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La Manna A, Chisari A, Giacchi G, Capodanno D, Longo G, Di Silvestro M, Capranzano P, Tamburino C. Everolimus-eluting bioresorbable vascular scaffolds versus second generation drug-eluting stents for percutaneous treatment of chronic total coronary occlusions: Technical and procedural outcomes from the GHOST-CTO registry. Catheter Cardiovasc Interv 2016; 88:E155-E163. [PMID: 26756959 DOI: 10.1002/ccd.26397] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 12/21/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVES We aimed at comparing the acute performance of bioresorbable scaffolds (BRS) and second-generation drug-eluting stents (DES) for the treatment of chronic total occlusions (CTO). BACKGROUND There is a lack of knowledge regarding the use of BRS in CTO. METHODS Key outcomes of interest were technical and procedural success. Technical success was defined as successful stent delivery and implantation, postprocedural residual diameter stenosis <30% within the treated segment, and restoration of thrombolysis in myocardial infarction (TIMI) grade 3 flow. Procedural success was defined as technical success with no in-hospital major adverse cardiac events (MACE). RESULTS Between May 2013 and May 2014, 32 patients underwent CTO percutaneous coronary intervention (PCI) with the Absorb BRS (Abbott Vascular, Santa Clara, CA) and were compared with a historical control group of 54 patients who had undergone CTO PCI with second-generation DES. Baseline characteristics were similar between the BRS and DES groups, with the exception of a larger mean reference vessel diameter in the BRS group (2.92 ± 0.34 vs 2.50 ± 0.68; P < 0.001). Technical success was less likely to be achieved in the BRS group compared with the DES group (78.1% vs 96.3%, P = 0.012). Procedural success rates were 78.1% and 94.4% in the BRS and DES group, respectively (P = 0.035). CONCLUSIONS Compared with second-generation DES for PCI of CTO lesions, BRS were associated with lower rates of technical and procedural success. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Alessio La Manna
- Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Alberto Chisari
- Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Giuseppe Giacchi
- Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Davide Capodanno
- Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Giovanni Longo
- Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Michele Di Silvestro
- Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Piera Capranzano
- Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Corrado Tamburino
- Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy.,Excellence through Newest Advances (ETNA) Foundation, Catania, Italy
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202
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Tamburino C, Capranzano P, Francaviglia B, Ina Tamburino C, Longo G, Capodanno D. Update on clinical evidence (Part II): A summary of the main post market studies. Catheter Cardiovasc Interv 2016; 88:31-37. [PMID: 27797461 DOI: 10.1002/ccd.26809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 09/14/2016] [Indexed: 11/09/2022]
Abstract
Bioresorbable vascular scaffolds (BVS, Absorb, Abbott Vascular, Santa Clara, CA) received the CE mark in October 2011, and were approved by the Food and Drug Administration in July 2016. After their introduction in clinical practice a broad amount of post-marketing clinical experience with BVS has been generated so far in Europe and outside the United States. The available BVS registries differ in many aspects, including their being single-center or multicenter, single-arm or controlled, sponsored or investigator-initiated, published or presented at a large-scale international meeting. This article provides an overview of clinical results of the main post-marketing studies of BVS available. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Corrado Tamburino
- Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Piera Capranzano
- Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy.
| | - Bruno Francaviglia
- Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Claudia Ina Tamburino
- Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Giovanni Longo
- Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Davide Capodanno
- Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy
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203
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Current practices of Asia-Pacific cardiologists in the utilization of bioresorbable scaffolds. Int J Cardiol 2016; 222:832-840. [PMID: 27522385 DOI: 10.1016/j.ijcard.2016.07.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 07/21/2016] [Accepted: 07/30/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND & AIMS Although Absorb Bioresorbable Vascular Scaffolds (A-BVS) are routinely used in the Asia-Pacific, there is little information on patient selection or deployment technique here. This document investigates the experiences of leading interventional cardiologists from the Asia-Pacific region with a focus on patient characteristics, deployment techniques and management. METHODS AND RESULTS A detailed questionnaire was distributed to 28 highly-experienced interventional cardiologists ('Authors') from 13 Asia-Pacific countries. The results were discussed at a meeting on patient selection, technical consideration, deployment practices and patient management. Potential patient benefits of Absorb compared to metallic DES, the learning curve for patient selection and preparation, device deployment, and subsequent patient management approaches are presented. CONCLUSIONS Current practices are derived from guidelines optimized for European patients. Differences in approach exist in the Asia-Pacific context, including limited access to imaging and frequency of occurrence of complex lesions. Nevertheless, the use of the Absorb BVS ('Absorb') in certain Asia-Pacific countries has flourished and practices here are continuing to mature.
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de Ribamar Costa J, Abizaid A, Bartorelli A, Whitbourn R, Jepson N, Perin M, Steinwender C, Stuteville M, Ediebah D, Sudhir K, Serruys P. One-year clinical outcomes of patients treated with everolimus-eluting bioresorbable vascular scaffolds versus everolimus-eluting metallic stents: a propensity score comparison of patients enrolled in the ABSORB EXTEND and SPIRIT trials. EUROINTERVENTION 2016; 12:1255-1262. [DOI: 10.4244/eijv12i10a206] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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205
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Chamié D, Garcia-Garcia H, Costa RA, Onuma Y, Abizaid A, Serruys PW. Role of invasive imaging in acute and long-term assessment of bioresorbable scaffold technology. Catheter Cardiovasc Interv 2016; 88:38-53. [PMID: 27797463 DOI: 10.1002/ccd.26815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 10/01/2016] [Indexed: 11/11/2022]
Abstract
Fully bioresorbable scaffolds (BRS) represent a novel approach for the percutaneous treatment of coronary artery stenosis, providing temporary vessel scaffolding with drug-eluting capability during the restenosis-prone phase of the vascular healing. Beyond this initial critical period, when mechanical scaffolding support is no longer necessary, the device is bioresorbed, restoring the normal vascular physiology with the aim to eliminate the long-term safety concerns related to permanent metallic implants. Nonetheless, current BRS technology suffers from limited mechanical properties as compared to available metallic platforms, requiring careful attention to lesion preparation, accurate vessel sizing, and implantation technique. Intravascular imaging has played an important role in providing knowledge on the acute effects after BRS deployment, and it helped refine the current technique of BRS implantation. In addition, extensive work with multiple intravascular imaging modalities have also contributed to the understanding of the unique dynamic vascular changes that are experienced in the treated segment from post-implantation up to complete device bioresorption. In this manuscript, we review the role of invasive imaging modalities-from angiography to sound- and light-based techniques-to guide BRS implantation procedures, to assess its acute results postimplantation, and the changes experienced in the long-term until complete bioresorption has ensued. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Daniel Chamié
- Department of Interventional Cardiology, Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil. .,Cardiovascular Research Center, Sao Paulo, Brazil.
| | - Hector Garcia-Garcia
- Department of Interventional Cardiology, MedStar Heart and Vascular Institute, Washington, DC
| | - Ricardo A Costa
- Department of Interventional Cardiology, Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil.,Cardiovascular Research Center, Sao Paulo, Brazil
| | - Yoshinobu Onuma
- Department of Interventional Cardiology, Erasmus University Medical Center, Thoraxcenter, Rotterdam, The Netherlands.,Cardialysis BV, Rotterdam, The Netherlands
| | - Alexandre Abizaid
- Department of Interventional Cardiology, Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil.,Cardiovascular Research Center, Sao Paulo, Brazil.,Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Patrick W Serruys
- NHLI, Imperial College London, International Centre for Circulatory Health, London, United Kingdom
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206
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Bioresorbable vascular scaffolds for the treatment of coronary artery disease: Clinical outcomes from randomized controlled trials. Catheter Cardiovasc Interv 2016; 88:21-30. [DOI: 10.1002/ccd.26810] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 09/14/2016] [Indexed: 11/07/2022]
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207
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Tanaka A, Jabbour RJ, Latib A, Colombo A. Bioresorbable vascular scaffolds: From patient selection to optimal scaffold implantation; tips and tricks to minimize device failure. Catheter Cardiovasc Interv 2016; 88:10-20. [DOI: 10.1002/ccd.26812] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 09/14/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Akihito Tanaka
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus; Milan Italy
- Interventional Cardiology Unit, San Raffaele Scientific Institute; Milan Italy
| | - Richard J. Jabbour
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus; Milan Italy
- Interventional Cardiology Unit, San Raffaele Scientific Institute; Milan Italy
- Imperial College London; United Kingdom
| | - Azeem Latib
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus; Milan Italy
- Interventional Cardiology Unit, San Raffaele Scientific Institute; Milan Italy
| | - Antonio Colombo
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus; Milan Italy
- Interventional Cardiology Unit, San Raffaele Scientific Institute; Milan Italy
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Abizaid A, Ribamar Costa J. The unmet needs: How future technologies will address current limitations of bioresorbable scaffold technology. Catheter Cardiovasc Interv 2016; 88:54-59. [DOI: 10.1002/ccd.26813] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 09/27/2016] [Accepted: 09/27/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Alexandre Abizaid
- Instituto Dante Pazzanese de Cardiologia; São Paulo Brazil
- Hospital do Coração - Associação do Sanatorio Sírio; São Paulo Brazil
- Hospital Israelita Albert Einstein; São Paulo Brazil
| | - J. Ribamar Costa
- Instituto Dante Pazzanese de Cardiologia; São Paulo Brazil
- Hospital do Coração - Associação do Sanatorio Sírio; São Paulo Brazil
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Ielasi A, Varricchio A, Campo G, Leoncini M, Cortese B, Vicinelli P, Brugaletta S, di Uccio FS, Latib A, Tespili M. A prospective evaluation of a standardized strategy for the use of a polymeric everolimus-eluting bioresorbable scaffold in ST-segment elevation myocardial infarction: Rationale and design of the BVS STEMI STRATEGY-IT study. Catheter Cardiovasc Interv 2016; 89:1129-1138. [PMID: 27774758 DOI: 10.1002/ccd.26801] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 08/07/2016] [Accepted: 09/05/2016] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To assess the feasibility and the clinical results following a prespecified bioresorbable vascular scaffold (Absorb BVS) implantation strategy in ST-elevation myocardial infarction (STEMI) patients. BACKGROUNDS Concerns raised about the BVS safety in STEMI setting because a not negligible thrombosis rate was reported within 30 days and 12 months after implantation. Technical procedural issues related to the structural BVS features were advocated as probable causes for the thrombotic events. METHODS This is an investigators-owned and -directed, prospective, nonrandomized, single-arm multicenter registry intended to obtain data from 500 consecutive STEMI patients undergoing primary PCI with BVS (1.1 or GT1) following a prespecified implantation protocol. The study is recorded in ClinicalTrials.gov with the identifier: NCT02601781. RESULTS The primary endpoint is a device-oriented composite end-point (DOCE) of cardiac death, any myocardial infarction clearly attributable to the intervention culprit vessel and ischemic-driven target lesion revascularization within 30 days after the index procedure. The DOCE will be assessed even at 6-month, 1-, 3-, and 5-year follow-up. CONCLUSIONS This will be the first study investigating the feasibility and the early- and long-term clinical impact of a prespecified BVS implantation protocol in thrombotic lesions causing STEMI. Here, we describe the rationale and the design of the study. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Alfonso Ielasi
- Cardiology Division, Bolognini Hospital Seriate, Seriate, BG, Italy
| | | | - Gianluca Campo
- Cardiovascular Section, Medical Sciences Department, Azienda Ospedaliera Universitaria Sant' Anna, Ferrara, Italy
| | | | | | | | - Salvatore Brugaletta
- Cardiology Division, Cardiology Department, Thorax Institute; IDIBAPS, University of Barcelona, Hospital Clinic, Barcelona, Spain
| | | | - Azeem Latib
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus and San Raffaele Scientific Institute, Milan, Italy
| | - Maurizio Tespili
- Cardiology Division, Bolognini Hospital Seriate, Seriate, BG, Italy
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210
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Lipinski MJ, Escarcega RO, Baker NC, Benn HA, Gaglia MA, Torguson R, Waksman R. Scaffold Thrombosis After Percutaneous Coronary Intervention With ABSORB Bioresorbable Vascular Scaffold: A Systematic Review and Meta-Analysis. JACC Cardiovasc Interv 2016; 9:12-24. [PMID: 26762906 DOI: 10.1016/j.jcin.2015.09.024] [Citation(s) in RCA: 141] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 08/27/2015] [Accepted: 09/10/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The aim of this study was to determine the risk of scaffold thrombosis (ST) after percutaneous coronary intervention (PCI) with placement of an ABSORB bioresorbable vascular scaffold (BVS) (Abbott Vascular, Santa Clara, California) by conducting a systematic review and meta-analysis. BACKGROUND PCI with BVS placement holds great potential, but concern has recently been raised regarding the risk of ST. METHODS MEDLINE/PubMed, Cochrane CENTRAL, and meeting abstracts were searched for all studies that included outcomes data for patients after PCI with BVS placement. For studies comparing BVSs with drug-eluting stents (DES), pooled estimates of outcomes, presented as odds ratios (ORs) with 95% confidence intervals (CIs), were generated with random-effects models. RESULTS Our analysis included 10,510 patients (8,351 with a BVS and 2,159 with DES) with a follow-up of 6.4 ± 5.1 months and 60 ± 11 years of age; 78% were male, 36% had stable angina, and 59% had acute coronary syndrome (ACS). Among patients with a BVS, cardiovascular death occurred in 0.6%, myocardial infarction (MI) in 2.1%, target lesion revascularization in 2.0%, and definite/probable ST in 1.2% of patients. Of BVS patients, 0.27% had acute ST and 0.57% had subacute ST. Meta-analysis demonstrated that patients who received a BVS were at a higher risk of MI (OR: 2.06, 95% CI: 1.31 to 3.22, p = 0.002) and definite/probable ST (OR: 2.06, 95% CI: 1.07 to 3.98, p = 0.03) compared with patients who received DES, whereas there was a trend toward decreased all-cause mortality with a BVS (OR: 0.40, 95% CI: 0.15 to 1.06, p = 0.06). CONCLUSIONS Patients undergoing PCI with a BVS had increased definite/probable ST and MI during follow-up compared with DES. Further studies with long-term follow-up are needed to assess the risk of ST with a BVS.
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Affiliation(s)
- Michael J Lipinski
- MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, Washington, DC
| | - Ricardo O Escarcega
- MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, Washington, DC
| | - Nevin C Baker
- MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, Washington, DC
| | - Hadiya A Benn
- MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, Washington, DC
| | - Michael A Gaglia
- MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, Washington, DC
| | - Rebecca Torguson
- MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, Washington, DC
| | - Ron Waksman
- MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, Washington, DC.
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Ming Fam J, van Der Sijde JN, Karanasos A, Felix C, Diletti R, van Mieghem N, de Jaegere P, Zijlstra F, Jan van Geuns R, Regar E. Comparison of acute expansion of bioresorbable vascular scaffolds versus metallic drug-eluting stents in different degrees of calcification: An optical coherence tomography study. Catheter Cardiovasc Interv 2016; 89:798-810. [DOI: 10.1002/ccd.26676] [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] [Received: 03/02/2016] [Accepted: 07/03/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Jiang Ming Fam
- Thorax Centre; Erasmus University Medical Centre; Rotterdam Netherlands
- National Heart Centre Singapore
| | | | | | - Cordula Felix
- Thorax Centre; Erasmus University Medical Centre; Rotterdam Netherlands
| | - Roberto Diletti
- Thorax Centre; Erasmus University Medical Centre; Rotterdam Netherlands
| | | | - Peter de Jaegere
- Thorax Centre; Erasmus University Medical Centre; Rotterdam Netherlands
| | - Felix Zijlstra
- Thorax Centre; Erasmus University Medical Centre; Rotterdam Netherlands
| | | | - Evelyn Regar
- Thorax Centre; Erasmus University Medical Centre; Rotterdam Netherlands
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212
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Prevalence of parameters of suboptimal scaffold deployment following angiographic guided bioresorbable vascular scaffold implantation in real world practice - an optical coherence tomography analysis. Int J Cardiol 2016; 220:32-42. [PMID: 27372040 DOI: 10.1016/j.ijcard.2016.06.096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 05/19/2016] [Accepted: 06/21/2016] [Indexed: 11/22/2022]
Abstract
AIM To assess the prevalence of suboptimal bioresorbable vascular scaffold (BVS, Abbott Vascular, Santa Clara, California) deployment in real world practice with intracoronary optical coherence tomography (OCT) imaging. METHODS Consecutive patients who underwent percutaneous coronary intervention using BVS and the final optimization assessed with OCT imaging in two tertiary care centers between December 2012 and February 2015 were evaluated for parameters of suboptimal scaffold deployment by OCT. RESULTS Overall, 36 scaffolds were implanted in 27 patients during this period. Mean age of the population was 54.7±8.2years and 19 (70.4%) were type B2/C lesions. The prevalence of parameters of suboptimal scaffold deployment were: underexpansion-22(61.1%), geographic miss-3(8.3%), tissue prolapse-7(25.9%), scaffold pattern irregularity-1(2.8%), longitudinal elongation-7(38.8%). Of the 7 overlaps imaged: excessive overlap was observed in 3 and scaffold gap in one. The median duration of follow up was 679days (range 193-963days). There were four events during this period. None were associated with suboptimal scaffold deployment. CONCLUSION OCT based parameters of suboptimal scaffold deployment are common in real world scenario and were not associated with adverse outcomes on long term follow up. These findings need to be confirmed in larger studies.
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213
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Mukete BN, van der Heijden LC, Tandjung K, Baydoun H, Yadav K, Saleh QA, Doggen CJ, Rafeh NA, Le Jemtel TH, von Birgelen C. Safety and efficacy of everolimus-eluting bioresorbable vascular scaffolds versus durable polymer everolimus-eluting metallic stents assessed at 1-year follow-up: A systematic review and meta-analysis of studies. Int J Cardiol 2016; 221:1087-94. [DOI: 10.1016/j.ijcard.2016.07.101] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 07/06/2016] [Accepted: 07/07/2016] [Indexed: 10/21/2022]
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214
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Panoulas VF, Ielasi A. Bioresorbable scaffolds and drug-eluting balloons for the management of spontaneous coronary artery dissections. J Thorac Dis 2016; 8:E1328-E1330. [PMID: 27867618 DOI: 10.21037/jtd.2016.10.54] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Vasileios F Panoulas
- Harefield and Royal Brompton Hospital NHS Trust, London, UK;; National Heart and Lung Institute, Imperial College London, London, UK
| | - Alfonso Ielasi
- Cardiology Division, Bolognini Hospital Seriate, ASST Bergamo Est, Italy
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215
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Abstract
The introduction of percutaneous treatment of coronary artery stenosis with balloon angioplasty was the first revolution in interventional cardiology; the advent of metallic coronary stents (bare and drug-eluting) marked the second and third revolutions. However, the latest generation of drug-eluting stents is limited by several factors. Permanent vessel caging impairs arterial physiology, and the incidence of very late stent thrombosis - although lower with the second generation than with the first generation of drug-eluting stents - remains a major concern. This complication is mainly related to the presence of permanent metallic implants, chronic degeneration triggered by an inflammatory response to the coating polymer, and/or adverse effects of antiproliferative drugs on endothelial regeneration. In 2011, self-degrading coronary stents - the bioresorbable vascular scaffolds (BVS) - were introduced into clinical practice, showing good short-term results owing to their adequate strength. The advantage of these devices is the transient nature of vascular scaffolding, which avoids permanent vessel caging. In this Review, we summarize the latest research on BVS, with a particular emphasis on the implantation technique (which is different from that used with metallic stents) to outline the concept that BVS deployment methods have a major effect on procedural success and prognosis of patients with coronary artery stenosis. Furthermore, the clinical outcome of BVS in randomized clinical trials and in phase IV studies are discussed in different pathophysiological settings, such as stable or acute coronary disease. Finally, all the available data on the safety profile of BVS regarding scaffold thrombosis are discussed.
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216
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Chen D, Jepson N. Coronary stent technology: a narrative review. Med J Aust 2016; 205:277-81. [DOI: 10.5694/mja16.00444] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 07/26/2016] [Indexed: 11/17/2022]
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217
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Abstract
Bioresorbable vascular scaffolds (BVS) have emerged as an interesting alternative since the presence of the prosthesis in the coronary artery is transient. This technology enables to restore the normal vasomotor tone and allows positive remodeling, simultaneously reducing the trigger for persistent inflammation and facilitating further interventions by percutaneous or surgical means. Absorb BVS(®) is the first generation everolimus-eluting poly-L-lactide (PLLA) bioresorbable scaffold. In recent meta-analyses Absorb BVS(®) was definitely proved to be safe and effective device in the treatment of symptomatic coronary artery disease. This was recently confirmed by FDA advisory panel of experts who recommended approval of the device based on an analysis of its risks and rewards. Nevertheless, still there are some concerns regarding stent thrombosis, and the real vessel functionality restoration at long-term observation. Worth mentioning is the fact that apart from stable coronary disease Absorb BVS(®) is used successfully in a series of off-label clinical settings such as acute coronary syndromes including STEMI, in-stent restenosis, coronary bifurcations, left main stenting or chronic total occlusions. Moreover, new bioresorbable scaffolds are under development with DEsolve(®) and DREAM 2G(®), which are the most advanced.
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Affiliation(s)
- Jacek Bil
- Department of Invasive Cardiology, Central Clinical Hospital of the Ministry of the Interior, Warsaw, Poland
| | - Robert J Gil
- Department of Invasive Cardiology, Central Clinical Hospital of the Ministry of the Interior, Warsaw, Poland;; Institute of Experimental and Clinical Medicine, Polish Academy of Science, Warsaw, Poland
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218
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Collet C, de Winter RJ, Onuma Y, Serruys PW. The Absorb bioresorbable vascular scaffold for the treatment of coronary artery disease. Expert Opin Drug Deliv 2016; 13:1489-99. [PMID: 27550021 DOI: 10.1080/17425247.2016.1227788] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Every decade the field of interventional cardiology is revolutionized by new technology. The fully bioresorbable everolimus-eluting scaffold (ABSORB BVS) technology would preserve the benefits of metallic stents by sealing balloon-induced dissections, avoiding elastic recoil and vessel occlusion. The polymeric scaffold would be resorbed to restore the natural integrity of the vessel, superseding the consequence of the permanent presence of a foreign body in the coronary artery. AREAS COVERED This technology evaluation focuses on the clinical evidence for the use of bioresorbable everolimus-eluting scaffold for the treatment of coronary artery disease. EXPERT OPINION The current generation of the bioresorbable scaffold has structural and mechanical limitations that might preclude the widespread use in clinical practice. The strut thickness (150 µm) limits deliverability and creates laminar flow disruptions that might be the nidus of an increased rate of scaffold thrombosis. In the next generation of bioresorbable scaffolds, the resorption process should be faster and in particular, strut thickness must be reduced. This will probably represent a significant step forward in an attempt to increase the efficacy and safety profile of the device and achieve a similar performance with the current generation drug-eluting stent even in complex scenarios.
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Affiliation(s)
- Carlos Collet
- a Department of Cardiology, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Robbert J de Winter
- a Department of Cardiology, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Yoshinobu Onuma
- b Department of Interventional Cardiology , Erasmus Medical Center , Rotterdam , The Netherlands
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Foin N, Lee R, Bourantas C, Mattesini A, Soh N, Lim JE, Torii R, Ng J, Liang LH, Caiazzo G, Fabris E, Kilic D, Onuma Y, Low AF, Nijjer S, Sen S, Petraco R, Al Lamee R, Davies JE, Di Mario C, Wong P, Serruys PW. Bioresorbable vascular scaffold radial expansion and conformation compared to a metallic platform: insights from in vitro expansion in a coronary artery lesion model. EUROINTERVENTION 2016; 12:834-44. [DOI: 10.4244/eijv12i7a138] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Bioresorbable vascular scaffolds for the treatment of coronary artery disease: what have we learned from randomized-controlled clinical trials? Coron Artery Dis 2016; 28:77-89. [PMID: 27561169 DOI: 10.1097/mca.0000000000000414] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Although current everolimus-eluting coronary stents have shown improved event-free survival within the first year following implantation compared with bare-metal stents or earlier generation drug-eluting stents, they remain associated with an ongoing risk for adverse outcomes (thrombosis, myocardial infarction, and restenosis) beyond 1 year at rates similar to those observed following bare-metal stent deployment. This ongoing very late hazard has been attributed to the permanent presence of the metal frame and/or polymer in these stents. The Absorb everolimus-eluting bioresorbable vascular scaffold (Absorb BVS) has been developed to provide mechanical support and drug-delivery functions similar to metallic drug-eluting stents, followed by complete resorption with recovery of more normal vascular structure and function, thus avoiding the limitations associated with permanent metallic endovascular prostheses. Absorb BVS has shown safety and efficacy in the dedicated clinical trial development program of Abbott Vascular and in an array of investigator-sponsored studies involving a broad spectrum of clinical (patient) as well as coronary anatomic complexity. Longer-term evidence, largely limited to single-arm studies, appears to reflect durable safety and efficacy and suggests Absorb BVS to be an attractive therapeutic option. Interim evidence from a series of randomized-clinical trials (RCTs) comparing Absorb BVS with the Xience cobalt-chromium metallic everolimus-eluting stent has shown noninferiority of Absorb BVS with respect to target lesion failure (composite occurrence of cardiac death, target vessel-related myocardial infarction, and ischemia-driven target lesion revascularization) beyond the first year, with no statistically significant differences in other safety/efficacy measures. However, concerns do exist in terms of increased rates of scaffold thrombosis, the risk for which may be mitigated by improved patient and lesion selection, procedural technique, and device iteration. We provide an overview of the evolution of percutaneous coronary intervention, in-vivo characterization of Absorb BVS resorption, and a summary with a critical evaluation of available evidence from RCTs, pooled analyses, and meta-analyses of RCTs for the safety and efficacy of Absorb BVS obtained primarily following the treatment of noncomplex coronary lesions in patients with stable ischemic heart disease and/or stabilized acute coronary syndromes.
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Farag M, Spinthakis N, Gorog DA, Prasad A, Sullivan K, Akhtar Z, Kukreja N, Srinivasan M. Use of bioresorbable vascular scaffold: a meta-analysis of patients with coronary artery disease. Open Heart 2016; 3:e000462. [PMID: 27621831 PMCID: PMC5013412 DOI: 10.1136/openhrt-2016-000462] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 07/04/2016] [Accepted: 07/24/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Differences in outcomes between bioresorbable vascular scaffold (BVS) systems and drug-eluting metal stents (DES) have not been fully evaluated. We aimed to compare clinical and angiographic outcomes in randomised studies of patients with coronary artery disease (CAD), with a secondary analysis performed among registry studies. METHODS A meta-analysis comparing outcomes between BVS and DES in patients with CAD. Overall estimates of treatment effect were calculated with random-effects model and fixed-effects model. RESULTS In 6 randomised trials (3818 patients), BVS increased the risk of subacute stent thrombosis (ST) over and above DES (OR 2.14; CI 1.01 to 4.53; p=0.05), with a trend towards an increase in the risk of myocardial infarction (MI) (125 events in those assigned to BVS and 50 to DES; OR 1.36; CI 0.97 to 1.91; p=0.07). The risk of in-device late lumen loss (LLL) was higher with BVS than DES (mean difference 0.08 mm; CI 0.03 to 0.13; p=0.004). There was no difference in the risk of death or target vessel revascularisation (TVR) between the two devices. In 6 registry studies (1845 patients), there was no difference in the risk of death, MI, TVR or subacute ST between the two stents. Final BVS dilation pressures were higher in registry than in randomised studies (18.7±4.6 vs 15.2±3.3 atm; p<0.001). CONCLUSIONS Patients treated with BVS had an increased risk of subacute ST and slightly higher LLL compared with those with DES, but this might be related to inadequate implantation techniques, in particular device underexpansion.
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Affiliation(s)
- Mohamed Farag
- Department of Cardiology, East and North Hertfordshire NHS Trust, Hertfordshire, UK; Postgraduate Medical School, University of Hertfordshire, Hertfordshire, UK
| | - Nikolaos Spinthakis
- Department of Cardiology , East and North Hertfordshire NHS Trust , Hertfordshire , UK
| | - Diana A Gorog
- Department of Cardiology, East and North Hertfordshire NHS Trust, Hertfordshire, UK; Postgraduate Medical School, University of Hertfordshire, Hertfordshire, UK; National Heart & Lung Institute, Imperial College, London, UK
| | | | - Keith Sullivan
- Postgraduate Medical School, University of Hertfordshire , Hertfordshire , UK
| | - Zaki Akhtar
- Department of Cardiology , East and North Hertfordshire NHS Trust , Hertfordshire , UK
| | - Neville Kukreja
- Department of Cardiology , East and North Hertfordshire NHS Trust , Hertfordshire , UK
| | - Manivannan Srinivasan
- Department of Cardiology , East and North Hertfordshire NHS Trust , Hertfordshire , UK
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Colombo A, Ruparelia N. Who Is Thrombogenic: The Scaffold or the Doctor? Back to the Future! JACC Cardiovasc Interv 2016; 9:25-27. [PMID: 26762907 DOI: 10.1016/j.jcin.2015.09.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 09/24/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Antonio Colombo
- Department of Interventional Cardiology, San Raffaele Scientific Institute, and EMO-GVM, Centro Cuore Columbus, Milan, Italy.
| | - Neil Ruparelia
- Department of Interventional Cardiology, San Raffaele Scientific Institute, and EMO-GVM, Centro Cuore Columbus, Milan, Italy; Department of Cardiology, Imperial College, London, United Kingdom
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Mallidi J, Lotfi A. Late and Very Late Stent Thrombosis in the Era of Second-Generation Drug-Eluding Stents. EUROPEAN MEDICAL JOURNAL 2016. [DOI: 10.33590/emj/10313883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
Stent thrombosis is a life-threatening complication of percutaneous coronary intervention that often results in ST-segment myocardial infarction or sudden cardiac death. First-generation drug-eluting stents (DESs) are associated with an increased risk of late and very late stent thrombosis compared with bare- metal stents due to delayed endothelialisation of the stent struts. The second-generation DES design includes a number of improved features (thinner stent struts, fluorinated copolymers, and different anti-proliferative agents) to decrease the risk of late stent thrombosis. Currently, the cobalt-chromium everolimus-eluting stent, a second-generation stent, has the lowest risk of stent thrombosis when compared with the available alternatives. Given the improved design of second-generation stents, a shorter duration of dual antiplatelet therapy of 6 months may be enough to reduce the rate of bleeding complications without increasing the risk of adverse cardiovascular events. Future large-scale randomised trials are required to evaluate the safety and efficacy of third-generation DESs which feature bioresorbable polymers and scaffolds.
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Affiliation(s)
- Jaya Mallidi
- Division of Cardiology, Baystate Medical Center, Tufts University, Springfield, Massachusetts, USA
| | - Amir Lotfi
- Division of Cardiology, Baystate Medical Center, Tufts University, Springfield, Massachusetts, USA
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Bioresorbable Vascular Scaffolds in Routine Clinical Practice: Should We Wait Longer? JACC Cardiovasc Interv 2016; 9:1664-6. [PMID: 27476091 DOI: 10.1016/j.jcin.2016.06.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 06/09/2016] [Accepted: 06/09/2016] [Indexed: 11/21/2022]
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Ortega-Paz L, Capodanno D, Giacchi G, Gori T, Nef H, Latib A, Caramanno G, Di Mario C, Naber C, Lesiak M, Capranzano P, Wiebe J, Mehilli J, Araszkiewicz A, Pyxaras S, Mattesini A, Geraci S, Naganuma T, Colombo A, Münzel T, Sabaté M, Tamburino C, Brugaletta S. Impact of overlapping on 1-year clinical outcomes in patients undergoing everolimus-eluting bioresorbable scaffolds implantation in routine clinical practice: Insights from the European multicenter GHOST-EU registry. Catheter Cardiovasc Interv 2016; 89:812-818. [PMID: 27515568 DOI: 10.1002/ccd.26674] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 06/05/2016] [Accepted: 07/02/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND Overlapping implantation of bioresorbable scaffolds (BRSs) are frequent in long coronary lesions. Its impact on clinical outcomes is unknown. OBJECTIVE To compare the clinical outcomes of patients treated with overlapping BRS with those patients treated with no-overlap BRS. METHODS We analyzed the 1-year clinical outcomes of 1,477 patients treated with BRS in the GHOST-EU registry, according to the implantation of overlapping BRS. Primary endpoint was patient oriented composite endpoint (PoCE) of: all-cause death, any myocardial infarction (MI) and any repeated revascularization. Scaffold thrombosis, according to Academic Research Consortium definition, was also analyzed. RESULTS A total of 320 (21.7%) patients were treated with overlapping BRS (overlap group), whereas the remaining 1,157 (78.3%) received no-overlap BRS (no-overlap group). The overlap group had significantly higher frequency of male sex, diabetes mellitus, stable angina, B2/C lesion type, SYNTAX score ≥22, lesion length >34 mm, use of intracoronary imaging guidance, pre- and postdilatation. At 1-year, there were no differences in PoCE between the overlap versus no-overlap group (18.4% vs. 18.2%; HR 1.07, [0.80-1.44]; P = 0.636), even after adjustment (HR 1.05, [0.48-2.20]; P = 0.904). Scaffold thrombosis rate did not differ either at one-month (1.3% vs. 1.5%, P = 0.769) or at 1-year (1.9% vs. 2.1%, P = 0.823). CONCLUSIONS In "Real-world" clinical practice, overlapping BRS does not appear to have an impact on clinical outcomes as compared to no-overlapping BRS. These preliminary data should be confirmed. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Luis Ortega-Paz
- Cardiovascular Clinic Institute, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | | | - Giuseppe Giacchi
- Cardiovascular Clinic Institute, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Tommaso Gori
- Medizinische Klinik und Poliklinik, Universitätsmedizin Mainz, University Medical Center, Mainz, Germany
| | - Holger Nef
- Department of Cardiology, University of Giessen, Giessen, Germany
| | - Azeem Latib
- EMOGVM Centro Cuore and San Raffaele Hospitals, Milan, Italy
| | | | - Carlo Di Mario
- Royal Brompton Hospital & Imperial College, London, United Kingdom
| | - Christoph Naber
- Klinik für Kardiologie und Angiologie, Elisabeth-Krankenhaus, Essen, Germany
| | - Maciej Lesiak
- Department of Cardiology, University of Medical Sciences, Poznan, Poland
| | | | - Jens Wiebe
- Department of Cardiology, University of Giessen, Giessen, Germany
| | - Julinda Mehilli
- Department of Cardiology, Klinikum Großhadern, Ludwig-Maximilian Universität, Munich, Germany
| | | | - Stelios Pyxaras
- Klinik für Kardiologie und Angiologie, Elisabeth-Krankenhaus, Essen, Germany
| | | | | | - Toru Naganuma
- EMOGVM Centro Cuore and San Raffaele Hospitals, Milan, Italy
| | - Antonio Colombo
- EMOGVM Centro Cuore and San Raffaele Hospitals, Milan, Italy
| | - Thomas Münzel
- Medizinische Klinik und Poliklinik, Universitätsmedizin Mainz, University Medical Center, Mainz, Germany
| | - Manel Sabaté
- Cardiovascular Clinic Institute, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | | | - Salvatore Brugaletta
- Cardiovascular Clinic Institute, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
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Gareri C, De Rosa S, Indolfi C. MicroRNAs for Restenosis and Thrombosis After Vascular Injury. Circ Res 2016; 118:1170-84. [PMID: 27034278 DOI: 10.1161/circresaha.115.308237] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 03/01/2016] [Indexed: 12/21/2022]
Abstract
Percutaneous revascularization revolutionized the therapy of patients with coronary artery disease. Despite continuous technical advances that substantially improved patients' outcome after percutaneous revascularization, some issues are still open. In particular, restenosis still represents a challenge, even though it was dramatically reduced with the advent of drug-eluting stents. At the same time, drug-eluting stent thrombosis emerged as a major concern because of incomplete or delayed re-endothelialization after vascular injury. The discovery of microRNAs revealed a previously unknown layer of regulation for several biological processes, increasing our knowledge on the biological mechanisms underlying restenosis and stent thrombosis, revealing novel promising targets for more efficient and selective therapies. The present review summarizes recent experimental and clinical evidence on the role of microRNAs after arterial injury, focusing on practical aspects of their potential therapeutic application for selective inhibition of smooth muscle cell proliferation, enhancement of endothelial regeneration, and inhibition of platelet activation after coronary interventions. Application of circulating microRNAs as potential biomarkers is also discussed.
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Affiliation(s)
- Clarice Gareri
- From the Department of Medicine, Duke University, Durham, NC (C.G.); Division of Cardiology, Department of Medical and Surgical Science, "Magna Graecia" University, Catanzaro, Italy (S.D.R., C.I.); and URT-CNR, Department of Medicine, URT of Consiglio Nazionale delle Ricerche, Catanzaro, Italy (C.I.)
| | - Salvatore De Rosa
- From the Department of Medicine, Duke University, Durham, NC (C.G.); Division of Cardiology, Department of Medical and Surgical Science, "Magna Graecia" University, Catanzaro, Italy (S.D.R., C.I.); and URT-CNR, Department of Medicine, URT of Consiglio Nazionale delle Ricerche, Catanzaro, Italy (C.I.)
| | - Ciro Indolfi
- From the Department of Medicine, Duke University, Durham, NC (C.G.); Division of Cardiology, Department of Medical and Surgical Science, "Magna Graecia" University, Catanzaro, Italy (S.D.R., C.I.); and URT-CNR, Department of Medicine, URT of Consiglio Nazionale delle Ricerche, Catanzaro, Italy (C.I.).
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Abstract
PURPOSE OF REVIEW Bioresorbable scaffolds (BRS) are a major advancement in interventional cardiology, but experience with BRS use in daily routine is currently limited. Here, we review technical features of commercially available BRS and place them in context with current clinical scientific evidence. RECENT FINDINGS Everolimus and novolimus-eluting poly-L-lactic acid (PLLA)-based BRS are commercially available in Europe. The everolimus-eluting BRS is the most widely investigated BRS and several all-comers investigations with this device are ongoing. Of the patients in these studies, 37-100% underwent catheterization due to acute coronary syndrome and up to 25% were diabetic. Up to 64.7% of all lesions treated were considered to be complex. Follow-up varied between 30 days and 1 year. The target lesion revascularization rate was up to 10% and scaffold thrombosis was 0-3%. SUMMARY Accumulating data on BRS application are now available. Several studies have demonstrated that BRS implantation is technically feasible in a variety of different patient subsets and clinical presentations, and follow-up results support BRS use. Patients with acute coronary syndrome represent the most investigated subpopulation, and results suggest that BRS use for this indication is reasonable.
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228
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Kraak RP, Grundeken MJ, Hassell ME, Elias J, Koch KT, Henriques JP, Piek JJ, Baan J, Vis MM, Tijssen JGP, de Winter RJ, Wykrzykowska JJ. Two-year clinical outcomes of Absorb bioresorbable vascular scaffold implantation in complex coronary artery disease patients stratified by SYNTAX score and ABSORB II study enrolment criteria. EUROINTERVENTION 2016; 12:e557-65. [PMID: 27497355 DOI: 10.4244/eijv12i5a95] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS This study presents the two-year clinical outcomes of the Amsterdam ABSORB registry stratified by lesion and patient characteristics complexity (SYNTAX score and ABSORB II study enrolment criteria). METHODS AND RESULTS Patients treated with BVS were included in this prospective registry and stratified according to the ABSORB II trial inclusion and exclusion criteria and the SYNTAX score. The registry comprises 135 patients (59±11 years, 73% male, 18% diabetic) with 159 lesions. Median follow-up duration was 774 days (742-829). Median SYNTAX score was 11.5 (Q1-Q3: 6-17.5). Two-year event rates were cardiac death 0.7%, MI 5.3%, TVR 13.6%, TLR 11.4%, definite ST 3.0% and TVF 14.4%, respectively. Stratified analyses showed a significantly higher revascularisation rate in patients not meeting ABSORB II criteria (TVR: 2.3% vs. 19.2%, p=0.010, and TLR: 2.3% vs. 15.8%, p=0.025) and patients with SYNTAX score ≥11.5 (TVR: 4.8% vs. 21.8%, p=0.006, and TLR: 3.2% vs. 17.4%, p=0.007). CONCLUSIONS The use of Absorb BVS in patients meeting the ABSORB II trial inclusion criteria or those with low SYNTAX scores is associated with acceptable clinical outcomes at two-year follow-up. Patients with more complex characteristics have significantly higher revascularisation rates.
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Affiliation(s)
- Robin P Kraak
- AMC Heartcenter, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands
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Gori T, Wiebe J, Capodanno D, Latib A, Lesiak M, Pyxaras SA, Mehilli J, Caramanno G, Di Mario C, Brugaletta S, Weber J, Capranzano P, Sabate M, Mattesini A, Geraci S, Naber CK, Araszkiewicz A, Colombo A, Tamburino C, Nef H, Münzel T. Early and midterm outcomes of bioresorbable vascular scaffolds for ostial coronary lesions: insights from the GHOST-EU registry. EUROINTERVENTION 2016; 12:e550-6. [PMID: 26348681 DOI: 10.4244/eijy15m09_10] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS We aimed to investigate the outcomes of bioresorbable vascular scaffolds (BVS) in coronary ostial lesions. Ostial lesions represent a challenging angiographic subset, with higher event rates compared with non-ostial lesions. BVS might be associated with advantages over the long term, but their safety in this setting remains to be explored. METHODS AND RESULTS Procedural and 12-month follow-up data from consecutive patients treated with BVS for lesions located at the ostium of the right (RCA), left anterior (LAD) or circumflex (LCX) coronary in 11 European centres were collected. The primary device-oriented endpoint was defined as a combination of cardiovascular death, target vessel myocardial infarction or target lesion revascularisation. The database included a total of 1,549 lesions in 1,304 patients with a mean age of 62±11years. There were 90 ostial lesions (5.8%) in 84 patients (6.4%) located at the ostial RCA (14; 16%), LCX (29; 32%), or LAD (47; 52%). Patients presenting with ostial lesions did not differ from the remaining cohort except for a higher incidence of prior revascularisation. Predilation was performed in 97% of the lesions (vs. 96% in non-ostial, p=0.618), post-dilation in 43% (versus 58% in the non-ostial group, p=0.008). At quantitative coronary angiography, treatment of ostial lesions was associated with higher residual stenosis (30% [23-41] vs. 26% [20-37], p=0.035), but no difference in minimum lumen diameter existed (p=0.447). Follow-up data were available at 385 [362-465] days. The 12-month Kaplan-Meier estimated rates of scaffold thrombosis were 4.9% and 2.0% (ostial and non-ostial lesion groups, respectively, log-rank p=0.005). The device-oriented composite endpoint occurred, respectively, in 12.6% and 4.6% at 12 months (log-rank p=0.001). Treatment of ostial lesions was an independent predictor of this endpoint (p=0.0025, HR 2.65 [1.41-4.97]). CONCLUSIONS In combination with a suboptimal implantation technique, treatment of coronary ostial lesions was an independent predictor of clinical events in a cohort of patients treated with BVS.
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Affiliation(s)
- Tommaso Gori
- 2. Medizinische Klinik und Poliklinik, Universitätsmedizin Mainz, University Medical Center, Mainz and DZHK Rhein-Main, Germany
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Mattesini A, Boeder N, Valente S, Löblich K, Dörr O, Secco GG, Foin N, Caiazzo G, Ghione M, Gensini GF, Porto I, Di Mario C, Nef H. Absorb vs. DESolve: an optical coherence tomography comparison of acute mechanical performances. EUROINTERVENTION 2016; 12:e566-73. [DOI: 10.4244/eijv12i5a96] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Mid- to Long-Term Clinical Outcomes of Patients Treated With the Everolimus-Eluting Bioresorbable Vascular Scaffold: The BVS Expand Registry. JACC Cardiovasc Interv 2016; 9:1652-63. [PMID: 27476094 DOI: 10.1016/j.jcin.2016.04.035] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 03/30/2016] [Accepted: 04/21/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVES This study sought to report on clinical outcomes beyond 1 year of the BVS Expand registry. BACKGROUND Multiple studies have proven feasibility and safety of the Absorb bioresorbable vascular scaffold (BVS) (Abbott Vascular, Santa Clara, California). However, data on medium- to long-term outcomes are limited and available only for simpler lesions. METHODS This is an investigator-initiated, prospective, single-center, single-arm study evaluating performance of the BVS in a lesion subset representative of daily clinical practice, including calcified lesions, total occlusions, long lesions, and small vessels. Inclusion criteria were patients presenting with non-ST-segment elevation myocardial infarction, stable/unstable angina, or silent ischemia caused by a de novo stenotic lesion in a native previously untreated coronary artery. Procedural and medium- to long-term clinical outcomes were assessed. Primary endpoint was major adverse cardiac events, defined as a composite of cardiac death, myocardial infarction, and target lesion revascularization. RESULTS From September 2012 to January 2015, 249 patients with 335 lesions were enrolled. Mean number of scaffolds per patient was 1.79 ± 1.15. Invasive imaging was used in 39%. In 38.1% there were American College of Cardiology/American Heart Association classification type B2/C lesions. Mean lesion length was 22.16 ± 13.79 mm. Post-procedural acute lumen gain was 1.39 ± 0.59 mm. Median follow-up period was 622 (interquartile range: 376 to 734) days. Using Kaplan-Meier methods, the MACE rate at 18 months was 6.8%. Rates of cardiac mortality, myocardial infarction, and target lesion revascularization at 18 months were 1.8%, 5.2%, and 4.0%, respectively. Definite scaffold thrombosis rate was 1.9%. CONCLUSIONS In our study, BVS implantation in a complex patient and lesion subset was associated with an acceptable rate of adverse events in the longer term, whereas no cases of early thrombosis were observed.
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Cassese S, Kastrati A. Bioresorbable Vascular Scaffold Technology Benefits From Healthy Skepticism. J Am Coll Cardiol 2016; 67:932-935. [PMID: 26916482 DOI: 10.1016/j.jacc.2015.12.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 12/14/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Salvatore Cassese
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany.
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233
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Naganuma T, Colombo A, Lesiak M, Capodanno D, Gori T, Nef H, Caramanno G, Naber C, Di Mario C, Ruparelia N, Capranzano P, Wiebe J, Araszkiewicz A, Geraci S, Kawamoto H, Pyxaras S, Mattesini A, Münzel T, Tamburino C, Latib A. Bioresorbable vascular scaffold use for coronary bifurcation lesions: A substudy from GHOST EU registry. Catheter Cardiovasc Interv 2016; 89:47-56. [DOI: 10.1002/ccd.26634] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 06/05/2016] [Indexed: 01/21/2023]
Affiliation(s)
- Toru Naganuma
- EMO-GVM Centro Cuore and San Raffaele Hospitals; Milan Italy
- New Tokyo Hospital; Chiba Japan
| | - Antonio Colombo
- EMO-GVM Centro Cuore and San Raffaele Hospitals; Milan Italy
| | - Maciej Lesiak
- Department of Cardiology; University of Medical Sciences; Poznan Poland
| | | | - Tommaso Gori
- Medizinische Klinik Und Poliklinik, Universitätsmedizin Mainz, University Medical Center; Mainz Germany
| | - Holger Nef
- Department of Cardiology; University of Giessen; Giessen Germany
| | | | - Christoph Naber
- Klinik Für Kardiologie Und Angiologie, Elisabeth-Krankenhaus; Essen Germany
| | - Carlo Di Mario
- National Institute of Health Research Cardiovascular BRU; Royal Brompton Hospital and Imperial College; London United Kingdom
| | - Neil Ruparelia
- EMO-GVM Centro Cuore and San Raffaele Hospitals; Milan Italy
| | | | - Jens Wiebe
- Department of Cardiology; University of Giessen; Giessen Germany
| | | | | | - Hiroyoshi Kawamoto
- EMO-GVM Centro Cuore and San Raffaele Hospitals; Milan Italy
- New Tokyo Hospital; Chiba Japan
| | - Stelios Pyxaras
- Klinik Für Kardiologie Und Angiologie, Elisabeth-Krankenhaus; Essen Germany
| | - Alessio Mattesini
- National Institute of Health Research Cardiovascular BRU; Royal Brompton Hospital and Imperial College; London United Kingdom
| | - Thomas Münzel
- Medizinische Klinik Und Poliklinik, Universitätsmedizin Mainz, University Medical Center; Mainz Germany
| | | | - Azeem Latib
- EMO-GVM Centro Cuore and San Raffaele Hospitals; Milan Italy
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Bioresorbable Coronary Scaffold Thrombosis: Multicenter Comprehensive Analysis of Clinical Presentation, Mechanisms, and Predictors. J Am Coll Cardiol 2016; 67:921-931. [PMID: 26916481 DOI: 10.1016/j.jacc.2015.12.019] [Citation(s) in RCA: 264] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 11/23/2015] [Accepted: 12/01/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Recent reports suggest an elevated incidence of bioresorbable vascular scaffold (BVS) thrombosis (scaffold thrombosis [ScT]). OBJECTIVES This study investigated occurrence rates, clinical and angiographic characteristics, and possible mechanisms of ScT in all-comer patients undergoing BVS implantation at 2 German and 2 Swiss hospitals. METHODS A total of 1,305 consecutive patients (mean age 64 years, 78% male) who received 1,870 BVS (mean 1.4 ± 0.8 BVS/patient) were enrolled. Clinical/procedural characteristics, mortality, and ScT data at 485 days (range 312 to 652 days) were examined. RESULTS ScT occurred in 42 patients. The incidence of probable and definite ScT was 1.8% at 30 days and 3.0% at 12 months, without differences among centers (p = 0.60). A total of 22 (52%) ScTs presented as ST-segment elevation myocardial infarction and 6 (17%) as sudden cardiac death. In multivariable analysis, ostial lesions (p = 0.049) and impaired left ventricular ejection fraction (p = 0.019) were independently associated with ScT. Nine (21%) of the ScTs occurred in patients who had suspended dual antiplatelet therapy, in 6 cases prematurely. Lower post-procedural minimum lumen and reference vessel diameters were hallmarks of ScT (all p < 0.0001). The risk of ScT appeared to rapidly increase for post-procedural minimum lumen diameters below 2.4 mm (for the 2.5- to 3.0-mm BVS) and 2.8 mm (for the 3.5-mm BVS). When a BVS-specific implantation strategy was implemented, 12-month ScT rates fell from 3.3% to 1.0%, an effect that remained significant when adjusted for multivariable propensity score (p = 0.012; hazard ratio: 0.19; 95% confidence interval: 0.05 to 0.70). CONCLUSIONS The 12-month incidence of ScT reached 3% and could be significantly reduced when an optimized implantation strategy was employed. (retrospective multicentric registry and Mainz Intracoronary Database. The Coronary Slow-flow and Microvascular Diseases Registry [MICAT]; NCT02180178).
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Giacchi G, Ortega-Paz L, Brugaletta S, Ishida K, Sabaté M. Bioresorbable vascular scaffolds technology: current use and future developments. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2016; 9:185-98. [PMID: 27468252 PMCID: PMC4946828 DOI: 10.2147/mder.s90461] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Coronary bioresorbable vascular scaffolds are a new appealing therapeutic option in interventional cardiology. The most used and studied is currently the Absorb BVS™. Its backbone is made of poly-L-lactide and coated by a thin layer of poly-D,L-lactide, it releases everolimus and is fully degraded to H2O and CO2 in 2-3 years. Absorb BVS™ seems to offer several theoretical advantages over metallic stent, as it gives temporary mechanical support to vessel wall without permanently caging it. Therefore, long-term endothelial function and structure are not affected. A possible future surgical revascularization is not compromised. Natural vasomotion in response to external stimuli is also recovered. Several observational and randomized trials have been published about BVS clinical outcomes. The main aim of this review is to carry out a systematic analysis about Absorb BVS™ studies, evaluating also the technical improvements of the Absorb GT1 BVS™.
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Affiliation(s)
- Giuseppe Giacchi
- Cardiology Department, Clinic Cardiovascular Institute, Hospital Clinic, August Pi and Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Luis Ortega-Paz
- Cardiology Department, Clinic Cardiovascular Institute, Hospital Clinic, August Pi and Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Salvatore Brugaletta
- Cardiology Department, Clinic Cardiovascular Institute, Hospital Clinic, August Pi and Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Kohki Ishida
- Cardiology Department, Clinic Cardiovascular Institute, Hospital Clinic, August Pi and Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Manel Sabaté
- Cardiology Department, Clinic Cardiovascular Institute, Hospital Clinic, August Pi and Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain
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Derimay F, Souteyrand G, Motreff P, Guerin P, Pilet P, Ohayon J, Darremont O, Rioufol G, Finet G. Sequential Proximal Optimizing Technique in Provisional Bifurcation Stenting With Everolimus-Eluting Bioresorbable Vascular Scaffold: Fractal Coronary Bifurcation Bench for Comparative Test Between Absorb and XIENCE Xpedition. JACC Cardiovasc Interv 2016; 9:1397-406. [PMID: 27388830 DOI: 10.1016/j.jcin.2016.04.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 03/15/2016] [Accepted: 04/07/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of this fractal bifurcation bench study was to compare provisional bifurcation stenting with a "re-POT" sequence, comprising a proximal optimizing technique (POT), side branch inflation, and final POT, between a bioresorbable vascular scaffold (BVS) and a metallic stent. BACKGROUND Re-POT proved significantly better than kissing balloon inflation in maintaining circular geometry without overstretch in metal stents, while significantly reducing side branch ostium strut obstruction and global strut malapposition. This should be useful for BVSs, which are more easily breakable. METHODS Twenty left main-like and 20 left anterior descending-like fractal coronary bifurcation bench models used 10 each 2.5 × 24 mm and 3.5 × 24 mm Absorb (Ab) BVSs and 10 each 2.5 × 24 mm and 3.5 × 24 mm XIENCE Xpedition (XX) metal stents, implanted by re-POT, with optical coherence tomographic analysis at each step and micro-computed tomographic analysis of Ab devices to detect strut fracture. RESULTS With Ab devices, re-POT reduced percentage strut malapposition close to XX rates (0.8 ± 0.7% vs. 0.0 ± 0.0%, p < 0.05; 3.5 ± 1.7% vs. 0.3 ± 0.6%, p < 0.05), conserving proximal circularity (elliptical ratio, 1.04 vs. 1.03 and 1.04 vs. 1.04; p = NS). Mean post-re-POT proximal expansion was 0.6 ± 0.1 mm (+21.6 ± 2.1%) for 2.5-mm and 1.0 ± 0.1 mm (+23.6 ± 2.2%) for 3.5-mm Ab devices, with only 1 strut fracture (left anterior descending-like bench). Side branch ostium strut obstruction was greater with Ab scaffolds than XX stents: 41.1 ± 9.4% versus 16.4 ± 8.1% (p < 0.05) and 31.8 ± 3.2% versus 10.0 ± 5.3% (p < 0.05), respectively, for 2.5- and 3.5-mm scaffolds and stents. Ab scaffolds showed 2 ± 1% moderate but significant late recoil as of 1 h, reaching 4 ± 2% by 24 h (p < 0.05). CONCLUSIONS Re-POT optimized most Ab provisional bifurcation treatments, without fracture, respecting fractal geometry, and without exceeding 1.0-mm proximal differential diameter.
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Affiliation(s)
- François Derimay
- Department of Interventional Cardiology, Cardiovascular Hospital and Claude Bernard University and INSERM Unit 1060 CARMEN, Lyon, France
| | - Géraud Souteyrand
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Pascal Motreff
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Paul Pilet
- Cardiology, UMR 915, Institut du Thorax, Nantes, France
| | - Jacques Ohayon
- Laboratory TIMC-IMAG, DynaCell, CNRS UMR 5525, Institut de l'Ingénierie et de l'Information de Santé, Grenoble, France
| | | | - Gilles Rioufol
- Department of Interventional Cardiology, Cardiovascular Hospital and Claude Bernard University and INSERM Unit 1060 CARMEN, Lyon, France
| | - Gérard Finet
- Department of Interventional Cardiology, Cardiovascular Hospital and Claude Bernard University and INSERM Unit 1060 CARMEN, Lyon, France.
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Caiazzo G, Longo G, Giavarini A, Kilic ID, Fabris E, Serdoz R, Mattesini A, Foin N, Secco GG, De Rosa S, Indolfi C, Di Mario C. Optical coherence tomography guidance for percutaneous coronary intervention with bioresorbable scaffolds. Int J Cardiol 2016; 221:352-8. [PMID: 27404705 DOI: 10.1016/j.ijcard.2016.07.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 07/04/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The effect of optical coherence tomography (OCT) guidance on the implantation strategy during all phases of percutaneous coronary intervention (PCI) with bioresorbable vascular scaffolds (BVSs) in a real-world scenario has been poorly investigated. METHODS Consecutive patients undergoing BVS implantation at our institution were included in this registry. Frequency-domain OCT pullbacks were performed at the operator's discretion during all phases of BVS implantation procedures to optimize preparation of lesions, confirm BVS size, and optimize expansion and apposition of scaffolds. RESULTS Between September 2012 and July 2015, 203 BVSs were implanted in 101 consecutive patients at our institution (2.01 BVSs/patient). In 66 patients, the procedure was performed under OCT guidance. In the OCT subgroup, 66 (77.6%) of the 85 treated lesions were complex (B2/C AHA/ACC type). Overall, 147 OCT pullbacks were performed and 72/147 (49.0%) pullbacks indicated the need for changing strategy. After angiography-only-guided optimisation of BVS in 27 (31.8%) lesions, an OCT examination prompted performance of a second post-expansion. This resulted in an increase in the minimal scaffold area (5.5 to 6.3mm(2), p=0.004) and a decrease in the incomplete scaffold apposition area (1.1 to 0.6mm(2), p=0.082), with no new stent fractures. When the population was divided according to the time of BVS implantation, an initial learning adaptation became evident, with the number of OCT-guided changes in strategy significantly decreasing between the initial and final time periods (p=0.017). CONCLUSIONS OCT guidance for BVS implantation significantly affects the procedural strategy, with favourable effects on acute results and the learning curve.
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Affiliation(s)
- Gianluca Caiazzo
- Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Græcia" University, Catanzaro, Italy; National Institute of Health Research Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom
| | - Giovanni Longo
- National Institute of Health Research Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom
| | - Alessandra Giavarini
- National Institute of Health Research Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom
| | - Ismail Dogu Kilic
- Pamukkale University School of Medicine, Cardiology, Denizli, Turkey
| | - Enrico Fabris
- National Institute of Health Research Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom; Cardiovascular Department, "Ospedali Riuniti" & University of Trieste, Trieste, Italy
| | - Roberta Serdoz
- National Institute of Health Research Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom
| | - Alessio Mattesini
- National Institute of Health Research Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom
| | | | - Gioel Gabrio Secco
- National Institute of Health Research Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom
| | - Salvatore De Rosa
- Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Græcia" University, Catanzaro, Italy
| | - Ciro Indolfi
- Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Græcia" University, Catanzaro, Italy
| | - Carlo Di Mario
- National Institute of Health Research Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom.
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Everolimus-eluting bioresorbable scaffold implantation for the treatment of bifurcation lesions — Implications from early clinical experience during daily practice. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2016; 17:313-7. [DOI: 10.1016/j.carrev.2016.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 03/11/2016] [Indexed: 11/22/2022]
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Rizik DG, Hermiller JB, Kereiakes DJ. The ABSORB bioresorbable vascular scaffold: A novel, fully resorbable drug-eluting stent: Current concepts and overview of clinical evidence. Catheter Cardiovasc Interv 2016; 86:664-77. [PMID: 26386235 DOI: 10.1002/ccd.26172] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 07/31/2015] [Accepted: 07/31/2015] [Indexed: 11/09/2022]
Abstract
The advent of fully bioresorbable stent technology and specifically the ABSORB™, a bioresorbable vascular scaffold (BVS) stent, is heralded as breakthrough technology in the current era of percutaneous coronary interventions. This article reviews the current understanding of this technology along with the clinical evidence from trials and registries of ABSORB BVS that included patients with both simple as well as more complex "real-world" coronary lesions. In addition, considering the current limitations of this device-mostly associated with the mechanical properties of the polymeric scaffold structure-a review of guidelines on successful implantation of the ABSORB BVS is presented. Although expert feedback suggests extensive use of this device in routine clinical practice outside the United States despite a paucity of data on long-term safety in this setting, attention to procedural details and implantation technique is obligatory to achieve optimal clinical outcomes.
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Affiliation(s)
- David G Rizik
- Director of Structural & Coronary Interventions, HonorHealth and Scottsdale Healthcare Hospital, Scottsdale, Arizona
| | - James B Hermiller
- Director of Interventional Cardiology and Director of Interventional Cardiology Fellowship, St. Vincent Heart Center of Indiana, Indianapolis, Indiana
| | - Dean J Kereiakes
- Medical Director of The Christ Hospital Heart and Vascular Center, Cincinnati, Ohio.,The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, Ohio
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Park Y, Franchi F, Rollini F, Angiolillo DJ. Dual antiplatelet therapy after coronary stenting. Expert Opin Pharmacother 2016; 17:1775-87. [DOI: 10.1080/14656566.2016.1202924] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Yongwhi Park
- Division of Cardiology, University of Florida College of Medicine – Jacksonville, Jacksonville, FL, USA
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Korea
| | - Francesco Franchi
- Division of Cardiology, University of Florida College of Medicine – Jacksonville, Jacksonville, FL, USA
| | - Fabiana Rollini
- Division of Cardiology, University of Florida College of Medicine – Jacksonville, Jacksonville, FL, USA
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine – Jacksonville, Jacksonville, FL, USA
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241
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De Paolis M, Felix C, van Ditzhuijzen N, Fam JM, Karanasos A, de Boer S, van Mieghem NM, Daemen J, Costa F, Bergoli LC, Ligthart JMR, Regar E, de Jaegere PP, Zijlstra F, van Geuns RJ, Diletti R. Everolimus-eluting bioresorbable vascular scaffolds implanted in coronary bifurcation lesions: Impact of polymeric wide struts on side-branch impairment. Int J Cardiol 2016; 221:656-64. [PMID: 27423087 DOI: 10.1016/j.ijcard.2016.06.153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 06/24/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Limited data are available on bioresorbable vascular scaffolds (BVS) performance in bifurcations lesions and on the impact of BVS wider struts on side-branch impairment. METHODS Patients with at least one coronary bifurcation lesion involving a side-branch ≥2mm in diameter and treated with at least one BVS were examined. Procedural and angiographic data were collected and a dedicated methodology for off-line quantitative coronary angiography (QCA) in bifurcation was applied (eleven-segment model), to assess side-branch impairment occurring any time during the procedure. Two- and three-dimensional QCA were used. Optical coherence tomography (OCT) analysis was performed in a subgroup of patients and long-term clinical outcomes reported. RESULTS A total of 102 patients with 107 lesions, were evaluated. Device- and procedural-successes were 99.1% and 94.3%, respectively. Side-branch impairment occurring any time during the procedure was reported in 13 bifurcations (12.1%) and at the end of the procedure in 6.5%. Side-branch minimal lumen diameter (Pre: 1.45±0.41mm vs Final: 1.48±0.42mm, p=0.587) %diameter-stenosis (Pre: 26.93±16.89% vs Final: 27.80±15.57%, p=0.904) and minimal lumen area (Pre: 1.97±0.89mm(2) vs Final: 2.17±1.09mm(2), p=0.334), were not significantly affected by BVS implantation. Mean malapposed struts at the bifurcation polygon-of-confluence were 0.63±1.11. CONCLUSIONS The results of the present investigation suggest feasibility and relative safety of BVS implantation in coronary bifurcations. BVS wide struts have a low impact on side-branch impairment when considering bifurcations with side-branch diameter≥2mm.
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Affiliation(s)
- Marcella De Paolis
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Cordula Felix
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Nienke van Ditzhuijzen
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Jiang Ming Fam
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Antonis Karanasos
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Sanneke de Boer
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Nicolas M van Mieghem
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Joost Daemen
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Francesco Costa
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Luis Carlos Bergoli
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Jurgen M R Ligthart
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Evelyn Regar
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Peter P de Jaegere
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Felix Zijlstra
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Robert Jan van Geuns
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Roberto Diletti
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.
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Saad M, Abdin A, Thiele H, Desch S, Ibrahimi P, Wikstroem G, Hoeher M, Henein M. Bioresorbable Vascular Scaffolds in a Real-World Patient Population-Results From a Mid-Term Angiographic Follow-Up. J Interv Cardiol 2016; 29:341-7. [DOI: 10.1111/joic.12297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Mohammed Saad
- Department of Public Health and Clinical Medicine; Umea University; Umea Sweden
- Department of Cardiology; Klinikum Bayreuth; Bayreuth Germany
- Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine); University Heart Center Lübeck; Lübeck Germany
- German Center for Cardiovascular Research (DZHK); Partner Site Hamburg/Kiel/Luebeck; Lübeck Germany
| | - Amr Abdin
- Department of Cardiology; Klinikum Bayreuth; Bayreuth Germany
- Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine); University Heart Center Lübeck; Lübeck Germany
- German Center for Cardiovascular Research (DZHK); Partner Site Hamburg/Kiel/Luebeck; Lübeck Germany
| | - Holger Thiele
- Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine); University Heart Center Lübeck; Lübeck Germany
- German Center for Cardiovascular Research (DZHK); Partner Site Hamburg/Kiel/Luebeck; Lübeck Germany
| | - Steffen Desch
- Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine); University Heart Center Lübeck; Lübeck Germany
- German Center for Cardiovascular Research (DZHK); Partner Site Hamburg/Kiel/Luebeck; Lübeck Germany
| | - Pranvera Ibrahimi
- Department of Public Health and Clinical Medicine; Umea University; Umea Sweden
| | - Gerhard Wikstroem
- Department of Medical Sciences; Cardiology; Uppsala University; Uppsala Sweden
| | - Martin Hoeher
- Department of Cardiology; Klinikum Bayreuth; Bayreuth Germany
| | - Michael Henein
- Department of Public Health and Clinical Medicine; Umea University; Umea Sweden
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Cuculi F, Puricel S, Jamshidi P, Valentin J, Kallinikou Z, Toggweiler S, Weissner M, Münzel T, Cook S, Gori T. Optical Coherence Tomography Findings in Bioresorbable Vascular Scaffolds Thrombosis. Circ Cardiovasc Interv 2016; 8:e002518. [PMID: 26399265 DOI: 10.1161/circinterventions.114.002518] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Everolimus-eluting bioresorbable vascular scaffolds have been developed to improve late outcomes after coronary interventions. However, recent registries raised concerns regarding an increased incidence of scaffold thrombosis (ScT). The mechanism of ScT remains unknown. METHODS AND RESULTS The present study investigated angiographic and optical coherence tomography findings in patients experiencing ScT. Fifteen ScT (14 patients, 79% male, age 59±10 years) occurred at a median of 16 days (25%-75% interquartile range: 1-263 days) after implantation. Early ScT (<30 days) occurred in 8 cases (53%). Possible causal factors in these patients included insufficient platelet inhibition in 2 cases and procedural factors (scaffold underexpansion, undersizing, or geographical miss) in 4 cases. No obvious cause could be found in 2 early ScT. In late (>1 month) and very late (>1 year) ScT (respectively, 5 and 2 cases), 5 scaffolds showed intimal neovessels or marked peristrut low-intensity areas. Scaffold fractures were additionally found in 2 patients, and scaffold collapse was found in 1 patient with very late ScT. Extensive strut malapposition was the presumed cause for ScT in 1 case. One scaffold did not show any morphological abnormality. Thrombectomy specimens were analyzed in 3 patients and did not demonstrate increased numbers of inflammatory cells. CONCLUSIONS The mechanisms of early ScT seem to be similar to metallic stents (mechanical and inadequate antiplatelet therapy). The predominant finding in late and very late ScT is peristrut low-intensity area.
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Affiliation(s)
- Florim Cuculi
- From the Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland (F.C., P.J., S.T.); Hospital and University of Fribourg, Fribourg, Switzerland (S.P., J.V., Z.K., S.C.); and Department of Medicine II, University Medical Center Mainz & German Center for Cardiovascular Research (DZHK e.V.), partner site Rhine Main, Mainz, Germany (M.W., T.M., T.G.)
| | - Serban Puricel
- From the Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland (F.C., P.J., S.T.); Hospital and University of Fribourg, Fribourg, Switzerland (S.P., J.V., Z.K., S.C.); and Department of Medicine II, University Medical Center Mainz & German Center for Cardiovascular Research (DZHK e.V.), partner site Rhine Main, Mainz, Germany (M.W., T.M., T.G.)
| | - Peiman Jamshidi
- From the Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland (F.C., P.J., S.T.); Hospital and University of Fribourg, Fribourg, Switzerland (S.P., J.V., Z.K., S.C.); and Department of Medicine II, University Medical Center Mainz & German Center for Cardiovascular Research (DZHK e.V.), partner site Rhine Main, Mainz, Germany (M.W., T.M., T.G.)
| | - Jérémy Valentin
- From the Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland (F.C., P.J., S.T.); Hospital and University of Fribourg, Fribourg, Switzerland (S.P., J.V., Z.K., S.C.); and Department of Medicine II, University Medical Center Mainz & German Center for Cardiovascular Research (DZHK e.V.), partner site Rhine Main, Mainz, Germany (M.W., T.M., T.G.)
| | - Zacharenia Kallinikou
- From the Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland (F.C., P.J., S.T.); Hospital and University of Fribourg, Fribourg, Switzerland (S.P., J.V., Z.K., S.C.); and Department of Medicine II, University Medical Center Mainz & German Center for Cardiovascular Research (DZHK e.V.), partner site Rhine Main, Mainz, Germany (M.W., T.M., T.G.)
| | - Stefan Toggweiler
- From the Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland (F.C., P.J., S.T.); Hospital and University of Fribourg, Fribourg, Switzerland (S.P., J.V., Z.K., S.C.); and Department of Medicine II, University Medical Center Mainz & German Center for Cardiovascular Research (DZHK e.V.), partner site Rhine Main, Mainz, Germany (M.W., T.M., T.G.)
| | - Melissa Weissner
- From the Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland (F.C., P.J., S.T.); Hospital and University of Fribourg, Fribourg, Switzerland (S.P., J.V., Z.K., S.C.); and Department of Medicine II, University Medical Center Mainz & German Center for Cardiovascular Research (DZHK e.V.), partner site Rhine Main, Mainz, Germany (M.W., T.M., T.G.)
| | - Thomas Münzel
- From the Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland (F.C., P.J., S.T.); Hospital and University of Fribourg, Fribourg, Switzerland (S.P., J.V., Z.K., S.C.); and Department of Medicine II, University Medical Center Mainz & German Center for Cardiovascular Research (DZHK e.V.), partner site Rhine Main, Mainz, Germany (M.W., T.M., T.G.)
| | - Stéphane Cook
- From the Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland (F.C., P.J., S.T.); Hospital and University of Fribourg, Fribourg, Switzerland (S.P., J.V., Z.K., S.C.); and Department of Medicine II, University Medical Center Mainz & German Center for Cardiovascular Research (DZHK e.V.), partner site Rhine Main, Mainz, Germany (M.W., T.M., T.G.).
| | - Tommaso Gori
- From the Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland (F.C., P.J., S.T.); Hospital and University of Fribourg, Fribourg, Switzerland (S.P., J.V., Z.K., S.C.); and Department of Medicine II, University Medical Center Mainz & German Center for Cardiovascular Research (DZHK e.V.), partner site Rhine Main, Mainz, Germany (M.W., T.M., T.G.).
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Abellas-Sequeiros RA, Ocaranza-Sanchez R, Galvão Braga C, Raposeiras-Roubin S, Lopez-Otero D, Cid-Alvarez B, Souto-Castro P, Trillo-Nouche R, Gonzalez-Juanatey JR. "Assessment of effectiveness and security in high pressure postdilatation of bioresorbable vascular scaffolds during percutaneous coronary intervention. Study in a contemporary, non-selected cohort of Spanish patients". Int J Cardiol 2016; 219:264-70. [PMID: 27343418 DOI: 10.1016/j.ijcard.2016.06.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 06/12/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To determine security and benefits of high pressure postdilatation (HPP) of bioresorbable vascular scaffolds (BVS) in percutaneous coronary intervention (PCI) of complex lesions whatever its indication is. BACKGROUND Acute scaffold disruption has been proposed as the main limitation of BVS when they are overexpanded. However, clinical implications of this disarray are not yet clear and more evidence is needed. METHODS A total of 25 BVS were deployed during PCI of 14 complex lesions after mandatory predilatation. In all cases HPP was performed with NC balloon in a 1:1 relation to the artery. After that, optical coherence tomography (OCT) analyses were performed. RESULTS Mean and maximal postdilatation pressure were 17±3.80 and 20 atmospheres (atm) respectively. Postdilatation balloon/scaffold diameter ratio was 1.01. A total of 39,590 struts were analyzed. Mean, minimal and maximal scaffold diameter were respectively: 3.09±0.34mm, 2.88±0.31mm and 3.31±0.40mm. Mean eccentricity index was 0.13±0.05. ISA percentage was 1.42% with a total of 564 malapposed struts. 89 struts were identified as disrupted, which represents a percentage of disrupted struts of 0.22%. At 30days, none of our patients died, suffered from stroke, stent thrombosis or needed target lesion revascularization (TLR). CONCLUSIONS NC balloon HPP of BVS at more than 17atm (up to 20atm) is safe during PCI and allows to achieve better angiographic and clinical results.
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Affiliation(s)
- Rosa A Abellas-Sequeiros
- Interventional Cardiology Unit, Universitary Clinical Hospital of Santiago de Compostela, 15706, Spain.
| | - Raymundo Ocaranza-Sanchez
- Interventional Cardiology Unit, Universitary Clinical Hospital of Santiago de Compostela, 15706, Spain
| | | | - Sergio Raposeiras-Roubin
- Interventional Cardiology Unit, Universitary Clinical Hospital of Santiago de Compostela, 15706, Spain
| | - Diego Lopez-Otero
- Interventional Cardiology Unit, Universitary Clinical Hospital of Santiago de Compostela, 15706, Spain
| | - Belen Cid-Alvarez
- Interventional Cardiology Unit, Universitary Clinical Hospital of Santiago de Compostela, 15706, Spain
| | - Pablo Souto-Castro
- Interventional Cardiology Unit, Universitary Clinical Hospital of Santiago de Compostela, 15706, Spain
| | - Ramiro Trillo-Nouche
- Interventional Cardiology Unit, Universitary Clinical Hospital of Santiago de Compostela, 15706, Spain
| | - Jose R Gonzalez-Juanatey
- Interventional Cardiology Unit, Universitary Clinical Hospital of Santiago de Compostela, 15706, Spain
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245
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Jabbour RJ, Colombo A. Bioresorbable scaffolds: the fee comes now and the reward comes later. Future Cardiol 2016; 12:397-400. [PMID: 27291396 DOI: 10.2217/fca-2016-0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Richard J Jabbour
- Interventional Cardiology Department, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Department, EMO-GVM, Centro Cuore Columbus, Milan, Italy.,Cardiology Department, Imperial College, London, UK
| | - Antonio Colombo
- Interventional Cardiology Department, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Department, EMO-GVM, Centro Cuore Columbus, Milan, Italy
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246
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Abstract
The fully bioabsorbable vascular scaffold (BVS) has been developed to reduce late adverse events after coronary stenting such as device thrombosis. The device consists of polylactic acid, which is gradually absorbed within the first few years after its implantation. The initial experience with the device in low-risk patients presenting with simple lesions was satisfying and generated optimism among interventional cardiologists by promising better patient outcomes. However, the unrestricted use of the device in patients presenting with a higher baseline risk and more complex lesions came at the cost of alarmingly high rates of early device thrombosis. The performance of the device largely depends on an optimal implantation technique, which differs from that employed with metallic drug-eluting stents due to the device's distinct physical propensity. Mid-term outcomes in large-scale randomized clinical trial were disappointing. Although its non-inferiority compared to metallic everolimus-eluting stents was formally met, there was a clear trend towards an increased occurrence of myocardial infarction and device thrombosis during the first year after device implantation. However, the BVS's putative advantages are expected to manifest themselves at long-term, that is 3 to 5 years after the device has been implanted. Evidence pertaining to these long-term outcomes is eagerly awaited.
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Affiliation(s)
- Diego Arroyo
- Department of Cardiology, University and Hospital Fribourg, Fribourg, Switzerland
| | - Stéphane Cook
- Department of Cardiology, University and Hospital Fribourg, Fribourg, Switzerland
| | - Serban Puricel
- Department of Cardiology, University and Hospital Fribourg, Fribourg, Switzerland
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247
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Alfonso F, Cuesta J, Bastante T, Rivero F, García-Guimaraes M, Alvarado T, Benedicto A, Cortese B, Byrne R, Kastrati A. Bioresorbable vascular scaffolds in patients with acute myocardial infarction: a new step forward to optimized reperfusion? J Thorac Dis 2016; 8:E417-23. [PMID: 27293870 DOI: 10.21037/jtd.2016.03.75] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Bioresorbable vascular scaffolds (BVS) represent a disruptive technology that has caused a new revolution in interventional cardiology. BVS appear to be particularly appealing in patients presenting with an acute myocardial infarction (MI). The available evidence on the value of BVS implantation in this challenging scenario is very promising but still limited. Results come from preliminary small observational studies, prospective registries that include a control group, and from scarce randomized clinical trials with surrogate mechanistic or angiographic primary end-points. Further studies, powered for clinical endpoints, are required to establish the relative safety and efficacy of BVS vs. new-generation metallic drug-eluting stents (DES) in patients with ST-segment elevation acute MI.
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Affiliation(s)
- Fernando Alfonso
- 1 Cardiology Department, Hospital Universitario de La Princesa, Madrid, Spain ; 2 Cardiac Department, A.O. Fatebenefratelli, Milano, Italy ; 3 Deutsches Herzzentrum München, Technische Universität München, Munich, Germany ; 4 DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Javier Cuesta
- 1 Cardiology Department, Hospital Universitario de La Princesa, Madrid, Spain ; 2 Cardiac Department, A.O. Fatebenefratelli, Milano, Italy ; 3 Deutsches Herzzentrum München, Technische Universität München, Munich, Germany ; 4 DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Teresa Bastante
- 1 Cardiology Department, Hospital Universitario de La Princesa, Madrid, Spain ; 2 Cardiac Department, A.O. Fatebenefratelli, Milano, Italy ; 3 Deutsches Herzzentrum München, Technische Universität München, Munich, Germany ; 4 DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Fernando Rivero
- 1 Cardiology Department, Hospital Universitario de La Princesa, Madrid, Spain ; 2 Cardiac Department, A.O. Fatebenefratelli, Milano, Italy ; 3 Deutsches Herzzentrum München, Technische Universität München, Munich, Germany ; 4 DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Marcos García-Guimaraes
- 1 Cardiology Department, Hospital Universitario de La Princesa, Madrid, Spain ; 2 Cardiac Department, A.O. Fatebenefratelli, Milano, Italy ; 3 Deutsches Herzzentrum München, Technische Universität München, Munich, Germany ; 4 DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Teresa Alvarado
- 1 Cardiology Department, Hospital Universitario de La Princesa, Madrid, Spain ; 2 Cardiac Department, A.O. Fatebenefratelli, Milano, Italy ; 3 Deutsches Herzzentrum München, Technische Universität München, Munich, Germany ; 4 DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Amparo Benedicto
- 1 Cardiology Department, Hospital Universitario de La Princesa, Madrid, Spain ; 2 Cardiac Department, A.O. Fatebenefratelli, Milano, Italy ; 3 Deutsches Herzzentrum München, Technische Universität München, Munich, Germany ; 4 DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Bernardo Cortese
- 1 Cardiology Department, Hospital Universitario de La Princesa, Madrid, Spain ; 2 Cardiac Department, A.O. Fatebenefratelli, Milano, Italy ; 3 Deutsches Herzzentrum München, Technische Universität München, Munich, Germany ; 4 DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Robert Byrne
- 1 Cardiology Department, Hospital Universitario de La Princesa, Madrid, Spain ; 2 Cardiac Department, A.O. Fatebenefratelli, Milano, Italy ; 3 Deutsches Herzzentrum München, Technische Universität München, Munich, Germany ; 4 DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Adnan Kastrati
- 1 Cardiology Department, Hospital Universitario de La Princesa, Madrid, Spain ; 2 Cardiac Department, A.O. Fatebenefratelli, Milano, Italy ; 3 Deutsches Herzzentrum München, Technische Universität München, Munich, Germany ; 4 DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
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248
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Harada Y, Byrne RA. Bioresorbable Drug-Eluting Stents. JACC Cardiovasc Interv 2016; 9:1228-1230. [DOI: 10.1016/j.jcin.2016.05.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 05/09/2016] [Accepted: 05/11/2016] [Indexed: 10/21/2022]
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249
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Suárez de Lezo J, Martín P, Pan M, Ojeda S, Nóvoa J, Segura J, Mazuelos F, Romero M, Medina A, Suárez de Lezo J. Tratamiento de lesiones en bifurcaciones coronarias con armazón vascular bioabsorbible. Resultados inmediatos y al año de seguimiento. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2015.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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250
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Cortese B, Buccheri D, Stefanini GG, Mehran R. The Contemporary Pulse of Bioresorbable-Scaffold Thrombosis Among Expert Operators. J Am Coll Cardiol 2016; 67:2905-6. [DOI: 10.1016/j.jacc.2016.03.576] [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: 03/04/2016] [Accepted: 03/31/2016] [Indexed: 10/21/2022]
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