151
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[Update peripheral arterial occlusive disease]. Herz 2015; 40:1013-22; quiz 1023-4. [PMID: 26432712 DOI: 10.1007/s00059-015-4357-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Due to demographic changes, peripheral arterial occlusive disease (PAD) has become one of the most prevalent diseases in western industrial nations. In recent years the trend towards initial endovascular treatment approaches has further continued. Because of the high primary success and low complication rates, intervention-based revascularization strategies are the method of choice in the majority of cases. The treatment strategy should always be assessed in a multidisciplinary setting and if possible, within a designated vascular center. One of the main limitations of interventions is the occurrence of restenosis, in particular in infrapopliteal arterial lesions. A major progress arose from drug-eluting balloons, which dramatically reduced restenosis rates particular for femoropopliteal lesions. A potential alternative strategy could be the use of a combination therapy, such as plaque removal followed by insertion of drug-eluting balloons; however, economic issues have to be kept in mind for such approaches.
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152
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Lu C, Filion KB, Eisenberg MJ. The Safety and Efficacy of Absorb Bioresorbable Vascular Scaffold: A Systematic Review. Clin Cardiol 2015; 39:48-55. [PMID: 26395019 DOI: 10.1002/clc.22451] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 08/12/2015] [Indexed: 10/23/2022] Open
Abstract
Bioresorbable stents are novel devices designed to overcome the long-term limitations of permanent stent implantation. The Absorb bioresorbable vascular scaffold (BVS; Abbott Vascular, Santa Clara, CA) was the first bioresorbable stent with Conformité Européenne mark approval in coronary vessels and has been the subject of multiple clinical studies. Despite its potential advantages, the safety and efficacy of BVS remain unclear. To address this, we conducted a systematic review to examine the safety and efficacy of BVS. The MEDLINE, Embase, Current Index to Nursing & Allied Health Literature (CINAHL), Cochrane, and Science Citation Index Expanded (SCIE) databases were searched for studies examining BVS safety and efficacy. Our search was restricted to studies published in English or French. Outcomes of interest include cardiac death, myocardial infarction, target-lesion revascularization, restenosis, and composite endpoints. Eleven studies met our inclusion criteria (n = 2990), which included 1 randomized controlled trial and 10 cohort studies (2 controlled). These studies varied in size (11-1189) and follow-up duration (1-60 months). The incidence of major adverse cardiac events ranged from 2.6% to 15.5%, with no statistically significant difference between BVS and control in studies that included a comparison group. Although available data are limited, current evidence is promising and suggests that the use of BVS is not associated with a significant increase in major cardiac events in the short term. Numerous randomized controlled trials are currently in progress that will further improve our understanding of the safety and efficacy of this device.
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Affiliation(s)
- Chang Lu
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Kristian B Filion
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada.,Division of Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Mark J Eisenberg
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada.,Division of Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.,Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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153
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Fabris E, Caiazzo G, Kilic ID, Serdoz R, Secco GG, Sinagra G, Lee R, Foin N, Di Mario C. Is high pressure postdilation safe in bioresorbable vascular scaffolds? Optical coherence tomography observations after noncompliant balloons inflated at more than 24 atmospheres. Catheter Cardiovasc Interv 2015; 87:839-46. [DOI: 10.1002/ccd.26222] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 08/09/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Enrico Fabris
- NIHR Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust; London United Kingdom
- Cardiovascular Department; Ospedali Riuniti and University of Trieste; Trieste Italy
| | - Gianluca Caiazzo
- NIHR Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust; London United Kingdom
| | - Ismail Dogu Kilic
- NIHR Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust; London United Kingdom
- Department of Cardiology; Pamukkale University; Denizli Turkey
| | - Roberta Serdoz
- NIHR Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust; London United Kingdom
| | - Gioel Gabrio Secco
- NIHR Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust; London United Kingdom
- Department of Clinical and Experimental Medicine; University of Eastern Piedmont; Novara Italy
| | - Gianfranco Sinagra
- Cardiovascular Department; Ospedali Riuniti and University of Trieste; Trieste Italy
| | - Renick Lee
- National Heart Centre Singapore; Singapore
| | | | - Carlo Di Mario
- NIHR Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust; London United Kingdom
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154
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Cortese B, Ielasi A, Varricchio A, Tarantini G, LaVecchia L, Pisano F, Facchin M, Gistri R, D’Urbano M, Lucci V, Loi B, Tumminello G, Colombo A, Limbruno U, Nicolino A, Calzolari D, Tognoni G, Defilippi G, Buccheri D, Tespili M, Corrado D, Steffenino G. Registro Absorb Italiano (BVS-RAI): an investigators-owned and -directed, open, prospective registry of consecutive patients treated with the Absorb™ BVS: study design. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2015; 16:340-3. [DOI: 10.1016/j.carrev.2015.05.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 05/24/2015] [Accepted: 05/28/2015] [Indexed: 12/22/2022]
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155
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Everolimus-eluting Bioresorbable Vascular Scaffold Implantation in Real World and Complex Coronary Disease: Procedural and 30-day Outcomes at Two Australian Centres. Heart Lung Circ 2015; 24:854-9. [DOI: 10.1016/j.hlc.2015.02.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 01/12/2015] [Accepted: 02/16/2015] [Indexed: 11/19/2022]
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156
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Kristensen SD, Christiansen EH, Maeng M. Deliver the drug and be resorbed: evidence from ABSORB Japan. Eur Heart J 2015; 36:3343-5. [DOI: 10.1093/eurheartj/ehv459] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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157
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Incidence and imaging outcomes of acute scaffold disruption and late structural discontinuity after implantation of the absorb Everolimus-Eluting fully bioresorbable vascular scaffold: optical coherence tomography assessment in the ABSORB cohort B Trial (A Clinical Evaluation of the Bioabsorbable Everolimus Eluting Coronary Stent System in the Treatment of Patients With De Novo Native Coronary Artery Lesions). JACC Cardiovasc Interv 2015; 7:1400-11. [PMID: 25523532 DOI: 10.1016/j.jcin.2014.06.016] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 05/20/2014] [Accepted: 06/02/2014] [Indexed: 12/20/2022]
Abstract
OBJECTIVES This study sought to describe the frequency and clinical impact of acute scaffold disruption and late strut discontinuity of the second-generation Absorb bioresorbable polymeric vascular scaffolds (Absorb BVS, Abbott Vascular, Santa Clara, California) in the ABSORB (A Clinical Evaluation of the Bioabsorbable Everolimus Eluting Coronary Stent System in the Treatment of Patients With De Novo Native Coronary Artery Lesions) cohort B study by optical coherence tomography (OCT) post-procedure and at 6, 12, 24, and 36 months. BACKGROUND Fully bioresorbable scaffolds are a novel approach to treatment for coronary narrowing that provides transient vessel support with drug delivery capability without the long-term limitations of metallic drug-eluting stents. However, a potential drawback of the bioresorbable scaffold is the potential for disruption of the strut network when overexpanded. Conversely, the structural discontinuity of the polymeric struts at a late stage is a biologically programmed fate of the scaffold during the course of bioresorption. METHODS The ABSORB cohort B trial is a multicenter single-arm trial assessing the safety and performance of the Absorb BVS in the treatment of 101 patients with de novo native coronary artery lesions. The current analysis included 51 patients with 143 OCT pullbacks who underwent OCT at baseline and follow-up. The presence of acute disruption or late discontinuities was diagnosed by the presence on OCT of stacked, overhung struts or isolated intraluminal struts disconnected from the expected circularity of the device. RESULTS Of 51 patients with OCT imaging post-procedure, acute scaffold disruption was observed in 2 patients (3.9%), which could be related to overexpansion of the scaffold at the time of implantation. One patient had a target lesion revascularization that was presumably related to the disruption. Of 49 patients without acute disruption, late discontinuities were observed in 21 patients. There were no major adverse cardiac events associated with this finding except for 1 patient who had a non-ischemia-driven target lesion revascularization. CONCLUSIONS Acute scaffold disruption is a rare iatrogenic phenomenon that has been anecdotally associated with anginal symptoms, whereas late strut discontinuity is observed in approximately 40% of patients and could be viewed as a serendipitous OCT finding of a normal bioresorption process without clinical implications. (ABSORB Clinical Investigation, Cohort B [ABSORB B]; NCT00856856).
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158
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Suárez de Lezo J, Martín P, Mazuelos F, Nóvoa J, Ojeda S, Pan M, Segura J, Hernández E, Romero M, Melián F, Medina A, Suárez de Lezo J. Direct bioresorbable vascular scaffold implantation: Feasibility and midterm results. Catheter Cardiovasc Interv 2015; 87:E173-82. [DOI: 10.1002/ccd.26133] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 04/24/2015] [Accepted: 07/11/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Javier Suárez de Lezo
- Department of Cardiology; Reina Sofia Hospital, University of Córdoba (IMIBIC); Spain
| | - Pedro Martín
- Department of Cardiology; Dr. Negrin Hospital, University of Las Palmas; Las Palmas De Gran Canaria Spain
| | - Francisco Mazuelos
- Department of Cardiology; Reina Sofia Hospital, University of Córdoba (IMIBIC); Spain
| | - José Nóvoa
- Department of Cardiology; Dr. Negrin Hospital, University of Las Palmas; Las Palmas De Gran Canaria Spain
| | - Soledad Ojeda
- Department of Cardiology; Reina Sofia Hospital, University of Córdoba (IMIBIC); Spain
| | - Manuel Pan
- Department of Cardiology; Reina Sofia Hospital, University of Córdoba (IMIBIC); Spain
| | - José Segura
- Department of Cardiology; Reina Sofia Hospital, University of Córdoba (IMIBIC); Spain
| | - Enrique Hernández
- Department of Cardiology; Reina Sofia Hospital, University of Córdoba (IMIBIC); Spain
| | - Miguel Romero
- Department of Cardiology; Reina Sofia Hospital, University of Córdoba (IMIBIC); Spain
| | - Francisco Melián
- Department of Cardiology; Dr. Negrin Hospital, University of Las Palmas; Las Palmas De Gran Canaria Spain
| | - Alfonso Medina
- Department of Cardiology; Dr. Negrin Hospital, University of Las Palmas; Las Palmas De Gran Canaria Spain
| | - José Suárez de Lezo
- Department of Cardiology; Reina Sofia Hospital, University of Córdoba (IMIBIC); Spain
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159
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Wiebe J, Gilbert F, Dörr O, Liebetrau C, Wilkens E, Bauer T, Elsässer A, Möllmann H, Hamm CW, Nef HM. Implantation of everolimus-eluting bioresorbable scaffolds in a diabetic all-comers population. Catheter Cardiovasc Interv 2015; 86:975-81. [DOI: 10.1002/ccd.26140] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 07/12/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Jens Wiebe
- University of Giessen, Medizinische Klinik I, Department of Cardiology; Klinikstrasse 33 Giessen Germany
| | - Florian Gilbert
- University of Giessen, Medizinische Klinik I, Department of Cardiology; Klinikstrasse 33 Giessen Germany
| | - Oliver Dörr
- University of Giessen, Medizinische Klinik I, Department of Cardiology; Klinikstrasse 33 Giessen Germany
| | - Christoph Liebetrau
- Kerckhoff Heart and Thorax Center, Department of Cardiology; Benekestrasse 2-8 Bad Nauheim Germany
| | - Eva Wilkens
- University of Giessen, Medizinische Klinik I, Department of Cardiology; Klinikstrasse 33 Giessen Germany
| | - Timm Bauer
- University of Giessen, Medizinische Klinik I, Department of Cardiology; Klinikstrasse 33 Giessen Germany
| | - Albrecht Elsässer
- Heart Center Oldenburg, Department of Cardiology; Rahel-Straus-Strasse 10 Oldenburg Germany
| | - Helge Möllmann
- Kerckhoff Heart and Thorax Center, Department of Cardiology; Benekestrasse 2-8 Bad Nauheim Germany
| | - Christian W. Hamm
- University of Giessen, Medizinische Klinik I, Department of Cardiology; Klinikstrasse 33 Giessen Germany
- Kerckhoff Heart and Thorax Center, Department of Cardiology; Benekestrasse 2-8 Bad Nauheim Germany
| | - Holger M. Nef
- University of Giessen, Medizinische Klinik I, Department of Cardiology; Klinikstrasse 33 Giessen Germany
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160
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Albuquerque FN, Bortnick A, Iqbal J, Ishibashi Y, Stone GW, Serruys PW. Dual antiplatelet therapy, drug-eluting stents and bioresorbable vascular scaffolds: Evolutionary perspectives. Catheter Cardiovasc Interv 2015; 87:909-19. [DOI: 10.1002/ccd.26099] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 06/14/2015] [Indexed: 12/29/2022]
Affiliation(s)
- Felipe N. Albuquerque
- Division of Cardiovascular Diseases-Montefiore Medical Center; Albert Einstein College of Medicine; New York New York
| | - Anna Bortnick
- Division of Cardiovascular Diseases-Montefiore Medical Center; Albert Einstein College of Medicine; New York New York
| | - Javaid Iqbal
- ThoraxCenter; Erasmus University Medical Center; Rotterdam The Netherlands
| | - Yuki Ishibashi
- ThoraxCenter; Erasmus University Medical Center; Rotterdam The Netherlands
| | - Gregg W. Stone
- Columbia University Medical Center/New York-Presbyterian Hospital; New York New York
| | - Patrick W. Serruys
- ThoraxCenter; Erasmus University Medical Center; Rotterdam The Netherlands
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161
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Estévez-Loureiro R, Pérez de Prado A, Pérez-Martínez C, Cuellas-Ramón C, Regueiro-Purriños M, Gonzalo-Orden JM, López-Benito M, Molina-Crisol M, Duocastella-Codina L, Fernández-Vázquez F. Safety and Efficacy of New Sirolimus-eluting Stent Models in a Preclinical Study. ACTA ACUST UNITED AC 2015. [PMID: 26206247 DOI: 10.1016/j.rec.2015.02.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION AND OBJECTIVES Initial preclinical studies are required during the process of improving polymers, platforms, and drug-eluting systems for new coronary stent designs. Our objective was to analyze the efficacy and safety of new drug-eluting stent models compared with a conventional stent and commercialized drug-eluting stents in an experimental model with healthy porcine coronary arteries. METHODS Sixty stents (conventional stent, new sirolimus-eluting stents: drug-eluting stents 1, 2 and 3; Cypher(®) and Xience(®)) were randomly placed in the coronary arteries of 20 Large White domestic pigs. Angiographic and histomorphometric studies were done 28 days later. RESULTS The stents were implanted at a stent/artery ratio of 1.34±0.15, with no significant differences between groups. The new stents showed less late loss and angiographic restenosis than conventional stents (P=.006 and P<.001, respectively). Histologically, restenosis and neointimal area were lower with all the new platforms than with the conventional stents (P<.001 for each variable), and no differences were found vs the drug-eluting stents on the market. Safety data showed that endothelialization was lower with drug-eluting stents than with conventional stents, except for drug-eluting stent 3 (P=.084). Likewise, inflammation was lower with drug-eluting stent 3 than with other stents. CONCLUSIONS The new drug-eluting stent platforms studied are associated with less restenosis than conventional stents and showed no significant differences in safety or efficacy vs commercialized drug-eluting stents.
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Affiliation(s)
- Rodrigo Estévez-Loureiro
- Grupo Cardiovascular (HemoLeon), Fundación Investigación Sanitaria en León y del Instituto de Biomedicina (IBIOMED), Universidad de León, Hospital de León, León, Spain.
| | - Armando Pérez de Prado
- Grupo Cardiovascular (HemoLeon), Fundación Investigación Sanitaria en León y del Instituto de Biomedicina (IBIOMED), Universidad de León, Hospital de León, León, Spain
| | - Claudia Pérez-Martínez
- Grupo Cardiovascular (HemoLeon), Fundación Investigación Sanitaria en León y del Instituto de Biomedicina (IBIOMED), Universidad de León, Hospital de León, León, Spain
| | - Carlos Cuellas-Ramón
- Grupo Cardiovascular (HemoLeon), Fundación Investigación Sanitaria en León y del Instituto de Biomedicina (IBIOMED), Universidad de León, Hospital de León, León, Spain
| | - Marta Regueiro-Purriños
- Grupo Cardiovascular (HemoLeon), Fundación Investigación Sanitaria en León y del Instituto de Biomedicina (IBIOMED), Universidad de León, Hospital de León, León, Spain
| | - José M Gonzalo-Orden
- Grupo Cardiovascular (HemoLeon), Fundación Investigación Sanitaria en León y del Instituto de Biomedicina (IBIOMED), Universidad de León, Hospital de León, León, Spain
| | - María López-Benito
- Grupo Cardiovascular (HemoLeon), Fundación Investigación Sanitaria en León y del Instituto de Biomedicina (IBIOMED), Universidad de León, Hospital de León, León, Spain
| | | | | | - Felipe Fernández-Vázquez
- Grupo Cardiovascular (HemoLeon), Fundación Investigación Sanitaria en León y del Instituto de Biomedicina (IBIOMED), Universidad de León, Hospital de León, León, Spain
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O’Brien B, Zafar H, Ibrahim A, Zafar J, Sharif F. Coronary Stent Materials and Coatings: A Technology and Performance Update. Ann Biomed Eng 2015; 44:523-35. [DOI: 10.1007/s10439-015-1380-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 06/27/2015] [Indexed: 12/15/2022]
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163
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Ishibashi Y, Muramatsu T, Nakatani S, Sotomi Y, Suwannasom P, Grundeken MJ, Cho YK, Garcia-Garcia HM, van Boven AJ, Piek JJ, Sabaté M, Helqvist S, Baumbach A, McClean D, de Sousa Almeida M, Wasungu L, Miquel-Hebert K, Dudek D, Chevalier B, Onuma Y, Serruys PW. Incidence and Potential Mechanism(s) of Post-Procedural Rise of Cardiac Biomarker in Patients With Coronary Artery Narrowing After Implantation of an Everolimus-Eluting Bioresorbable Vascular Scaffold or Everolimus-Eluting Metallic Stent. JACC Cardiovasc Interv 2015. [DOI: 10.1016/j.jcin.2015.06.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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164
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Pichette M, Chevalier F, Généreux P. Coronary artery perforation at the level of two-overlapping bioresorbable vascular scaffolds: The importance of vessel sizing and scaffold thickness. Catheter Cardiovasc Interv 2015; 86:686-91. [DOI: 10.1002/ccd.26055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Revised: 02/10/2015] [Accepted: 05/19/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Maxime Pichette
- Department of Cardiology; Hôpital Du Sacré-Coeur De Montréal; Montréal Québec Canada
| | - Florent Chevalier
- Department of Cardiology; Hôpital Du Sacré-Coeur De Montréal; Montréal Québec Canada
| | - Philippe Généreux
- Department of Cardiology; Hôpital Du Sacré-Coeur De Montréal; Montréal Québec Canada
- Columbia University Medical Center and the Cardiovascular Research Foundation; New York New York
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165
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Charpentier E, Barna A, Guillevin L, Juliard JM. Fully bioresorbable drug-eluting coronary scaffolds: A review. Arch Cardiovasc Dis 2015; 108:385-97. [PMID: 26113479 DOI: 10.1016/j.acvd.2015.03.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 03/07/2015] [Accepted: 03/12/2015] [Indexed: 12/20/2022]
Abstract
Following the development of stents, then drug-eluting stents (DES), bioresorbable scaffolds are proposed as a third evolution in coronary angioplasty, aiming to reduce the incidence of restenosis and stent thrombosis and to restore vascular physiology. At least 16 such devices are currently under development, but published clinical data were available for only three of them in September 2014. The first device is Abbott's BVS(®), a poly-L-lactic acid (PLLA)-based everolimus-eluting device, which has been tested in a registry and two non-randomized trials. Clinical results seem close to what is expected from a modern DES, but possibly with more post-procedural side-effects. Two randomized trials versus DES are underway. This device is already marketed in many European countries. The second device is Elixir's DESolve(®), a PLLA-based novolimus-eluting device, which has been evaluated in two single-arm trials. Results are not widely different from those expected from a DES. The third device is Biotronik's DREAMS(®), a metallic magnesium-based paclitaxel-eluting device, which has been assessed in an encouraging single-arm trial; its second version is currently undergoing evaluation in a single-arm trial. The available results suggest that the technological and clinical development of bioresorbable scaffolds is not yet complete: their possible clinical benefits are still unclear compared with third-generation DES; the impact of arterial physiology restoration has to be assessed over the long term; and their cost-effectiveness has to be established. From the perspective of a health technology assessment, there is no compelling reason to hasten the clinical use of these devices before the results of ongoing randomized controlled trials become available.
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Affiliation(s)
- Emmanuel Charpentier
- Comité d'évaluation et de diffusion des innovations technologiques (CEDIT), Assistance Publique-Hôpitaux de Paris (AP-HP), 3, avenue Victoria, 75186 Paris cedex 16, France.
| | - Alexandre Barna
- Comité d'évaluation et de diffusion des innovations technologiques (CEDIT), Assistance Publique-Hôpitaux de Paris (AP-HP), 3, avenue Victoria, 75186 Paris cedex 16, France
| | - Loïc Guillevin
- Comité d'évaluation et de diffusion des innovations technologiques (CEDIT), Assistance Publique-Hôpitaux de Paris (AP-HP), 3, avenue Victoria, 75186 Paris cedex 16, France
| | - Jean-Michel Juliard
- Comité d'évaluation et de diffusion des innovations technologiques (CEDIT), Assistance Publique-Hôpitaux de Paris (AP-HP), 3, avenue Victoria, 75186 Paris cedex 16, France; Département de cardiologie, département hospitalo-universitaire FIRE, université Paris-Diderot, Sorbonne Paris-Cité, Inserm U-1148, Hôpital Bichat, AP-HP, 75877 Paris, France
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166
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Ishibashi Y, Onuma Y, Muramatsu T, Nakatani S, Iqbal J, Garcia-Garcia HM, Bartorelli AL, Whitbourn R, Abizaid A, Serruys PW. Lessons learned from acute and late scaffold failures in the ABSORB EXTEND trial. EUROINTERVENTION 2015; 10:449-57. [PMID: 24469426 DOI: 10.4244/eijv10i4a78] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Bioresorbable scaffolds are increasingly used in patients with coronary artery disease undergoing percutaneous coronary interventions. ABSORB EXTEND is an ongoing study that will recruit 800 patients. This report evaluates acute and late scaffold failure in the first 450 patients enrolled in ABSORB EXTEND who have completed 12 months follow-up. METHODS AND RESULTS Clinical event data from the first 450 patients enrolled in ABSORB EXTEND have demonstrated low rates of ischaemia-driven MACE (4.2%) and target vessel failure (4.7%) at 12 months. There have been seven cases of device failure in this study: three cases of scaffold dislodgement (0.67%) and four cases of subacute or late scaffold thrombosis (0.89%). All scaffold dislodgements occurred in the left circumflex (LCX), and in two cases dislodgement was observed after reinsertion of the same device. Two cases of subacute scaffold thrombosis and two late scaffold thromboses were observed. Two out of four cases of scaffold thrombosis seemed to be related to either premature discontinuation of dual antiplatelet therapy (DAPT) or resistance to clopidogrel. CONCLUSIONS This is the first report specifically describing the incidence and the potential mechanisms of scaffold dislodgement and scaffold thrombosis as seen in the ABSORB EXTEND trial.
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Affiliation(s)
- Yuki Ishibashi
- Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
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Kochman J, Tomaniak M, Kołtowski Ł, Jąkała J, Proniewska K, Legutko J, Roleder T, Pietrasik A, Rdzanek A, Kochman W, Brugaletta S, Kaluza GL. A 12-month angiographic and optical coherence tomography follow-up after bioresorbable vascular scaffold implantation in patients with ST-segment elevation myocardial infarction. Catheter Cardiovasc Interv 2015; 86:E180-9. [PMID: 26015294 DOI: 10.1002/ccd.26006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 03/14/2015] [Accepted: 04/11/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The aim of the study was to evaluate the healing process at 12 months after ABSORB™ bioresorbable vascular scaffold (BVS) implantation in patients with ST-segment elevation myocardial infarction (STEMI). BACKGROUND There is currently no data on long-term BVS performance in the acute thrombotic setting. The underlying altered plaque pathomorphology may impact the neointima healing pattern, potentially making it different to that observed in stable coronary artery disease (CAD). METHODS We have performed an angiographic and optical coherence tomography (OCT) 12-month follow-up of 19 STEMI patients who were treated with a BVS implantation (23 scaffolds). An independent core laboratory performed a paired analysis of the corresponding frames at baseline and follow-up. RESULTS At 12 months, the OCT follow-up showed a decrease in the mean lumen area (8.29 ± 1.53 mm(2) vs. 6.82 ± 1.57 mm(2) , P < 0.001), but no significant change in the mean scaffold area (8.49 ± 1.53 mm(2) vs. 8.90 ± 1.51 mm(2) ). Significant decreases in malapposed strut ratio (4.9 ± 8.65% vs. 0.4 ± 1.55%, P < 0.001) and malapposition area (0.29 ± 0.60 mm(2) 0.08 ± 0.32 mm(2) , P = 0.002) were observed. A nonhomogenous proliferation of neointima was revealed with a symmetry index of 0.15 (0.08-0.27), a mean neointima thickness of 203 μm (183-249) and mean neointima area of 2.07 ± 0.51 mm(2) . The quantitative coronary angiography showed late lumen loss of 0.08 ± 0.23 mm and no significant change in the minimal lumen diameter (P = 0.11). There were no major adverse cardiovascular events (MACE), except for one nontarget vessel revascularization. CONCLUSIONS The OCT revealed a favorable healing pattern after BVS implantation in a STEMI population.
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Affiliation(s)
- Janusz Kochman
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Mariusz Tomaniak
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Łukasz Kołtowski
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Jacek Jąkała
- Krakow Cardiovascular Research Institute, Krakow, Poland
| | | | - Jacek Legutko
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Roleder
- Krakow Cardiovascular Research Institute, Krakow, Poland
| | | | - Adam Rdzanek
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Wacław Kochman
- Faculty of Health Sciences, Medical University of Gdansk, Gdansk, Poland
| | - Salvatore Brugaletta
- Department of Cardiology, Thorax Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Grzegorz L Kaluza
- Department of Cardiology, Thorax Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
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Castro Rodriguez J, Dessy H, Demanet H. Implantation of an Absorb bioresorbable vascular scaffold in the stenotic aortopulmonary collateral artery of a young child with Alagille syndrome. Catheter Cardiovasc Interv 2015; 86:E76-80. [DOI: 10.1002/ccd.26019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 04/08/2015] [Accepted: 04/18/2015] [Indexed: 11/11/2022]
Affiliation(s)
| | - Hugues Dessy
- Department of Adult Cardiology; CHU-Brugmann; Brussels Belgium
| | - Hélène Demanet
- Department of Adult Cardiology; CHU-Brugmann; Brussels Belgium
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169
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Sgarioto M, Adhikari R, Gunatillake PA, Moore T, Patterson J, Nagel MD, Malherbe F. High Modulus Biodegradable Polyurethanes for Vascular Stents: Evaluation of Accelerated in vitro Degradation and Cell Viability of Degradation Products. Front Bioeng Biotechnol 2015; 3:52. [PMID: 26000274 PMCID: PMC4422008 DOI: 10.3389/fbioe.2015.00052] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 03/27/2015] [Indexed: 01/13/2023] Open
Abstract
We have recently reported the mechanical properties and hydrolytic degradation behavior of a series of NovoSorb™ biodegradable polyurethanes (PUs) prepared by varying the hard segment (HS) weight percentage from 60 to 100. In this study, the in vitro degradation behavior of these PUs with and without extracellular matrix (ECM) coating was investigated under accelerated hydrolytic degradation (phosphate buffer saline; PBS/70°C) conditions. The mass loss at different time intervals and the effect of aqueous degradation products on the viability and growth of human umbilical vein endothelial cells (HUVEC) were examined. The results showed that PUs with HS 80% and below completely disintegrated leaving no visual polymer residue at 18 weeks and the degradation medium turned acidic due to the accumulation of products from the soft segment (SS) degradation. As expected the PU with the lowest HS was the fastest to degrade. The accumulated degradation products, when tested undiluted, showed viability of about 40% for HUVEC cells. However, the viability was over 80% when the solution was diluted to 50% and below. The growth of HUVEC cells is similar to but not identical to that observed with tissue culture polystyrene standard (TCPS). The results from this in vitro study suggested that the PUs in the series degraded primarily due to the SS degradation and the cell viability of the accumulated acidic degradation products showed poor viability to HUVEC cells when tested undiluted, however particles released to the degradation medium showed cell viability over 80%.
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Affiliation(s)
- Melissa Sgarioto
- Faculty of Life and Social Sciences, Swinburne University of Technology , Hawthorn, VIC , Australia ; UMR CNRS 7338 Biomécanique et Bioingénierie, Centre de Recherches de Royallieu, Université de Technologie de Compiègne , Compiègne , France
| | - Raju Adhikari
- CSIRO Manufacturing Flagship , Clayton, VIC , Australia
| | | | - Tim Moore
- PolyNovo Biomaterials Pty Ltd. , Port Melbourne, VIC , Australia
| | - John Patterson
- Faculty of Life and Social Sciences, Swinburne University of Technology , Hawthorn, VIC , Australia
| | - Marie-Danielle Nagel
- UMR CNRS 7338 Biomécanique et Bioingénierie, Centre de Recherches de Royallieu, Université de Technologie de Compiègne , Compiègne , France
| | - François Malherbe
- Faculty of Life and Social Sciences, Swinburne University of Technology , Hawthorn, VIC , Australia
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170
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Holm NR, Adriaenssens T, Motreff P, Shinke T, Dijkstra J, Christiansen EH. OCT for bifurcation stenting: what have we learned? EUROINTERVENTION 2015; 11 Suppl V:V64-70. [DOI: 10.4244/eijv11sva14] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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171
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Current status of clinically available bioresorbable scaffolds in percutaneous coronary interventions. Neth Heart J 2015; 23:153-60. [PMID: 25626697 PMCID: PMC4352158 DOI: 10.1007/s12471-015-0652-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Drug-eluting stents (DES) are widely used as first choice devices in percutaneous coronary interventions. However, certain concerns are associated with the use of DES, i.e. delayed arterial healing with a subsequent risk of neo-atherosclerosis, late stent thrombosis and hypersensitivity reactions to the DES polymer. Bioresorbable vascular scaffolds are the next step in percutaneous coronary interventions introducing the concept of supporting the natural healing process following initial intervention without leaving any foreign body materials resulting in late adverse events. The first-generation devices have shown encouraging results in multiple studies of selected patients up to the point of full bioresorption, supporting the introduction in regular patient care. During its introduction in daily clinical practice outside the previously selected patient groups, a careful approach should be followed in which outcome is continuously monitored.
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172
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Varcoe RL, Schouten O, Thomas SD, Lennox AF. Initial Experience With the Absorb Bioresorbable Vascular Scaffold Below the Knee. J Endovasc Ther 2015; 22:226-32. [DOI: 10.1177/1526602815575256] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To investigate a new bioresorbable vascular scaffold for the treatment of focal tibial and distal popliteal lesions. Methods: Tibial and distal popliteal angioplasty was performed in 15 limbs of 14 patients (9 men; median age 82 years) with critical limb ischemia (CLI, n=7) or severe claudication. The 18 lesions (mean length 22.2±14.0 mm) were implanted with 22 everolimus-eluting bioresorbable scaffolds (Absorb). Clinical and ultrasound follow-up was performed at 1, 3, 6, and 12 months to detect restenosis and evaluate safety, midterm restenosis rate, and clinical improvement. Results: Immediate technical success was 100%, although a single limb suffered 2 scaffold thromboses on the first day; it was salvaged with repeat endovascular intervention. All patients were available for surveillance examinations during a follow-up of 6.1±3.9 months; no patient died. Of the 15 limbs in the analysis, clinical improvement was present in 12 (4 of 7 CLI patients); there was no amputation, bypass surgery, or evidence of binary restenosis on follow-up sonographic examination. Conclusion: Midterm follow-up for this small pilot sample demonstrates acceptable safety and patency results, together with freedom from all major adverse limb events, using the Absorb bioresorbable vascular scaffold below the knee.
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Affiliation(s)
- Ramon L. Varcoe
- Prince of Wales Hospital, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Olaf Schouten
- Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Shannon D. Thomas
- Prince of Wales Hospital, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
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Bourantas CV, Farooq V, Zhang Y, Muramatsu T, Gogas BD, Thuesen L, McClean D, Chevalier B, Windecker S, Koolen J, Ormiston J, Whitbourn R, Dorange C, Rapoza R, Onuma Y, Garcia-Garcia HM, Serruys PW. Circumferential distribution of the neointima at six-month and two-year follow-up after a bioresorbable vascular scaffold implantation: a substudy of the ABSORB Cohort B Clinical Trial. EUROINTERVENTION 2015; 10:1299-306. [DOI: 10.4244/eijy14m04_11] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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175
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Nakatani S, Onuma Y, Ishibashi Y, Muramatsu T, Iqbal J, Zhang YJ, van Geuns RJ, Ormiston JA, Serruys PW. Early (before 6 months), late (6-12 months) and very late (after 12 months) angiographic scaffold restenosis in the ABSORB Cohort B trial. EUROINTERVENTION 2015; 10:1288-98. [DOI: 10.4244/eijv10i11a218] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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176
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Wiebe J, Nef HM, Hamm CW. Current status of bioresorbable scaffolds in the treatment of coronary artery disease. J Am Coll Cardiol 2015; 64:2541-51. [PMID: 25500240 DOI: 10.1016/j.jacc.2014.09.041] [Citation(s) in RCA: 169] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 09/23/2014] [Accepted: 09/26/2014] [Indexed: 01/13/2023]
Abstract
State-of-the-art drug-eluting metal stents are the gold standard for interventional treatment of coronary artery disease. Although they overcome some disadvantages and limitations of plain balloon angioplasty and bare-metal stents, some limitations apply, most notably a chronic local inflammatory reaction due to permanent implantation of a foreign body, restriction of vascular vasomotion due to a metal cage, and the risk of late and very late stent thrombosis. The development of biodegradable scaffolds is a new approach that attempts to circumvent these drawbacks. These devices provide short-term scaffolding of the vessel and then dissolve, which should theoretically circumvent the side effects of metal drug-eluting stents. Various types of these bioresorbable scaffolds are currently under clinical evaluation. This review discusses different concepts of bioresorbable scaffolds with respect to material, design, and drug elution and presents the most recent evidence.
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Affiliation(s)
- Jens Wiebe
- Department of Cardiology, Kerckhoff Heart Center, University of Giessen, Giessen, Germany
| | - Holger M Nef
- Department of Cardiology, Kerckhoff Heart Center, University of Giessen, Giessen, Germany
| | - Christian W Hamm
- Department of Cardiology, Kerckhoff Heart Center, University of Giessen, Giessen, Germany.
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Kraak RP, Hassell ME, Grundeken MJ, Koch KT, Henriques JP, Piek JJ, Baan J, Vis MM, Arkenbout EK, Tijssen JG, de Winter RJ, Wykrzykowska JJ. Initial experience and clinical evaluation of the Absorb bioresorbable vascular scaffold (BVS) in real-world practice: the AMC Single Centre Real World PCI Registry. EUROINTERVENTION 2015; 10:1160-8. [DOI: 10.4244/eijy14m08_08] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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178
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Allahwala UK, Cockburn JA, Shaw E, Figtree GA, Hansen PS, Bhindi R. Clinical utility of optical coherence tomography (OCT) in the optimisation of Absorb bioresorbable vascular scaffold deployment during percutaneous coronary intervention. EUROINTERVENTION 2015; 10:1154-9. [DOI: 10.4244/eijv10i10a190] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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179
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Echogenicity as a surrogate for bioresorbable everolimus-eluting scaffold degradation: analysis at 1-, 3-, 6-, 12- 18, 24-, 30-, 36- and 42-month follow-up in a porcine model. Int J Cardiovasc Imaging 2015; 31:471-82. [PMID: 25627777 PMCID: PMC4368838 DOI: 10.1007/s10554-015-0591-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 01/10/2015] [Indexed: 01/01/2023]
Abstract
The objective of the study is to validate intravascular quantitative echogenicity as a surrogate for molecular weight assessment of poly-l-lactide-acid (PLLA) bioresorbable scaffold (Absorb BVS, Abbott Vascular, Santa Clara, California). We analyzed at 9 time points (from 1- to 42-month follow-up) a population of 40 pigs that received 97 Absorb scaffolds. The treated regions were analyzed by echogenicity using adventitia as reference, and were categorized as more (hyperechogenic or upperechogenic) or less bright (hypoechogenic) than the reference. The volumes of echogenicity categories were correlated with the measurements of molecular weight (Mw) by gel permeation chromatography. Scaffold struts appeared as high echogenic structures. The quantification of grey level intensity in the scaffold-vessel compartment had strong correlation with the scaffold Mw: hyperechogenicity (correlation coefficient = 0.75; P < 0.01), upperechogenicity (correlation coefficient = 0.63; P < 0.01) and hyper + upperechogenicity (correlation coefficient = 0.78; P < 0.01). In the linear regression, the R2 for high echogenicity and Mw was 0.57 for the combination of hyper and upper echogenicity. IVUS high intensity grey level quantification is correlated to Absorb BVS residual molecular weight and can be used as a surrogate for the monitoring of the degradation of semi-crystalline polymers scaffolds.
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180
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Shaw E, Allahwala UK, Cockburn JA, Hansen TCE, Mazhar J, Figtree GA, Hansen PS, Bhindi R. The effect of coronary artery plaque composition, morphology and burden on Absorb bioresorbable vascular scaffold expansion and eccentricity - A detailed analysis with optical coherence tomography. Int J Cardiol 2015; 184:230-236. [PMID: 25723650 DOI: 10.1016/j.ijcard.2015.01.033] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 10/23/2014] [Accepted: 01/24/2015] [Indexed: 11/24/2022]
Abstract
AIMS Suboptimal stent expansion correlates with adverse cardiac events. There is limited information regarding Absorb bioresorbable vascular scaffold (BVS) expansion characteristics. Optical coherence tomography (OCT) allows for high-resolution assessment of plaque morphology, composition and assessment of BVS expansion. This study evaluates coronary plaque composition, morphology and burden and their effect on Absorb BVS expansion using OCT. METHODS AND RESULTS Two thousand three hundred and thirty four frames totalling 462.6 mm of BVS from twenty OCT-guided BVS implantations were examined. 200 μm longitudinal cross-sections of each BVS were analysed for lumen contours and plaque characteristics. The relationship between each plaque characteristic and scaffold expansion index (SEI) or scaffold eccentricity index (SEC) was analysed by repeated measures ANOVA. Forty-four fibrous and 265 calcific plaques were identified. Lower SEI was significantly (p<0.001) associated with greater calcific plaque (CP) area (mean SEI 78.9% vs. 80.0%), thickness (78.5% vs. 80.4%) and lower CP depth (78.3% vs. 80.2%). Lower SEC was significantly (p<0.001) associated with greater fibrous plaque (FP) area (0.84 vs. 0.85), thickness (0.83 vs. 0.86), arc angle (0.84 vs. 0.85), greater CP area (0.83 vs. 0.86), CP thickness (0.83 vs. 0.86), CP angle (0.84 vs. 0.85) and lower CP depth (0.84 vs. 0.85). Greater FP area was associated with greater SEI (81.0% vs. 80.0%, p<0.001), even after adjustment for target vessel size. Greater FP angle (80.7% vs 78.3%, p<0.001) and quadrants occupied were also associated (80.0% vs 78.5%, p<0.002) with greater SEI. CONCLUSION BVS expansion and eccentricity are significantly impacted by plaque composition, morphology and burden.
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Affiliation(s)
- Elizabeth Shaw
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia; North Shore Heart Research Group, Kolling Institute of Medical Research, The University of Sydney, Sydney, Australia
| | - Usaid K Allahwala
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
| | - James A Cockburn
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
| | - Thomas C E Hansen
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
| | - Jawad Mazhar
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
| | - Gemma A Figtree
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia; North Shore Heart Research Group, Kolling Institute of Medical Research, The University of Sydney, Sydney, Australia
| | - Peter S Hansen
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
| | - Ravinay Bhindi
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia; North Shore Heart Research Group, Kolling Institute of Medical Research, The University of Sydney, Sydney, Australia.
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Simsekyilmaz S, Liehn EA, Militaru C, Vogt F. Progress in interventional cardiology: challenges for the future. Thromb Haemost 2015; 113:464-72. [PMID: 25608683 DOI: 10.1160/th14-07-0599] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 12/10/2014] [Indexed: 01/11/2023]
Abstract
Cardiovascular disease is the leading cause of death in the western and developing countries. Percutaneous transluminal coronary interventions have become the most prevalent treatment option for coronary artery disease; however, due to serious complications, such as stent thrombosis and in-stent restenosis (ISR), the efficacy and safety of the procedure remain important issues to address. Strategies to overcome these aspects are under extensive investigation. In this review, we summarise relevant milestones during the time to overcome these limitations of coronary stents, such as the development of polymer-free drug-eluting stents (DES) to avoid pro-inflammatory response due to the polymer coating or the developement of stents with cell-directing drugs to, simultaneously, improve re-endothelialisation and inhibit ISR amongst other techniques most recently developed, which have not fully entered the clinical stage. Also the novel concept of fully biodegradable DES featured by the lack of a permanent foreign body promises to be a beneficial and applicable tool to restore a natural vessel with maintained vasomotion and to enable optional subsequent surgical revascularisation.
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Affiliation(s)
| | | | | | - Felix Vogt
- Felix Vogt, MD, Department of Cardiology, Pulmonology, Intensive Care and Vascular Medicine, Medical Faculty, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany, Tel.: +49 241 80 35525, Fax: +49 241 80 82716, E-mail:
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Scalone G, Brugaletta S, Gómez-Monterrosas O, Otsuki S, Sabate M. ST-segment elevation myocardial infarction – ideal scenario for bioresorbable vascular scaffold implantation? Circ J 2015; 79:263-70. [PMID: 25744740 DOI: 10.1253/circj.cj-14-1398] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Bioresorbable vascular scaffolds (BVS) represent a breakthrough technology for percutaneous coronary intervention (PCI). In this context, because of the unique properties of bioresorbable devices, ST-segment elevation myocardial infarction (STEMI) may represent the ideal scenario for BVS implantation. Consistently, 57% of physicians declare they currently use BVS in this group of patients. However, continuous and growing evidence on the good performance of these devices has been actually shown only in small studies with short- and mid-term follow-up. For these reasons, we need data from sufficiently large observational studies, with long-term follow-up, to confirm that BVS can deliver the same results as 2nd-generation drug-eluting stents when using an appropriate implantation technique. In this review, we discuss the potential advantages of BVS implantation in STEMI patients, together with the most recent evidence from clinical studies, highlighting safety and procedural concerns.
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Affiliation(s)
- Giancarla Scalone
- Department of Cardiology, Thorax Institute, Hospital Clinic, Biomedical Investigation Institute, IDIBAPS, University of Barcelona, Spain
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Serruys PW, Chevalier B, Dudek D, Cequier A, Carrié D, Iniguez A, Dominici M, van der Schaaf RJ, Haude M, Wasungu L, Veldhof S, Peng L, Staehr P, Grundeken MJ, Ishibashi Y, Garcia-Garcia HM, Onuma Y. A bioresorbable everolimus-eluting scaffold versus a metallic everolimus-eluting stent for ischaemic heart disease caused by de-novo native coronary artery lesions (ABSORB II): an interim 1-year analysis of clinical and procedural secondary outcomes from a randomised controlled trial. Lancet 2015; 385:43-54. [PMID: 25230593 DOI: 10.1016/s0140-6736(14)61455-0] [Citation(s) in RCA: 449] [Impact Index Per Article: 49.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Despite rapid dissemination of an everolimus-eluting bioresorbable scaffold for treatment for coronary artery disease, no data from comparisons with its metallic stent counterpart are available. In a randomised controlled trial we aimed to compare an everolimus-eluting bioresorbable scaffold with an everolimus-eluting metallic stent. Here we report secondary clinical and procedural outcomes after 1 year of follow-up. METHODS In a single-blind, multicentre, randomised trial, we enrolled eligible patients aged 18-85 years with evidence of myocardial ischaemia and one or two de-novo native lesions in different epicardial vessels. We randomly assigned patients in a 2:1 ratio to receive treatment with an everolimus-eluting bioresorbable scaffold (Absorb, Abbott Vascular, Santa Clara, CA, USA) or treatment with an everolimus-eluting metallic stent (Xience, Abbott Vascular, Santa Clara, CA, USA). Randomisation was stratified by diabetes status and number of planned target lesions. The co-primary endpoints of this study are vasomotion (change in mean lumen diameter before and after nitrate administration at 3 years) and difference between minimum lumen diameter (after nitrate administration) after the index procedure and at 3 years. Secondary endpoints were procedural performance assessed by quantitative angiography and intravascular ultrasound; composite clinical endpoints based on death, myocardial infarction, and coronary revascularisation; device and procedural success; and angina status assessed by the Seattle Angina Questionnaire and exercise testing at 6 and 12 months. Cumulative angina rate based on adverse event reporting was analysed post hoc. This trial is registered at ClinicalTrials.gov, number NCT01425281. FINDINGS Between Nov 28, 2011, and June 4, 2013, we enrolled 501 patients and randomly assigned them to the bioresorbable scaffold group (335 patients, 364 lesions) or the metallic stent group (166 patients, 182 lesions). Dilatation pressure and balloon diameter at the highest pressure during implantation or postdilatation were higher and larger in the metallic stent group, whereas the acute recoil post implantation was similar (0.19 mm for both, p=0.85). Acute lumen gain was lower for the bioresorbable scaffold by quantitative coronary angiography (1.15 mm vs 1.46 mm, p<0.0001) and quantitative intravascular ultrasound (2.85 mm(2)vs 3.60 mm(2), p<0.0001), resulting in a smaller lumen diameter or area post procedure. At 1 year, however, cumulative rates of first new or worsening angina from adverse event reporting were lower (72 patients [22%] in the bioresorbable scaffold group vs 50 [30%] in the metallic stent group, p=0.04), whereas performance during maximum exercise and angina status by SAQ were similar. The 1-year composite device orientated endpoint was similar between the bioresorbable scaffold and metallic stent groups (16 patients [5%] vs five patients [3%], p=0.35). Three patients in the bioresorbable scaffold group had definite or probable scaffold thromboses (one definite acute, one definite sub-acute, and one probable late), compared with no patients in the metallic stent group. There were 17 (5%) major cardiac adverse events in the bioresorbable scaffold group compared with five (3%) events in the metallic stent group, with the most common adverse events being myocardial infarction (15 cases [4%] vs two cases [1%], respectively) and clinically indicated target-lesion revascularisation (four cases [1%] vs three cases [2%], respectively). INTERPRETATION The everolimus-eluting bioresorbable scaffold showed similar 1-year composite secondary clinical outcomes to the everolimus-eluting metallic stent. FUNDING Abbott Vascular.
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Affiliation(s)
- Patrick W Serruys
- International Centre for Cardiovascular Health, Imperial College, London, UK.
| | | | - Dariusz Dudek
- Jagiellonian University, Department of Cardiology and Cardio Vascular Interventions, University Hospital, Krakow, Poland
| | | | | | | | | | | | - Michael Haude
- Städtisches Kliniken Neuss Lukaskrankenhaus GmbH, Neuss, Germany
| | | | | | - Lei Peng
- Abbott Vascular, Santa Clara, CA, USA
| | | | | | | | | | - Yoshinobu Onuma
- Erasmus MC, Rotterdam, Netherlands; Cardialysis BV, Rotterdam, Netherlands
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184
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Muraglitazar-Eluting Bioabsorbable Vascular Stent Inhibits Neointimal Hyperplasia in Porcine Iliac Arteries. J Vasc Interv Radiol 2015; 26:124-30. [DOI: 10.1016/j.jvir.2014.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 10/01/2014] [Accepted: 10/06/2014] [Indexed: 01/30/2023] Open
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Wiebe J, Liebetrau C, Dörr O, Most A, Weipert K, Rixe J, Bauer T, Möllmann H, Elsässer A, Hamm CW, Nef HM. Feasibility of everolimus-eluting bioresorbable vascular scaffolds in patients with chronic total occlusion. Int J Cardiol 2015; 179:90-4. [DOI: 10.1016/j.ijcard.2014.10.032] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 09/30/2014] [Accepted: 10/18/2014] [Indexed: 11/24/2022]
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186
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Gogas BD. Bioresorbable scaffolds for percutaneous coronary interventions. Glob Cardiol Sci Pract 2014; 2014:409-27. [PMID: 25780795 PMCID: PMC4355515 DOI: 10.5339/gcsp.2014.55] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 12/11/2014] [Indexed: 12/23/2022] Open
Abstract
Innovations in drug-eluting stents (DES) have substantially reduced rates of in-segment restenosis and early stent thrombosis, improving clinical outcomes following percutaneous coronary interventions (PCI). However a fixed metallic implant in a vessel wall with restored patency and residual disease remains a precipitating factor for sustained local inflammation, in-stent neo-atherosclerosis and impaired vasomotor function increasing the risk for late complications attributed to late or very late stent thrombosis and late target lesion revascularization (TLR) (late catch-up). The quest for optimal coronary stenting continues by further innovations in stent design and by using biocompatible materials other than cobalt chromium, platinum chromium or stainless steel for engineering coronary implants. Bioresorbable scaffolds made of biodegradable polymers or biocorrodible metals with properties of transient vessel scaffolding, local drug-elution and future restoration of vessel anatomy, physiology and local hemodynamics have been recently developed. These devices have been utilized in selected clinical applications so far providing preliminary evidence of safety showing comparable performance with current generation drug-eluting stents (DES). Herein we provide a comprehensive overview of the current status of these technologies, we elaborate on the potential benefits of transient coronary scaffolds over permanent stents in the context of vascular reparation therapy, and we further focus on the evolving challenges these devices have to overcome to compete with current generation DES. Condensed Abstract:: The quest for optimizing percutaneous coronary interventions continues by iterative innovations in device materials beyond cobalt chromium, platinum chromium or stainless steel for engineering coronary implants. Bioresorbable scaffolds made of biodegradable polymers or biocorrodible metals with properties of transient vessel scaffolding; local drug-elution and future restoration of vessel anatomy, physiology and local hemodynamics were recently developed. These devices have been utilized in selected clinical applications providing preliminary evidence of safety showing comparable intermediate term clinical outcomes with current generation drug-eluting stents.
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Affiliation(s)
- Bill D Gogas
- Andreas Gruentzig Cardiovascular Center, Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
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187
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Serruys PW, Onuma Y, Garcia-Garcia HM, Muramatsu T, van Geuns RJ, de Bruyne B, Dudek D, Thuesen L, Smits PC, Chevalier B, McClean D, Koolen J, Windecker S, Whitbourn R, Meredith I, Dorange C, Veldhof S, Hebert KM, Rapoza R, Ormiston JA. Dynamics of vessel wall changes following the implantation of the absorb everolimus-eluting bioresorbable vascular scaffold: a multi-imaging modality study at 6, 12, 24 and 36 months. EUROINTERVENTION 2014; 9:1271-84. [PMID: 24291783 DOI: 10.4244/eijv9i11a217] [Citation(s) in RCA: 194] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
AIMS To assess observations with multimodality imaging of the Absorb bioresorbable everolimus-eluting vascular scaffold performed in two consecutive cohorts of patients who were serially investigated either at 6 and 24 months or at 12 and 36 months. METHODS AND RESULTS In the ABSORB multicentre single-arm trial, 45 patients (cohort B1) and 56 patients (cohort B2) underwent serial invasive imaging, specifically quantitative coronary angiography (QCA), intravascular ultrasound (IVUS), radiofrequency backscattering (IVUS-VH) and optical coherence tomography (OCT). Between one and three years, late luminal loss remained unchanged (6 months: 0.19 mm, 1 year: 0.27 mm, 2 years: 0.27 mm, 3 years: 0.29 mm) and the in-segment angiographic restenosis rate for the entire cohort B (n=101) at three years was 6%. On IVUS, mean lumen, scaffold, plaque and vessel area showed enlargement up to two years. Mean lumen and scaffold area remained stable between two and three years whereas significant reduction in plaque behind the struts occurred with a trend toward adaptive restrictive remodelling of EEM. Hyperechogenicity of the vessel wall, a surrogate of the bioresorption process, decreased from 23.1% to 10.4% with a reduction of radiofrequency backscattering for dense calcium and necrotic core. At three years, the count of strut cores detected on OCT increased significantly, probably reflecting the dismantling of the scaffold; 98% of struts were covered. In the entire cohort B (n=101), the three-year major adverse cardiac event rate was 10.0% without any scaffold thrombosis. CONCLUSIONS The current investigation demonstrated the dynamics of vessel wall changes after implantation of a bioresorbable scaffold, resulting at three years in stable luminal dimensions, a low restenosis rate and a low clinical major adverse cardiac events rate. CLINICAL TRIAL REGISTRATION INFORMATION http://www.clinicaltrials.gov/ct2/show/NCT00856856.
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188
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Long-Term Favorable Coronary Healing After Bioresorbable Scaffold Implantation. J Am Coll Cardiol 2014; 64:2357-9. [DOI: 10.1016/j.jacc.2014.07.996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 07/08/2014] [Accepted: 07/14/2014] [Indexed: 11/16/2022]
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189
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Zhang YJ, Iqbal J, Nakatani S, Bourantas CV, Campos CM, Ishibashi Y, Cho YK, Veldhof S, Wang J, Onuma Y, Garcia-Garcia HM, Dudek D, van Geuns RJ, Serruys PW. Scaffold and edge vascular response following implantation of everolimus-eluting bioresorbable vascular scaffold: a 3-year serial optical coherence tomography study. JACC Cardiovasc Interv 2014; 7:1361-9. [PMID: 25457053 DOI: 10.1016/j.jcin.2014.06.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 04/30/2014] [Accepted: 06/19/2014] [Indexed: 12/23/2022]
Abstract
OBJECTIVES This study sought to investigate the in-scaffold vascular response (SVR) and edge vascular response (EVR) after implantation of an everolimus-eluting bioresorbable scaffold (BRS) using serial optical coherence tomography (OCT) imaging. BACKGROUND Although studies using intravascular ultrasound have evaluated the EVR in metal stents and BRSs, there is a lack of OCT-based SVR and EVR assessment after BRS implantation. METHODS In the ABSORB Cohort B (ABSORB Clinical Investigation, Cohort B) study, 23 patients (23 lesions) in Cohort B1 and 17 patients (18 lesions) in Cohort B2 underwent truly serial OCT examinations at 3 different time points (Cohort B1: post-procedure, 6 months, and 2 years; B2: post-procedure, 1 year, and 3 years) after implantation of an 18-mm scaffold. A frame-by-frame OCT analysis was performed at the 5-mm proximal, 5-mm distal edge, and 2-mm in-scaffold margins, whereas the middle 14-mm in-scaffold segment was analyzed at 1-mm intervals. RESULTS The in-scaffold mean luminal area significantly decreased from baseline to 6 months or 1 year (7.22 ± 1.24 mm(2) vs. 6.05 ± 1.38 mm(2) and 7.64 ± 1.19 mm(2) vs. 5.72 ± 0.89 mm(2), respectively; both p < 0.01), but remained unchanged from then onward. In Cohort B1, a significant increase in mean luminal area of the distal edge was observed (5.42 ± 1.81 mm(2) vs. 5.58 ± 1.53 mm(2); p < 0.01), whereas the mean luminal area of the proximal edge remained unchanged at 6 months. In Cohort B2, the mean luminal areas of the proximal and distal edges were significantly smaller than post-procedure measurements at 3 years. The mean luminal area loss at both edges was significantly less than the mean luminal area loss of the in-scaffold segment at both 6-month and 2-year follow-up in Cohort B1 or at 1 year and 3 years in Cohort B2. CONCLUSIONS This OCT-based serial EVR and SVR evaluation of the Absorb Bioresorbable Vascular Scaffold (Abbott Vascular, Santa Clara, California) showed less luminal loss at the edges than luminal loss within the scaffold. The luminal reduction of both edges is not a nosologic entity, but an EVR in continuity with the SVR, extending from the in-scaffold margin to both edges. (ABSORB Clinical Investigation, Cohort B [ABSORB B]; NCT00856856).
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Affiliation(s)
- Yao-Jun Zhang
- Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands; Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Javaid Iqbal
- Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Cardiovascular Science, University of Sheffield, Sheffield, United Kingdom
| | - Shimpei Nakatani
- Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Carlos M Campos
- Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Yuki Ishibashi
- Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Yun-Kyeong Cho
- Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Jin Wang
- Abbott Vascular, Diegem, Belgium
| | - Yoshinobu Onuma
- Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | | | | | - Patrick W Serruys
- Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands; International Centre for Circulatory Health, NHLI, Imperial College London, London, United Kingdom.
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190
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Garcia-Garcia HM, Serruys PW, Campos CM, Muramatsu T, Nakatani S, Zhang YJ, Onuma Y, Stone GW. Assessing Bioresorbable Coronary Devices. JACC Cardiovasc Imaging 2014; 7:1130-48. [DOI: 10.1016/j.jcmg.2014.06.018] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 06/11/2014] [Accepted: 06/26/2014] [Indexed: 11/29/2022]
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191
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Vorpahl M, Nakano M, Perkins LEL, Otsuka F, Jones R, Acampado E, Lane JP, Rapoza R, Kolodgie FD, Virmani R. Vascular healing and integration of a fully bioresorbable everolimus-eluting scaffold in a rabbit iliac arterial model. EUROINTERVENTION 2014; 10:833-841. [DOI: 10.4244/eijv10i7a143] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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192
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Gori T, Schulz E, Hink U, Wenzel P, Post F, Jabs A, Münzel T. Early outcome after implantation of Absorb bioresorbable drug-eluting scaffolds in patients with acute coronary syndromes. EUROINTERVENTION 2014; 9:1036-41. [PMID: 23999237 DOI: 10.4244/eijv9i9a176] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The safety of BVS implantation in patients with a high risk for early thrombotic complications has not been studied. We report on the outcomes of patients with acute coronary syndromes (ACS) treated with bioresorbable, everolimus-eluting, vascular scaffolds (BVS). METHODS AND RESULTS 150 consecutive patients with ACS (194 lesions) treated with BVS between May 2012 and July 2013 were compared with a control group composed of 103 consecutive patients (129 lesions) who underwent everolimus drug-eluting stent (DES) implantation in the same time period. The incidence of major adverse cardiac events (MACE: death, non-fatal myocardial infarction, or reintervention) before discharge, at one month and six months was evaluated. Clinical characteristics and presentation were similar between groups. Procedural characteristics were also similar between groups, except for the use of glycoprotein IIb/IIIa inhibitors (p<0.01). Procedural success was obtained in all but two patients in the BVS group. In-hospital, 30-day and six-month MACE rates were similar between both groups (all p>0.5), with most complications occurring during the first ten days. Definite or probable in-stent/scaffold thrombosis occurred in two BVS patients and one DES patient during the index admission and it occurred in another patient in each group in the first month after BVS/DES implantation. In multivariate analysis, BVS utilisation did not influence the incidence of MACE (p>0.9). CONCLUSIONS BVS implantation for patients with ACS is safe, with outcomes comparable with those of drug-eluting metal stents.
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Affiliation(s)
- Tommaso Gori
- Department of Medicine II, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
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193
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Foin N, Lee RD, Torii R, Guitierrez-Chico JL, Mattesini A, Nijjer S, Sen S, Petraco R, Davies JE, Di Mario C, Joner M, Virmani R, Wong P. Impact of stent strut design in metallic stents and biodegradable scaffolds. Int J Cardiol 2014; 177:800-8. [PMID: 25449502 DOI: 10.1016/j.ijcard.2014.09.143] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 08/25/2014] [Accepted: 09/27/2014] [Indexed: 10/24/2022]
Abstract
Advances in the understanding of healing mechanisms after stent implantation have led to the recognition of stent strut thickness as an essential factor affecting re-endothelialization and overall long term vessel healing response after Percutaneous Coronary Interventions (PCI). Emergence of Drug-eluting stents (DESs) with anti-proliferative coating has contributed to reducing the incidence of restenosis and Target Lesion Revascularization (TVR), while progress and innovations in stent materials have in the meantime facilitated the design of newer platforms with more conformability and thinner struts, producing lesser injury and improving integration into the vessel wall. Recent advances in biodegradable metal and polymer materials now also allow for the design of fully biodegradable platforms, which are aimed at scaffolding the vessel only temporarily to prevent recoil and constrictive remodeling of the vessel during the initial period required, and are then progressively resorbed thereby avoiding the drawback of leaving an unnecessary implant permanently in the vessel. The aim of this article is to review recent evolution in stent material and stent strut design while understanding their impact on PCI outcomes. The article describes the different metallic alloys and biodegradable material properties and how these have impacted the evolution of stent strut thickness and ultimately outcomes in patients.
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Affiliation(s)
| | | | - Ryo Torii
- Department of Mechanical Engineering, University College London, UK
| | | | - Alessio Mattesini
- Biomedical Research Unit, Royal Brompton & Harefield NHS Trust, London, UK
| | - Sukhjinder Nijjer
- International Centre for Circulatory Health, NHLI, Imperial College London, London, UK
| | - Sayan Sen
- International Centre for Circulatory Health, NHLI, Imperial College London, London, UK
| | - Ricardo Petraco
- International Centre for Circulatory Health, NHLI, Imperial College London, London, UK
| | - Justin E Davies
- International Centre for Circulatory Health, NHLI, Imperial College London, London, UK
| | - Carlo Di Mario
- Biomedical Research Unit, Royal Brompton & Harefield NHS Trust, London, UK
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194
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Şerban R, Scridon A, Dobreanu D, Elkaholut A. Coronary artery aneurysm formation within everolimus-eluting bioresorbable stent. Int J Cardiol 2014; 177:e4-5. [PMID: 25129265 DOI: 10.1016/j.ijcard.2014.07.197] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 07/27/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Răzvan Şerban
- Adults Cardiology Department (I), Emergency Institute for Cardiovascular Diseases and Transplantation Tîrgu Mureş, 540136 Tîrgu Mureş, Romania
| | - Alina Scridon
- Adults Cardiology Department (I), Emergency Institute for Cardiovascular Diseases and Transplantation Tîrgu Mureş, 540136 Tîrgu Mureş, Romania; Physiology Department, University of Medicine and Pharmacy of Tîrgu Mureş, 540139 Tîrgu Mureş, Romania.
| | - Dan Dobreanu
- Adults Cardiology Department (I), Emergency Institute for Cardiovascular Diseases and Transplantation Tîrgu Mureş, 540136 Tîrgu Mureş, Romania; Physiology Department, University of Medicine and Pharmacy of Tîrgu Mureş, 540139 Tîrgu Mureş, Romania
| | - Ayman Elkaholut
- Cardiac Catheterization Laboratory, Emergency Institute for Cardiovascular Diseases and Transplantation Tîrgu Mureş, 540136 Tîrgu Mureş, Romania
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195
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Abstract
Percutaneous coronary intervention (PCI) has undergone major advances including the evolution in stent technology, from bare metal stents (BMS), to their drug eluting counterparts, to the development of bioresorbable scaffolds (BRS). The primary notion of BRS was to facilitate complete vascular healing and restore normal endothelial function following the resorption of stent scaffold while providing equivalent mechanical properties of a metallic drug eluting stents (DES) in the earlier stages. BRS provide attractive physiologic advancements over the existing DES and have shown promising results in initial clinical studies albeit with small sample sizes. Their use has been primarily restricted to patients recruited in clinical trials with limited real-world applicability. Thus, data from larger randomised control trials is awaited. The major objective of this article is to review the evidence on BRS and identify their clinical applicability in current interventional practice.
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Affiliation(s)
| | | | - Cindy Grines
- Department of Cardiology, Detroit Medical Center, Michigan, US
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196
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Farooq V, Fraser DG, El-Omar M, Mamas MA, Clarke B, Fath-Ordoubadi F. Lessons from acute and late scaffold failures in the ABSORB EXTEND trial: have we really learned them all? EUROINTERVENTION 2014; 10:419-23. [DOI: 10.4244/eijv10i4a73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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197
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Costopoulos C, Latib A, Naganuma T, Miyazaki T, Sato K, Figini F, Sticchi A, Carlino M, Chieffo A, Montorfano M, Colombo A. Comparison of early clinical outcomes between ABSORB bioresorbable vascular scaffold and everolimus-eluting stent implantation in a real-world population. Catheter Cardiovasc Interv 2014; 85:E10-5. [DOI: 10.1002/ccd.25569] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Revised: 04/28/2014] [Accepted: 05/25/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Charis Costopoulos
- Interventional Cardiology Unit; San Raffaele Scientific Institute; Milan Italy
- Interventional Cardiology Unit; EMO-GVM Centro Cuore Columbus; Milan Italy
- Imperial College London; London United Kingdom
| | - Azeem Latib
- Interventional Cardiology Unit; San Raffaele Scientific Institute; Milan Italy
- Interventional Cardiology Unit; EMO-GVM Centro Cuore Columbus; Milan Italy
| | - Toru Naganuma
- Interventional Cardiology Unit; San Raffaele Scientific Institute; Milan Italy
- Interventional Cardiology Unit; EMO-GVM Centro Cuore Columbus; Milan Italy
| | - Tadashi Miyazaki
- Interventional Cardiology Unit; San Raffaele Scientific Institute; Milan Italy
- Interventional Cardiology Unit; EMO-GVM Centro Cuore Columbus; Milan Italy
| | - Katsumasa Sato
- Interventional Cardiology Unit; San Raffaele Scientific Institute; Milan Italy
- Interventional Cardiology Unit; EMO-GVM Centro Cuore Columbus; Milan Italy
| | - Filippo Figini
- Interventional Cardiology Unit; San Raffaele Scientific Institute; Milan Italy
- Interventional Cardiology Unit; EMO-GVM Centro Cuore Columbus; Milan Italy
| | - Alessandro Sticchi
- Interventional Cardiology Unit; San Raffaele Scientific Institute; Milan Italy
| | - Mauro Carlino
- Interventional Cardiology Unit; San Raffaele Scientific Institute; Milan Italy
| | - Alaide Chieffo
- Interventional Cardiology Unit; San Raffaele Scientific Institute; Milan Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit; San Raffaele Scientific Institute; Milan Italy
| | - Antonio Colombo
- Interventional Cardiology Unit; San Raffaele Scientific Institute; Milan Italy
- Interventional Cardiology Unit; EMO-GVM Centro Cuore Columbus; Milan Italy
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198
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Terapia de restauración vascular con plataformas biorreabsorbibles. La cuarta revolución. REVISTA COLOMBIANA DE CARDIOLOGÍA 2014. [DOI: 10.1016/j.rccar.2014.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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199
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Lane JP, Perkins LE, Sheehy AJ, Pacheco EJ, Frie MP, Lambert BJ, Rapoza RJ, Virmani R. Lumen Gain and Restoration of Pulsatility After Implantation of a Bioresorbable Vascular Scaffold in Porcine Coronary Arteries. JACC Cardiovasc Interv 2014; 7:688-95. [DOI: 10.1016/j.jcin.2013.11.024] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 10/30/2013] [Accepted: 11/21/2013] [Indexed: 10/25/2022]
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200
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Lipinski MJ, Escarcega RO, Lhermusier T, Waksman R. The effects of novel, bioresorbable scaffolds on coronary vascular pathophysiology. J Cardiovasc Transl Res 2014; 7:413-25. [PMID: 24800874 DOI: 10.1007/s12265-014-9571-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 04/21/2014] [Indexed: 12/01/2022]
Abstract
Percutaneous coronary intervention (PCI) has rapidly evolved over the past 30 years as technology has sought to improve clinical outcomes by addressing pathophysiologic complications arising from the intervention. Stents were designed to resolve the drawbacks of balloon angioplasty by providing radial support to prevent vessel recoil, by sealing coronary dissections, and by preventing abrupt vessel closure. The conceptualization of an ideal drug-eluting fully bioresorbable scaffold (BRS), whether metallic or polymeric, would theoretically address the adverse aspects of permanent metallic stents. In this review of the literature, we will discuss the impact these novel fully BRS platforms have on vascular pathophysiology following PCI.
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Affiliation(s)
- Michael J Lipinski
- MedStar Cardiovascular Research Network, MedStar Heart Institute, MedStar Washington Hospital Center, 110 Irving St., NW, Suite 4B-1, Washington, DC, 20010, USA
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