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Armazones vasculares bioabsorbibles en lesiones de bifurcación coronaria: solo en manos expertas. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2016.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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203
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Haude M, Ince H, Abizaid A, Toelg R, Lemos PA, von Birgelen C, Christiansen EH, Wijns W, Neumann FJ, Kaiser C, Eeckhout E, Lim ST, Escaned J, Onuma Y, Garcia-Garcia HM, Waksman R. Sustained safety and performance of the second-generation drug-eluting absorbable metal scaffold in patients with de novo coronary lesions: 12-month clinical results and angiographic findings of the BIOSOLVE-II first-in-man trial. Eur Heart J 2016; 37:2701-9. [PMID: 27190094 PMCID: PMC5037291 DOI: 10.1093/eurheartj/ehw196] [Citation(s) in RCA: 131] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 04/25/2016] [Indexed: 11/17/2022] Open
Abstract
Aims Metal absorbable scaffolds constitute a conceptually attractive alternative to polymeric scaffolds. Promising 6-month outcomes of a second-generation drug-eluting absorbable metal scaffold (DREAMS 2G), consisting of an absorbable magnesium scaffold backbone, have been reported. We assessed the 12-month safety and performance of this novel device. Methods and results The prospective, international, multi-centre, first-in-man BIOSOLVE-II trial enrolled 123 patients with up to two de novo lesions with a reference diameter between 2.2 and 3.7 mm. All patients were scheduled for angiographic follow-up at 6 months, and—if subjects consented—at 12 months. Dual antiplatelet therapy was recommended for 6 months. Quantitative coronary angiography (QCA) parameters remained stable from 6 to 12 months [paired data of 42 patients: in-segment late lumen loss 0.20 ± 0.21 mm vs. 0.25 ± 0.22 mm, P = 0.117, Δ 0.05 ± 0.21 mm (95% CI: −0.01;0.12); in-scaffold late lumen loss 0.37 ± 0.25 mm vs. 0.39 ± 0.27 mm, P = 0.446, Δ 0.03 ± 0.22 (95% CI: −0.04;0.10), respectively]. Intravascular ultrasound and optical coherence tomography findings corroborated the QCA results. Target lesion failure occurred in four patients (3.4%), consisting of one death of unknown cause, one target-vessel myocardial infarction, and two clinically driven target lesion revascularization. No additional event occurred beyond the 6-month follow-up. During the entire follow-up of 12 months, none of the patients experienced a definite or probable scaffold thrombosis. Conclusion The novel drug-eluting metal absorbable scaffold DREAMS 2G showed a continuous favourable safety profile up to 12 months and stable angiographic parameters between 6 and 12 months. ClinicalTrials.gov identifier NCT01960504.
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Affiliation(s)
- Michael Haude
- Medical Clinic I, Städtische Kliniken Neuss, Lukaskrankenhaus GmbH, Preussenstr. 84, 41464 Neuss, Germany
| | - Hüseyin Ince
- Department of Cardiology, Vivantes Klinikum im Friedrichschain and Am Urban, Berlin, Germany
| | | | - Ralph Toelg
- Herzzentrum Segeberger Kliniken GmbH, Bad Segeberg, Germany
| | - Pedro Alves Lemos
- Instituto do Coração - HCFMUSP, University of Sao Paulo, São Paulo, Brazil
| | - Clemens von Birgelen
- Department of Cardiology, Medisch Spectrum Twente, Thoraxcentrum Twente, Enschede, The Netherlands
| | | | - William Wijns
- Cardiology Department, Cardiovascular Research Center Aalst, OLV Hospital, Aalst, Belgium
| | - Franz-Josef Neumann
- Klinik für Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg - Bad Krozingen, Bad Krozingen, Germany
| | - Christoph Kaiser
- Department of Cardiology, University Hospital, Basel, Switzerland
| | - Eric Eeckhout
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Soo Teik Lim
- Department of Cardiology, National Heart Center Singapore, Singapore, Singapore
| | - Javier Escaned
- Department of Cardiology, Hospital Clinico San Carlos, Madrid, Spain
| | | | | | - Ron Waksman
- Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
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Schmidt W, Behrens P, Brandt-Wunderlich C, Siewert S, Grabow N, Schmitz KP. In vitro performance investigation of bioresorbable scaffolds - Standard tests for vascular stents and beyond. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2016; 17:375-83. [PMID: 27266902 DOI: 10.1016/j.carrev.2016.05.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 05/04/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND/PURPOSE Biodegradable polymers are the main materials for coronary scaffolds. Magnesium has been investigated as a potential alternative and was successfully tested in human clinical trials. However, it is still challenging to achieve mechanical parameters comparative to permanent bare metal (BMS) and drug-eluting stents (DES). As such, in vitro tests are required to assess mechanical parameters correlated to the safety and efficacy of the device. METHODS/MATERIALS In vitro bench tests evaluate scaffold profiles, length, deliverability, expansion behavior including acute elastic and time-dependent recoil, bending stiffness and radial strength. The Absorb GT1 (Abbott Vascular, Temecula, CA), DESolve (Elixir Medical Corporation, Sunnyvale, CA) and the Magmaris (BIOTRONIK AG, Bülach, Switzerland) that was previously tested in the BIOSOLVE II study, were tested. RESULTS Crimped profiles were 1.38±0.01mm (Absorb GT1), 1.39±0.01mm (DESolve) and 1.44±0.00mm (Magmaris) enabling 6F compatibility. Trackability was measured depending on stiffness and force transmission (pushability). Acute elastic recoil was measured at free expansion and within a mock vessel, respectively, yielding results of 5.86±0.76 and 5.22±0.38% (Absorb), 7.85±3.45 and 9.42±0.21% (DESolve) and 5.57±0.72 and 4.94±0.31% (Magmaris). Time-dependent recoil (after 1h) was observed for the Absorb and DESolve scaffolds but not for the Magmaris. The self-correcting wall apposition behavior of the DESolve did not prevent time-dependent recoil under vessel loading. CONCLUSIONS The results of the suggested test methods allow assessment of technical feasibility based on objective mechanical data and highlight the main differences between polymeric and metallic bioresorbable scaffolds.
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Affiliation(s)
- Wolfram Schmidt
- Institute for Biomedical Engineering, University Medicine Rostock, Friedrich-Barnewitz-Strasse 4, D-18119 Rostock-Warnemünde, Germany.
| | - Peter Behrens
- Institute for Biomedical Engineering, University Medicine Rostock, Friedrich-Barnewitz-Strasse 4, D-18119 Rostock-Warnemünde, Germany.
| | - Christoph Brandt-Wunderlich
- Institute for ImplantTechnology and Biomaterials - IIB e.V., Associated Institute of the University of Rostock, Friedrich-Barnewitz-Strasse 4, D-18119 Rostock-Warnemünde, Germany.
| | - Stefan Siewert
- Institute for ImplantTechnology and Biomaterials - IIB e.V., Associated Institute of the University of Rostock, Friedrich-Barnewitz-Strasse 4, D-18119 Rostock-Warnemünde, Germany.
| | - Niels Grabow
- Institute for Biomedical Engineering, University Medicine Rostock, Friedrich-Barnewitz-Strasse 4, D-18119 Rostock-Warnemünde, Germany.
| | - Klaus-Peter Schmitz
- Institute for ImplantTechnology and Biomaterials - IIB e.V., Associated Institute of the University of Rostock, Friedrich-Barnewitz-Strasse 4, D-18119 Rostock-Warnemünde, Germany.
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Colleran R, Byrne RA. Bioresorbable Vascular Scaffolds in Coronary Bifurcation Lesions: Only in Expert Hands. ACTA ACUST UNITED AC 2016; 69:543-6. [PMID: 27157886 DOI: 10.1016/j.rec.2016.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 03/08/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Roisin Colleran
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Robert A Byrne
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
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Kawamoto H, Ruparelia N, Tanaka A, Chieffo A, Latib A, Colombo A. Bioresorbable Scaffolds for the Management of Coronary Bifurcation Lesions. JACC Cardiovasc Interv 2016; 9:989-1000. [DOI: 10.1016/j.jcin.2016.02.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 01/21/2016] [Accepted: 02/25/2016] [Indexed: 10/21/2022]
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Hernández Hernández F, de la Torre Hernández JM, Rumoroso Cuevas JR, García Del Blanco B, Zunzunegui Martínez JL, Trillo Nouche R. Interventional Cardiology 2015: A Selection of Topical Issues. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2016; 69:415-420. [PMID: 26961796 DOI: 10.1016/j.rec.2015.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 12/16/2015] [Indexed: 06/05/2023]
Affiliation(s)
| | - José M de la Torre Hernández
- Unidad de Cardiología Intervencionista, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | | | | | | | - Ramiro Trillo Nouche
- Departamento de Cardiología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
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Hernández Hernández F, de la Torre Hernández JM, Rumoroso Cuevas JR, García del Blanco B, Zunzunegui Martínez JL, Trillo Nouche R. Selección de temas de actualidad en cardiología intervencionista 2015. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2015.12.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Basalus MW. Oversized post-dilatation of current bioresorbable vascular scaffolds: kill or cure? EUROINTERVENTION 2016; 11:1330-3. [DOI: 10.4244/eijv11i12a259] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Suwannasom P, Sotomi Y, Tateishi H, Tenekecioglu E, Zeng Y, Kraak RP, Wykrzykowska JJ, De Winter RJ, Serruys PW, Onuma Y. Bioresorbable drug-eluting scaffolds for treatment of vascular disease. Expert Opin Drug Deliv 2016; 13:725-39. [PMID: 26865247 DOI: 10.1517/17425247.2016.1153062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Theoretical advantages of fully bioresorbable scaffold (BRS) stem from transient vessel support without rigid caging. Therefore, it could reduce long-term adverse events associated with the presence of foreign materials. AREAS COVERED This article will provide an overview of: drug-eluting BRS for various applications in the treatment of vascular disease; The mechanisms of active agent release from such scaffolds; currently available drug-eluting BRS and their future applications are also discussed. EXPERT OPINION The current BRS have been developed in order to achieve optimal vascular patency while providing long-term safety. The clinical efficacy and safety of BRS in coronary treatment have been reported as equal to that of the current metallic drug eluting stents in simple lesions. The application of BRS can potentially be expanded to other vascular beds. The research in bioengineering for the appropriate materials should not only focus on biocompatibility but also should be tailored according to the sites of implantation, which may require different strength and supporting period. The ultimate goal in this field is to develop a biocompatible device that provides equivalent and complementary therapy to other devices, and is able to disappear when the mechanical support and drug delivery are no longer required.
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Affiliation(s)
- Pannipa Suwannasom
- a AMC Heartcenter, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands.,b ThoraxCenter , Erasmus Medical Center , Rotterdam , The Netherlands.,c Northern Region Heart Center, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand
| | - Yohei Sotomi
- a AMC Heartcenter, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Hiroki Tateishi
- b ThoraxCenter , Erasmus Medical Center , Rotterdam , The Netherlands
| | | | - Yaping Zeng
- b ThoraxCenter , Erasmus Medical Center , Rotterdam , The Netherlands
| | - Robin P Kraak
- a AMC Heartcenter, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Joanna J Wykrzykowska
- a AMC Heartcenter, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Robbert J De Winter
- a AMC Heartcenter, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Patrick W Serruys
- d International Centre for Circulatory Health, NHLI , Imperial College London , London , UK
| | - Yoshinobu Onuma
- b ThoraxCenter , Erasmus Medical Center , Rotterdam , The Netherlands
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Tenekecioglu E, Bourantas C, Abdelghani M, Zeng Y, Silva RC, Tateishi H, Sotomi Y, Onuma Y, Yılmaz M, Serruys PW. From drug eluting stents to bioresorbable scaffolds; to new horizons in PCI. Expert Rev Med Devices 2016; 13:271-86. [DOI: 10.1586/17434440.2016.1143356] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Steg PG, Serruys PW, Abdelghani M, Wijns W. The year in cardiology 2015: coronary intervention. Eur Heart J 2016; 37:335-43. [PMID: 26726048 DOI: 10.1093/eurheartj/ehv708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 12/03/2015] [Indexed: 11/14/2022] Open
Affiliation(s)
- Philippe Gabriel Steg
- FACT (French Alliance for Cardiovascular clinical Trials), an F-CRIN network, Département Hospitalo-Universitaire FIRE, AP-HP, Hôpital Bichat, 46 rue Henri Huchard, 75018 Paris, France Université Paris-Diderot, Sorbonne Paris Cité, Paris, France INSERM U-1148, Paris F-75018, France NHLI, Imperial College, Royal Brompton Hospital, London, UK
| | - Patrick W Serruys
- International Centre for Circulatory Health, NHLI, Imperial College London, London, UK
| | | | - William Wijns
- Cardiovascular Research Center Aalst, Aalst, Belgium
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213
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Zeymer U. Coronary intervention in 2015: Improvement of long-term outcomes after PCI. Nat Rev Cardiol 2016; 13:69-70. [PMID: 26763540 DOI: 10.1038/nrcardio.2015.204] [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: 11/09/2022]
Affiliation(s)
- Uwe Zeymer
- Klinikum Ludwigshafen and the Institut für Herzinfarktforschung Ludwigshafen, Bremser Strasse 79, 67063 Ludwigshafen, Germany
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Bouchi YH, Gogas BD. Biocorrodible metals for coronary revascularization: Lessons from PROGRESS-AMS, BIOSOLVE-I, and BIOSOLVE-II. Glob Cardiol Sci Pract 2015; 2015:63. [PMID: 26925408 PMCID: PMC4754561 DOI: 10.5339/gcsp.2015.63] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 09/29/2015] [Indexed: 12/17/2022] Open
Abstract
The impetus for developing drug-eluting bioresorbable scaffolds (BRS) has been driven by the need for elastic and transient platforms instead of stiff and permanent metallic implants in diseased coronary anatomies. This endeavor would prevent acute recoil or occlusion, allow sealing of post-procedural dissections following acute barotrauma, provide inhibition of in-segment restenosis through efficient drug-elution and would further prepare the vessel to enter a reparative phase following scaffold resorption. Biocorrodible metallic platforms have been introduced as alternatives to bioresorbable polymeric scaffolds for the treatment of significant atherosclerosis and in view of the body of evidence derived from recent clinical trials we elaborate on the clinical safety and efficacy of these devices in interventional cardiology.
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Affiliation(s)
- Yasir H Bouchi
- Andreas Gruentzig Cardiovascular Center, Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Bill D Gogas
- Andreas Gruentzig Cardiovascular Center, Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
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