1
|
Miyashita K, Ninomiya K, Tobe A, Masuda S, Kotoku N, Kageyama S, Revaiah PC, Tsai TY, Wang B, Garg S, Serruys PW, Onuma Y. Long-term outcomes following bioresorbable vascular scaffolds. Expert Rev Cardiovasc Ther 2024:1-17. [PMID: 39049728 DOI: 10.1080/14779072.2024.2375340] [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: 11/29/2023] [Revised: 02/20/2024] [Accepted: 06/28/2024] [Indexed: 07/27/2024]
Abstract
INTRODUCTION The higher scaffold thrombosis rates observed with the first-generation bioresorbable scaffolds (BRSs) compared to conventional drug-eluting stents were likely due in part to bioresorbable polymers having insufficient radial strength, necessitating larger strut profiles. Meta-analysis of the long-term outcomes from the first-generation Absorb bioresorbable vascular scaffold (BVS) showed that this period of excess risk ended at 3 years. Therefore, current attention has been focused on improving early outcomes by increasing the scaffold's tensile strength and reducing strut thickness. AREAS COVERED This review summaries the lessons learned from the first-generation BRS. It updates the long-term clinical outcomes of trials evaluating the ABSORB BVS and metallic alloy-based BRS. In addition, it reviews the next-generation BRSs manufactured in Asia. EXPERT OPINION Critical areas to improve the performance and safety of biodegradable scaffolds include further development in material science, surface modification, delivery systems, and long-term follow-up studies.
Collapse
Affiliation(s)
- Kotaro Miyashita
- The College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
- CORRIB Research Centre for Advanced Imaging and Core laboratory, University of Galway, Galway, Ireland
| | - Kai Ninomiya
- The College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
- CORRIB Research Centre for Advanced Imaging and Core laboratory, University of Galway, Galway, Ireland
| | - Akihiro Tobe
- The College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
- CORRIB Research Centre for Advanced Imaging and Core laboratory, University of Galway, Galway, Ireland
| | - Shinichiro Masuda
- The College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
- CORRIB Research Centre for Advanced Imaging and Core laboratory, University of Galway, Galway, Ireland
| | - Nozomi Kotoku
- The College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
- CORRIB Research Centre for Advanced Imaging and Core laboratory, University of Galway, Galway, Ireland
| | - Shigetaka Kageyama
- The College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
- CORRIB Research Centre for Advanced Imaging and Core laboratory, University of Galway, Galway, Ireland
| | - Pruthvi C Revaiah
- The College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
- CORRIB Research Centre for Advanced Imaging and Core laboratory, University of Galway, Galway, Ireland
| | - Tsung-Ying Tsai
- The College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
- CORRIB Research Centre for Advanced Imaging and Core laboratory, University of Galway, Galway, Ireland
| | - Bo Wang
- The College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
- CORRIB Research Centre for Advanced Imaging and Core laboratory, University of Galway, Galway, Ireland
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, UK
| | - Patrick W Serruys
- The College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
- CORRIB Research Centre for Advanced Imaging and Core laboratory, University of Galway, Galway, Ireland
| | - Yoshinobu Onuma
- The College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
- CORRIB Research Centre for Advanced Imaging and Core laboratory, University of Galway, Galway, Ireland
| |
Collapse
|
2
|
Dissections after bioresorbable vascular scaffold implantation in the POLAR ACS Registry. Adv Cardiol 2022; 18:131-136. [PMID: 36051830 PMCID: PMC9421522 DOI: 10.5114/aic.2022.118530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 06/04/2022] [Indexed: 11/17/2022]
Abstract
Introduction Percutaneous coronary intervention (PCI) is a common method of treatment for patients with coronary artery disease. One of the most common complications during the PCI procedure is coronary artery dissection. It usually requires an additional action to assure the patency of the treated vessel. Aim The aim of the publication is to describe the occurrence of coronary artery dissection after bioresorbable vascular scaffold (BVS) implantation. This selected type of PCI procedure is especially interesting because precise target vessel measurement before BVS implantation is required for optimal determination of scaffold size. Material and methods Based on angiographic data gathered in the POLAR ACS Registry, we assessed the frequency of dissections, their localization, and severity. Based on data regarding patients’ demographic, clinical status, and details regarding treatment strategy, the factors that could have an influence on the dissection occurrence were identified. Results A group of 100 patients included in the analyses. Group A consisted of 9 patients. This group was defined as patients in whom the significant dissection occurred after the BVS implantation. Group B comprised 91 patients. Both groups were very similar according to demographic data. The frequency of predilatation was similar; post-dilatation was performed more often in group A but without statistical significance. The presence of calcification in the target lesion was an independent factor of dissection during the index PCI procedure. Conclusions The occurrence of significant dissection can be effectively treated, and the good angiographic results of this treatment immediately after the initial procedure translate into good clinical results in longer follow-up.
Collapse
|
3
|
Boeder NF, Dörr O, Koepp T, Blachutzik F, Achenbach S, Elsässer A, Hamm CW, Nef HM. Acute Mechanical Performance of Magmaris vs. DESolve Bioresorbable Scaffolds in a Real-World Scenario. Front Cardiovasc Med 2021; 8:696287. [PMID: 34195239 PMCID: PMC8236697 DOI: 10.3389/fcvm.2021.696287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 05/21/2021] [Indexed: 02/03/2023] Open
Abstract
Background: After the bioresorbable PLLA-based vascular scaffold (Absorb BVS) was taken from the market due to its high adverse event rates, a magnesium-based scaffold (Magmaris) was introduced. Objective: To compare the acute performance of the sirolimus-eluting magnesium alloy Magmaris scaffold with that of the novolimus-eluting PLLA-based DESolve scaffold in terms of appropriate scaffold deployment using optical coherence tomography (OCT). Methods and Results: Data from the final OCT pullback of 98 patients were included (19 Magmaris, 79 DESolve) and analyzed at 1-mm intervals. The following indices were calculated: mean and minimal area, residual area stenosis, incomplete strut apposition, tissue prolapse, eccentricity index, symmetry index, strut fracture, and edge dissection. OCT showed a minimum lumen area for Magmaris vs. DESolve of 6.6 ± 1.6 vs. 6.0 ± 1.9 (p = 0.06). Scaffolds with residual area stenosis >20% were predominantly seen in the DESolve group (15.8 vs. 46.8%; p = 0.01). The mean eccentricity index did differ significantly (0.74 ± 0.06 vs. 0.63 ± 0.09; p < 0.001). No fractures were observed for Magmaris scaffolds, but 15.2% were documented for DESolve BRS (p < 0.001). Incomplete scaffold apposition area was significantly higher in the DESolve group (0.01 ± 0.02 vs. 1.05 ± 2.32 mm2; p < 0.001). Conclusion: This is the first study to compare the acute mechanical performance between Magmaris and DESolve in a real-world setting. The acute mechanical performance of Magmaris BRS seems to be superior to that of DESolve BRS, whereas OCT showed a good acute mechanical performance for both BRS in terms of generally accepted imaging criteria.
Collapse
Affiliation(s)
- Niklas F Boeder
- Medical Clinic I, University Hospital of Giessen, Giessen, Germany
| | - Oliver Dörr
- Medical Clinic I, University Hospital of Giessen, Giessen, Germany
| | - Tim Koepp
- Medical Clinic I, University Hospital of Giessen, Giessen, Germany
| | | | - Stephan Achenbach
- Medical Clinic 2, University Hospital of Erlangen, Erlangen, Germany
| | - Albrecht Elsässer
- Department of Cardiology, University Hospital of Oldenburg, Oldeburg, Germany
| | - Christian W Hamm
- Medical Clinic I, University Hospital of Giessen, Giessen, Germany.,Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany.,German Centre for Cardiovascular Research, RheinMain Chapter, Frankfurt am Main, Germany
| | - Holger M Nef
- Medical Clinic I, University Hospital of Giessen, Giessen, Germany
| |
Collapse
|
4
|
Huseynov A, Baumann S, Nef H, Riemer T, Schneider S, Pfannenbecker T, Achenbach S, Mehilli J, Münzel T, Gori T, Wöhrle J, Zahn R, Kastner J, Schmermund A, Richardt G, Hamm CW, Akin I. Comparison between treatment of "established" versus complex "off-label" coronary lesions with Absorb ® bioresorbable scaffold implantation: results from the GABI-R ® registry. Clin Res Cardiol 2019; 109:374-384. [PMID: 31256259 DOI: 10.1007/s00392-019-01517-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 06/24/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The purpose of this study was to compare the clinical outcomes of patients treated with bioresorbable scaffold (BRS) for off-label versus approved indications. BACKGROUND The BRS promised some advantages in terms of complete biodegradation within 2-4 years, restored vascular physiology, and absence of potential stent-related long-term complications. However, the implication of BRS for off-label indications and further long-term follow-up of this particular patient group is not well described. METHODS The short- and long-term outcome after implantation of an everolimus-eluting, poly-L-lactic acid-based bioresorbable scaffold system (ABSORB, Abbott Vascular, Santa Clara, CA, USA) was evaluated in the prospective, non-interventional, multicenter real-world German-Austrian ABSORB RegIstRy (GABI-R). RESULTS A total of 3188 patients were enrolled. Patients were divided into two groups: on-label BRS use (33.0%) and off-label use (66.9%) if at least one off-label use criteria was met. The incidence of scaffold thrombosis in confirmed cases was significantly higher in off-label group (1.3% versus 0.5%, p = 0.04; OR 2.41 (95% CI 1.00-5.82) with also a trend toward higher myocardial infarction rate (2.3% versus 1.4%, p = 0.077; OR 1.70 (95% CI 0.95-3.03) and cardiovascular death (1.2% versus 1.1%, p = 0.76, OR 1.11 (95% CI 0.56-2.21) at 6-month follow-up. CONCLUSIONS In a real-world setting, the majority patients were treated with BRS for off-label indications. The off-label use of BRS compared to confirmed indications appears to be associated with a higher rate of clinical endpoints considering more complex lesions and higher morbidity in this patients' group. Comparison between treatment of "established" versus complex "off-label" coronary lesions with Absorb® bioresorbable scaffold implantation: results from the GABI-R® registry.
Collapse
Affiliation(s)
- Aydin Huseynov
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Stefan Baumann
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Holger Nef
- Department of Cardiology, University of Giessen, Giessen, Germany
| | - Thomas Riemer
- IHF GmbH, Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | | | | | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Julinda Mehilli
- Department of Cardiology, Central Clinic Bad Berka, Bad Berka, Germany
| | - Thomas Münzel
- University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Tommaso Gori
- University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Jochen Wöhrle
- Department of Internal Medicine II, Cardiology, University Hospital of Ulm, Ulm, Germany
| | - Ralf Zahn
- Deparment of Cardiology, Heart Centre Ludwigshafen, Ludwigshafen, Germany
| | - Johannes Kastner
- Department of Cardiology, University of Vienna Medical School, Vienna, Austria
| | | | - Gert Richardt
- Heart Centre Segeberger Kliniken GmbH, Bad Segeberg, Germany
| | - Christian W Hamm
- Department of Cardiology, University of Giessen, Giessen, Germany
| | - Ibrahim Akin
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany. .,DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Mannheim, Germany.
| |
Collapse
|
5
|
Computed tomography angiography for guiding and follow-up of magnesium-bioresorbable scaffold implantation. Clin Res Cardiol 2018; 108:344-346. [PMID: 30182164 PMCID: PMC6394473 DOI: 10.1007/s00392-018-1362-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 08/21/2018] [Indexed: 11/15/2022]
|
6
|
Predictors for target lesion microcalcifications in patients with stable coronary artery disease: an optical coherence tomography study. Clin Res Cardiol 2018; 107:763-771. [PMID: 29654434 DOI: 10.1007/s00392-018-1243-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 04/09/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND The minimal fibrous cap thickness overlying the necrotic lipid core as well as the presence of macrophages are established characteristics of coronary plaque vulnerability. Recently, the presence of microcalcifications has emerged as a novel feature of vulnerable lesions. However, clinical and plaque morphological predictors of microcalcifications are unknown. METHODS In patients with stable coronary artery disease, analysis of plaque morphology (n = 112) was performed using optical coherence tomography prior to coronary intervention to assess predictors of microcalcifications. RESULTS Microcalcifications were present in 21/112 (18.7%) lesions. Segments with microcalcifications showed a higher total number of calcifications per lesion (6.7 ± 3.0 vs. 3.2 ± 2.5, p < 0.001), a lower percent area stenosis (70.9 ± 11.1 vs. 76.2 ± 9.7%, p = 0.028), and a higher frequency of macrophage infiltration (66.7 vs. 37.4%, p = 0.014). In lesions with vs. without microcalcifications, macrophage infiltration was characterized by a wider macrophage angle (31.1° ± 34.4° vs. 13.7° ± 20.6°, p = 0.003), a higher macrophage index (105.6 ± 269.0 vs. 31.6 ± 66.5° mm, p = 0.020), and an increased frequency of calcium-macrophage co-localization (47.6 vs. 15.6%, p = 0.001). In multivariable logistic regression analysis, the total number of calcifications per lesion (OR 1.53, 95% CI 1.23-1.91, p < 0.001), average macrophage angle (OR 1.28 for 10°-variation, 95% CI 1.03-1.60, p = 0.024), and percent area stenosis (OR 0.59 for 10% increase, 95% CI 0.34-1.04, p = 0.070) were independent predictors for the presence of microcalcifications, whereas the latter did not reach statistical significance. CONCLUSION Microcalcifications are related to a less advanced stenosis severity and to extensive plaque inflammation, but not to clinical parameters. Our data may add to the understanding and role of microcalcifications in coronary artery lesions.
Collapse
|
7
|
Optical Coherence Tomography Guided Percutaneous Coronary Intervention. Heart Lung Circ 2017; 26:1267-1276. [DOI: 10.1016/j.hlc.2017.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 06/05/2017] [Accepted: 07/10/2017] [Indexed: 11/23/2022]
|