verhaert D, Pereira B, Frambach P, Van Mieghem C, Barbato E, Willems E, Vrolix M, Dens J. One-year clinical and computed tomography follow-up after implantation of bioresorbable vascular scaffolds in patients with coronary chronic total occlusions. Catheter Cardiovasc Interv 2017; 92:488-496. [DOI: 10.1002/ccd.27390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 09/18/2017] [Accepted: 10/09/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Joren Maeremans
- Faculty of Medicine and Life Sciences; Universiteit Hasselt; Hasselt Belgium
- Department of Cardiology; Ziekenhuis Oost-Limburg; Genk Belgium
| | - David Verhaert
- Department of Cardiology; Ziekenhuis Oost-Limburg; Genk Belgium
| | - Bruno Pereira
- Department of Cardiology; Institut de Chirurgie Cardiaque et de Cardiologie Interventionelle; Luxembourg Luxembourg
| | - Peter Frambach
- Department of Cardiology; Institut de Chirurgie Cardiaque et de Cardiologie Interventionelle; Luxembourg Luxembourg
| | | | - Emanuele Barbato
- Department of Cardiology; Onze-Lieve-Vrouw-Ziekenhuis; Aalst Belgium
- Department of Advanced Biomedical Medicine; University of Naples Federico II; Naples Italy
| | - Endry Willems
- Department of Radiology; Ziekenhuis Oost-Limburg; Genk Belgium
| | - Mathias Vrolix
- Department of Cardiology; Ziekenhuis Oost-Limburg; Genk Belgium
| | - Jo Dens
- Faculty of Medicine and Life Sciences; Universiteit Hasselt; Hasselt Belgium
- Department of Cardiology; Ziekenhuis Oost-Limburg; Genk Belgium
| |
Collapse
|
94
|
Affiliation(s)
- Ron Waksman
- From the Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
| | - Arie Steinvil
- From the Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| |
Collapse
|
95
|
Steinvil A, Rogers T, Torguson R, Waksman R. Overview of the 2016 U.S. Food and Drug Administration Circulatory System Devices Advisory Panel Meeting on the Absorb Bioresorbable Vascular Scaffold System. JACC Cardiovasc Interv 2017; 9:1757-64. [PMID: 27609249 DOI: 10.1016/j.jcin.2016.06.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 06/03/2016] [Accepted: 06/15/2016] [Indexed: 02/06/2023]
Abstract
OBJECTIVES This study aims to describe the discussions and recommendations made during the U.S. Food and Drug Administration (FDA) Circulatory System Device Panel pre-market approval application for the Absorb Bioresorbable Vascular Scaffold (BVS) System. BACKGROUND The Absorb BVS System is a first-of-its-kind fully bioresorbable percutaneous coronary intervention technology. The absorb BVS was studied in the ABSORB III (A Clinical Evaluation of Absorb BVS, the Everolimus Eluting Bioresorbable Vascular Scaffold in the Treatment of Subjects with de Novo Native Coronary Artery Lesions) trial, the pivotal U.S. investigational device exemption trial. METHODS Observational report of the FDA Circulatory System Device Panel pre-market approval application meeting held on March 15, 2016. RESULTS The U.S. FDA Circulatory System Device Panel members reviewed the ABSROB III trial outcomes and additional post hoc analyses presented by the sponsor and the FDA. The ABSORB III trial met the primary endpoint of noninferiority of Absorb BVS compared with the control, XIENCE drug-eluting stent, for target lesion failure at 1 year. Although a higher numerical trend for adverse outcomes was reported for the Absorb BVS, there were no statistical differences between Absorb BVS and XIENCE for any safety or effectiveness components for target lesion failure or for the secondary pre-specified outcomes. Panel members raised concerns with regard to the ABSORB III results and post hoc analyses focusing mainly on the noninferiority design of the trial, the apparent safety issues of the Absorb BVS in small vessels, the mismatch of visually versus intravascular imaging assessed vessel size found in ABSORB III and its implications on the adequate device labeling, the safety of Absorb BVS in specific patient and lesion subsets, and the post-approval commitments of the sponsor. CONCLUSIONS Following panel discussions and the evidence presented, the panel voted for approval of the device.
Collapse
Affiliation(s)
- Arie Steinvil
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Rebecca Torguson
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
| |
Collapse
|
96
|
Tanaka A, Jabbour RJ, Mitomo S, Latib A, Colombo A. Hybrid Percutaneous Coronary Intervention With Bioresorbable Vascular Scaffolds in Combination With Drug-Eluting Stents or Drug-Coated Balloons for Complex Coronary Lesions. JACC Cardiovasc Interv 2017; 10:539-547. [PMID: 28335892 DOI: 10.1016/j.jcin.2016.12.285] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 12/05/2016] [Accepted: 12/29/2016] [Indexed: 12/26/2022]
Abstract
Bioresorbable vascular scaffolds (BVS) have become an attractive option in the percutaneous coronary intervention field due to the potential advantages associated with the complete resorption process that occurs within a few years. However, current-generation BVS have several limitations including thicker struts, reduced radial strength, and limited expansion capability when compared with drug-eluting stents (DES). As a result, complex coronary disease often contains BVS-inappropriate/unfavorable segments. This does not necessarily mean that BVS use must be completely avoided, and minimizing the length of permanent metallic caging may still be advantageous. Operators should fully understand the limitations of current BVS, and when to consider a hybrid strategy of BVS in combination with DES or drug-coated balloons.
Collapse
Affiliation(s)
- Akihito Tanaka
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy; Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Richard J Jabbour
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy; Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Department of Cardiology, Imperial College London, London, United Kingdom
| | - Satoru Mitomo
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy; Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Azeem Latib
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy; Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Colombo
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy; Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.
| |
Collapse
|
97
|
Huang CH, Lee SY, Horng S, Guy LG, Yu TB. In vitro and in vivo degradation of microfiber bioresorbable coronary scaffold. J Biomed Mater Res B Appl Biomater 2017; 106:1842-1850. [PMID: 28922543 PMCID: PMC6635671 DOI: 10.1002/jbm.b.33987] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 08/21/2017] [Accepted: 08/28/2017] [Indexed: 01/08/2023]
Abstract
The degradation of Mirage Bioresorbable Microfiber Scaffold was evaluated in vitro and in vivo. The degradation in polymer molecular weight (MW), strut morphology, and integrity was accessed using gel permeation chromatography (GPC), X‐ray micro‐computed tomography (micro‐CT) evaluation. To simulate the physiological degradation in vitro, scaffolds were deployed in silicone mock vessels connected to a peristaltic pumping system, which pumps 37°C phosphate‐buffered saline (PBS, pH 7.4) at a constant rate. At various time points (30D, 60D, 90D, 180D, 270D, and 360D), the MW of microfibers decreased to 57.3, 49.8, 36.9, 13.9, 6.4, and 5.1% against the baseline. The in vivo degradation study was performed by implanting scaffolds in internal thoracic arteries (ITAs) of mini‐swine. At the scheduled sacrifice time points (30D, 90D, 180D, 270D, 360D, and 540D), the implanted ITAs were excised for GPC analysis; the MW of the implanted scaffolds dropped to 58.5, 34.7, 24.8, 16.1, 12.9, and 7.1, respectively. Mass loss of scaffolds reached 72.4% at 540D of implantation. Two stages of hydrolysis were observed in in vitro and in vivo degradation kinetics, and the statistical analysis suggested a positive correlation between in vivo and in vitro degradation. After 6 months of incubation in animals, significant strut degradation was seen in the micro‐CT evaluation in all sections as strut fragments and separations. The micro‐CT results further confirmed that every sample at 720D had X‐ray transmission similar to surrounding tissue, thereby indicating full degradation within 2 years. © 2017 The Authors. Journal of Biomedical Materials Research Part B: Applied Biomaterials published by Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 1842–1850, 2018.
Collapse
Affiliation(s)
- Chi-Hung Huang
- Division of Cardiology, Department of Internal Medicine, Cathay General Hospital, Taipei, Taiwan.,School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Sheng-Yang Lee
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan.,Dental Department of Taipei Medical University, Wan-Fang Hospital, Taipei, Taiwan
| | - Sonida Horng
- Accellab Inc., Boisbriand, Quebec, J7H 1N8, Canada
| | | | | |
Collapse
|
98
|
Im SH, Jung Y, Kim SH. Current status and future direction of biodegradable metallic and polymeric vascular scaffolds for next-generation stents. Acta Biomater 2017; 60:3-22. [PMID: 28716610 DOI: 10.1016/j.actbio.2017.07.019] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 07/04/2017] [Accepted: 07/12/2017] [Indexed: 01/18/2023]
Abstract
Because of the increasing incidence of coronary artery disease, the importance of cardiovascular stents has continuously increased as a treatment of this disease. Biodegradable scaffolds fabricated from polymers and metals have emerged as promising materials for vascular stents because of their biodegradability. Although such stent framework materials have shown good clinical efficacy, it is difficult to decide whether polymers or metals are better vascular scaffolds because their properties are different. Therefore, there are still obstacles in the development of biodegradable vascular scaffolds in terms of improving clinical efficacy. This review analyzes the pros and cons of current stent materials with respect to five key factors for next-generation stent and discusses methods of improvement. Furthermore, we discuss biodegradable electronic stents with electrical conductivity, which has been considered unimportant until now, and highlight electrical conductivity as a key factor in the development of next-generation stents.
Collapse
|
99
|
Pavasini R, Serenelli M, Gallo F, Bugani G, Geraci S, Vicinelli P, Campo G. Effectiveness and safety of the ABSORB bioresorbable vascular scaffold for the treatment of coronary artery disease: systematic review and meta-analysis of randomized clinical trials. J Thorac Dis 2017; 9:S887-S897. [PMID: 28894594 DOI: 10.21037/jtd.2017.06.59] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND In the last years bioresorbable vascular scaffold (BVS) become a new therapeutic option for interventional cardiologists, with the advantage of a scaffold inducing a possible vessel wall restoration. Nevertheless, several trials tried to prove the safety and efficacy profile of scaffolds, but with conflicting results. METHODS A systematic review and meta-analysis was performed. The search was carried out in PubMed, Google Scholar, Biomed Central and Cochrane Library between January and March 2017. Inclusion criteria: randomized clinical trials (RCT) comparing the Absorb BVS versus durable polymer cobalt-chromium Everolimus Eluting Stent. The outcomes analysed were all-cause mortality, cardiac death, ischemia-driven target lesion revascularization, target vessel myocardial infarction (MI), target lesion failure (TLF)/device oriented composite endpoints (DOCE), and device thrombosis. Fixed-effect meta-analysis was performed. Data were expressed as odds ratio (OR). RESULTS Overall 5,674 patients were included (mean age 62.2±1.31 in drug eluting stents (DES) group vs. 62±1,47 in BVS group; P=0.942). DOCE (OR 1.16, 95% CI: 0.90-1.48; P=0.259, I2=0%), cardiac death (OR 0.86, 95% CI: 0.52-1.40; P=0.537, I2=0%) and all-cause death (OR 0.78, 95% CI: 0.53-1.15; P=0.205, I2=15%) did not differ between BVS and DES. Conversely, ischemia-driven target lesion revascularization was more frequent in the BVS group (OR 1.32, 95% CI: 1.01-1.73; P=0.039, I2=0%), as well as device thrombosis (2.2% vs. 0.6%, OR 2.94, 95% CI: 1.71-5.05, P=0.0001, I2=0%) and target-vessel MI (5.4% vs. 3%, OR 1.66, 95% CI: 1.25-2.21, P=0.001, I2=0%). CONCLUSIONS The implantation of BVS is associated with an increased risk of device thrombosis, ischemia-driven target lesion revascularization and target vessel MI. If longer follow-up or different implantation technique may change these findings should be addressed in future trials.
Collapse
Affiliation(s)
- Rita Pavasini
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Matteo Serenelli
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Francesco Gallo
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Giulia Bugani
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | | | - Paolo Vicinelli
- Cardiology Unit, ASST Milanese Ovest, Ospedale Fornaroli, Magenta, Italy
| | - Gianluca Campo
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy.,Maria Cecilia Hospital, GVM Care & Research, E.S.: Health Science Foundation, Cotignola, Italy
| |
Collapse
|
100
|
Secco GG, Verdoia M, Pistis G, De Luca G, Vercellino M, Audo A, Parisi R, Reale M, Ballestrero G, Marino PN, Di Mario C. Optical coherence tomography guidance during bioresorbable vascular scaffold implantation. J Thorac Dis 2017; 9:S986-S993. [PMID: 28894605 DOI: 10.21037/jtd.2017.07.111] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Bioresorbable vascular scaffold (BRS) represent a revolutionary concept in interventional cardiology. After initial enthusiasm, recent real world registries, including patients with increasing lesion complexity, reported not trivial rates of scaffold thrombosis (ScT). The importance of correct patients selection as well as technical aspects during BRS implantation procedures has been highlighted in several studies suggesting that the high rate of ScT might be related to uncorrected patients/lesions selection together with underutilization of intracoronary imaging guidance leading to suboptimal BRS implantation. The high-resolution power together with the lack of shadowing observed beyond polymer struts makes optical coherence tomography (OCT) the optimal imaging technique to guide BRS implantation and identifies eventually scaffolds failures.
Collapse
Affiliation(s)
- Gioel Gabrio Secco
- Department of Cardiology, "Santi Antonio e Biagio e Cesare Arrigo" Hospital, Alessandria, Italy
| | - Monica Verdoia
- Department of Cardiology, "University of Eastern Piedmont", Novara, Italy
| | - Gianfranco Pistis
- Department of Cardiology, "Santi Antonio e Biagio e Cesare Arrigo" Hospital, Alessandria, Italy
| | - Giuseppe De Luca
- Department of Cardiology, "University of Eastern Piedmont", Novara, Italy
| | - Matteo Vercellino
- Department of Cardiology, "Santi Antonio e Biagio e Cesare Arrigo" Hospital, Alessandria, Italy
| | - Andrea Audo
- Department of Cardiology, "Santi Antonio e Biagio e Cesare Arrigo" Hospital, Alessandria, Italy
| | - Rosario Parisi
- Interventional Cardiology, "Ospedali Riuniti Marche Nord", Pesaro, Italy
| | - Maurizio Reale
- Department of Cardiology, "Santi Antonio e Biagio e Cesare Arrigo" Hospital, Alessandria, Italy
| | - Giorgio Ballestrero
- Department of Cardiology, "Santi Antonio e Biagio e Cesare Arrigo" Hospital, Alessandria, Italy
| | | | - Carlo Di Mario
- Department of Cardiology, "Careggi University Hospital", Florence, Italy
| |
Collapse
|