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Tufaro V, Jaffer FA, Serruys PW, Onuma Y, van der Steen AFW, Stone GW, Muller JE, Marcu L, Van Soest G, Courtney BK, Tearney GJ, Bourantas CV. Emerging Hybrid Intracoronary Imaging Technologies and Their Applications in Clinical Practice and Research. JACC Cardiovasc Interv 2024; 17:1963-1979. [PMID: 39260958 DOI: 10.1016/j.jcin.2024.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 06/24/2024] [Accepted: 07/02/2024] [Indexed: 09/13/2024]
Abstract
Intravascular ultrasound and optical coherence tomography are used with increasing frequency for the care of coronary patients and in research studies. These imaging tools can identify culprit lesions in acute coronary syndromes, assess coronary stenosis severity, guide percutaneous coronary intervention (PCI), and detect vulnerable plaques and patients. However, they have significant limitations that have stimulated the development of multimodality intracoronary imaging catheters, which provide improvements in assessing vessel wall pathology and guiding PCI. Prototypes combining 2 or even 3 imaging probes with complementary attributes have been developed, and several multimodality systems have already been used in patients, with near-infrared spectroscopy intravascular ultrasound-based studies showing promising results for the identification of high-risk plaques. Moreover, postmortem histology studies have documented that hybrid imaging catheters can enable more accurate characterization of plaque morphology than standalone imaging. This review describes the evolution in the field of hybrid intracoronary imaging; presents the available multimodality catheters; and discusses their potential role in PCI guidance, vulnerable plaque detection, and the assessment of endovascular devices and emerging pharmacotherapies targeting atherosclerosis.
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Affiliation(s)
- Vincenzo Tufaro
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
| | - Farouc A Jaffer
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Yoshinobu Onuma
- Department of Cardiology, University of Galway, Galway, Ireland
| | | | - Gregg W Stone
- Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai, New York, New York, USA
| | - James E Muller
- Brigham and Women's Hospital, Division of Cardiovascular Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Laura Marcu
- Department of Biomedical Engineering, University of California, Davis, California, USA
| | - Gijs Van Soest
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Brian K Courtney
- Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada; Conavi Medical Inc, Toronto, Ontario, Canada
| | - Guillermo J Tearney
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard-MIT Health Sciences and Technology, Cambridge, Massachusetts, USA
| | - Christos V Bourantas
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom; Institute of Cardiovascular Sciences, University College London, London, United Kingdom.
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Predictors and outcomes of acute recoil after ultrathin bioresorbable polymer sirolimus-eluting stents implantation: an intravascular ultrasound in native coronary arteries. Coron Artery Dis 2021; 31:18-24. [PMID: 34086612 DOI: 10.1097/mca.0000000000001067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Ultrathin bioresorbable polymer sirolimus-eluting stents (BP-SESs) may easily lead to acute recoil. This study investigated acute recoil after BP-SES implantation on the basis of intravascular ultrasound (IVUS). METHODS We enrolled 40 consecutive stents. Absolute acute recoil by quantitative coronary angiography was defined as the difference between the mean diameter of the last inflated balloon (X) and mean lumen diameter of the BP-SES immediately after balloon deflation (Y). Percent (%) acute recoil was defined as (X-Y)×100/X. IVUS was performed within the culprit lesion. Plaque eccentricity, % plaque burden and calcification grade score were assessed using IVUS. Calcification grade was scored on the basis of quadrants. On the basis of the median acute recoil value of 5.0%, the stents were divided into two groups: low (LAR, n = 20) and high % acute recoil (HAR, n = 20). RESULTS Mean % acute recoil was 5.8 ± 5.3%. Plaque eccentricity, % plaque burden and stent/artery ratio were significantly higher in the HAR group than in the LAR group. Significant differences in % acute recoil were not observed regarding the types of stent diameter. In multivariate logistic regression and multiple linear regression analysis, plaque eccentricity and % plaque burden in the culprit plaque were significant positive predictors for the occurrence of % acute recoil. No significant differences, including clinical outcomes, were found between both groups at follow-up. CONCLUSION Acute recoil of BP-SESs may be influenced by an eccentric plaque with a large burden, which did not affect long-term outcomes. However, the present study might suggest the proper strategy (e.g. a more exhaustive plaque preparation) before BP-SES implantation in a case with these IVUS characteristics.
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Ueki Y, Räber L, Otsuka T, Rai H, Losdat S, Windecker S, Garcia-Garcia HM, Landmesser U, Koolen J, Byrne R, Haude M, Joner M. Mechanism of Drug-Eluting Absorbable Metal Scaffold Restenosis. Circ Cardiovasc Interv 2020; 13:e008657. [DOI: 10.1161/circinterventions.119.008657] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
The pathomechanisms underlying restenosis of the bioabsorbable sirolimus-eluting metallic scaffold (Magmaris) remain unknown. Using serial optical coherence tomography, we investigated causes of restenosis, including the contribution of late scaffold recoil versus neointimal hyperplasia.
Methods:
Patients enrolled in BIOSOLVE-II undergoing serial angiography and optical coherence tomography (post-intervention and follow-up: 6 months and/or 1 year) were analyzed. Patients were divided into 2 groups according to angiographic in-scaffold late lumen loss (LLL) <0.5 or ≥0.5 mm. End points were late absolute scaffold recoil and neointimal hyperplasia area as assessed by optical coherence tomography.
Results:
Serial data were available for analysis from 70 patients (LLL <0.5 mm: n=41; LLL ≥0.5 mm: n=29). Patient and lesion characteristics were comparable, and there was no significant difference in mean and minimal scaffold area between groups at post-intervention. Late absolute scaffold recoil was less among patients with LLL <0.5 mm (0.53±0.68 mm
2
) compared with those with LLL ≥0.5 mm (1.48±1.20 mm
2
;
P
<0.001). Neointimal hyperplasia area was smaller among patients with LLL <0.5 mm at follow-up (1.47±0.33 mm
2
) compared with patients with LLL ≥0.5 mm (1.68±0.34 mm
2
;
P
=0.013). In a matched-frame analysis (post-intervention and follow-up), late absolute scaffold recoil varied according to the underlying plaque type (lipid: 0.63±1.23 mm
2
; calcified: 0.81±1.44 mm
2
; and fibrous: 1.20±1.52 mm
2
;
P
<0.001), while there was no difference with regards to neointimal hyperplasia area (
P
=0.132).
Conclusions:
In addition to neointimal hyperplasia, late scaffold recoil contributed significantly to LLL of sirolimus-eluting absorbable metal scaffolds. The extent of late scaffold recoil was dependent on the underlying plaque morphology and was the highest among fibrotic lesions.
Registration:
URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT01960504.
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Affiliation(s)
- Yasushi Ueki
- Department of Cardiology, Bern University Hospital, Switzerland (Y.U., L.R., T.O., S.W.)
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, Switzerland (Y.U., L.R., T.O., S.W.)
| | - Tatsuhiko Otsuka
- Department of Cardiology, Bern University Hospital, Switzerland (Y.U., L.R., T.O., S.W.)
| | - Himanshu Rai
- Deutsches Herzzentrum München, Technische Universität München, Germany (H.R., R.B., M.J.)
| | - Sylvain Losdat
- Institute of Social and Preventive Medicine and Clinical Trials Unit, University of Bern, Switzerland (S.L.)
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Switzerland (Y.U., L.R., T.O., S.W.)
| | | | - Ulf Landmesser
- Department of Cardiology, Charite Universitätsmedizin Berlin, Germany (U.L.)
| | - Jacques Koolen
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands (J.K.)
| | - Robert Byrne
- Deutsches Herzzentrum München, Technische Universität München, Germany (H.R., R.B., M.J.)
| | - Michael Haude
- Medical Clinic I, Städtische Kliniken Neuss, Lukaskrankenhaus GmbH, Germany (M.H.)
| | - Michael Joner
- Deutsches Herzzentrum München, Technische Universität München, Germany (H.R., R.B., M.J.)
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Mechanical and physio-biological properties of peptide-coated stent for re-endothelialization. Biomater Res 2020; 24:4. [PMID: 31998531 PMCID: PMC6979279 DOI: 10.1186/s40824-020-0182-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/06/2020] [Indexed: 11/16/2022] Open
Abstract
Background The aim of this study was to characterize the mechanical and physio-biological properties of peptide-coated stent (PCS) compared to commercialized drug-eluting stents (DESs). Methods WKYMVm (Trp-Lys-Tyr-Met-Val-D-Met), a stimulating peptide for homing endothelial colony-forming cell was specially synthesized and coated to bare metal stent (BMS) by dopamine-derived coordinated bond. Biological effects of PCS were investigated by endothelial cell proliferation assay and pre-clinical animal study. And mechanical properties were examined by various experiment. Results The peptide was well-coated to BMS and was maintained and delivered to 21 and 7 days in vitro and in vivo, respectively. Moreover, the proliferation of endothelial cell in PCS group was increased (approximately 36.4 ± 5.77%) in PCS group at 7 day of culture compare to BMS. Although, the radial force of PCS was moderated among study group. The flexibility of PCS was (0.49 ± 0.082 N) was greatest among study group. PCS did not show the outstanding performance in recoil and foreshortening test (3.1 ± 0.22% and 2.1 ± 0.06%, respectively), which was the reasonable result under the guide line of FDA (less than 7.0%). The nominal pressure (3.0 mm in a diameter) of PCS established by compliance analysis was 9 atm. The changing of PCS diameter by expansion was similar to other DESs, which is less than 10 atm of pressure for the nominal pressure. Conclusions These results suggest that the PCS is not inferior to commercialized DES. In addition, since the PCS was fabricated as polymer–free process, secondary coating with polymer-based immunosuppressive drugs such as –limus derivatives may possible.
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Elabbassi W, Chowdhury MA, Hatala R. Bioresorbable scaffold technology: The yet unfulfilled promise of becoming the workhorse stent in the cardiac catherization laboratory. Egypt Heart J 2018; 70:409-414. [PMID: 30591764 PMCID: PMC6303354 DOI: 10.1016/j.ehj.2018.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 07/14/2018] [Indexed: 11/12/2022] Open
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Anadol R, Lorenz L, Weissner M, Ullrich H, Polimeni A, Münzel T, Gori T. Characteristics and outcome of patients with complex coronary lesions treated with bioresorbable scaffolds: three-year follow-up in a cohort of consecutive patients. EUROINTERVENTION 2018; 14:e1011-e1019. [PMID: 28966157 DOI: 10.4244/eij-d-17-00410] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The safety of bioresorbable scaffolds (BRS) has recently been challenged. However, it is unclear whether outcomes depend on the complexity of the lesion or on the technique used to implant the device. The aim of this study was to report on the outcomes after BRS implantation in complex lesions. METHODS AND RESULTS This investigator-initiated, single-centre, single-arm observational study recruited 657 consecutive patients (79% male, 66.7% acute coronary syndrome, age 63±12 years). Three hundred and twenty-two lesions (42.3%) in 297 (45.2%) patients with type B2 or C lesions were classified as the "complex lesions group". Post-procedural residual stenosis was slightly but significantly greater in the complex lesions group (15.7±11.3% vs. 13.5±10.2%, p=0.0109). The median follow-up was 1,076 (762-1,206) days without difference between groups. The Kaplan-Meier rates of early scaffold thrombosis (3.5% vs. 1.1%, p=0.0478, HR 3.03 [1.06-8.70]) and scaffold restenosis (9.9% vs. 9.1%, p=0.0262, HR 2.34 [1.11-4.94]) were higher in patients with complex lesions than in those with simple lesions. Late/very late thrombosis, death, repeat myocardial infarction, or repeat coronary interventions were not different. In patients in whom strict guidelines for implantation were applied, the incidence of thrombosis was reduced by 76% in complex lesions and by 92% in simple ones, such that there were no differences between groups (2.3% vs. 0.5%, p=0.3899). In contrast, the incidence of scaffold restenosis was reduced by 59% and 89%, and a difference between groups persisted (7.0% vs. 1.6%, p=0.0235). CONCLUSIONS BRS implantation in complex lesions is, as expected, associated with higher incidence of events as compared to simple ones. The technique used at the time of the implantation, however, reduces the incidence of adverse outcomes.
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Affiliation(s)
- Remzi Anadol
- Kardiologie I, Zentrum für Kardiologie, University Hospital Mainz, Mainz, Germany, and German Center for Cardiac and Vascular Research (DZHK), Standort Rhein-Main, Germany
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Liu SW, Weng CS, Wang WJ, Liu YH, Wu VC, Wang MC. BIOCOMPATIBILITY EVALUATION OF DRUG RELEASING ABSORBABLE VASCULAR STENTS. BIOMEDICAL ENGINEERING: APPLICATIONS, BASIS AND COMMUNICATIONS 2018. [DOI: 10.4015/s1016237218500357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This study examined the biocompatibility of blood vessels and a biodegradable drug-loaded vascular stent. The Traditional Chinese Medicine System Laboratory of Chung Yuan Christian University prepared the vascular stent, and our study verified the sustained release of drugs from the stent when it was within blood vessels. A platelet adhesion experiment revealed that stents with less surface roughness resulted in a reduction in the number of adhered platelets and decreased fibrinogen accumulation. The results of a hemolysis experiment verified that the hemolysis index was between 1% and 1.4%, within the range of no hemolysis and would not cause hypoxia. Subsequently, a drug release rate experiment indicated that the amount of released everolimus increased with time. The greatest amount of drug that was released occurred at 8[Formula: see text]h, with a release rate of 36.95%. A swelling rate experiment revealed that the degree of swelling of the hyaluronic acid (HA) that contained everolimus was 10 times less than that of the original HA; therefore, the use of a material with a low swelling rate in vascular stents did not immediately cause an obstruction in blood vessels. A lactate dehydrogenase (LDH) toxicity experiment revealed that the percentage of LDH released was 13–18%. This indicated that the cell viability was not affected and that there was no cytotoxicity; thus, the stent was suitable for use in blood vessels. This study proved that the prepared biodegradable drug-loaded vascular stent had favorable blood compatibility, no cytotoxicity, and a suitable drug release rate. Moreover, the drug release material was made from a material with a low degree of swelling. As a result of our findings, this new type of stent is suitable for application in blood vessels.
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Affiliation(s)
- Si W. Liu
- Department of Biomedical Engineering, Chung Yuan Christian University, Taoyuan, Taiwan, R. O. C
| | - Ching S. Weng
- Department of Biomedical Engineering, Chung Yuan Christian University, Taoyuan, Taiwan, R. O. C
| | - Wei J. Wang
- Department of Biomedical Engineering, Chung Yuan Christian University, Taoyuan, Taiwan, R. O. C
- Division of Nephrology, Department of Internal Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan, R. O. C
| | - Yuan H. Liu
- Section of Cardiology, Cardiovascular Center Far Eastern Memorial Hospital, 21, Sec. 2, Nan-Ya South Road, Pan Chiao, New Taipei City, Taiwan, R. O. C
| | - Vin C. Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, R. O. C
| | - Ming C. Wang
- Department of Biomedical Engineering, Chung Yuan Christian University, Taoyuan, Taiwan, R. O. C
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Wei L, Chen Q, Li Z. Influences of plaque eccentricity and composition on the stent–plaque–artery interaction during stent implantation. Biomech Model Mechanobiol 2018; 18:45-56. [DOI: 10.1007/s10237-018-1066-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 07/27/2018] [Indexed: 11/29/2022]
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9
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Hytönen JP, Taavitsainen J, Tarvainen S, Ylä-Herttuala S. Biodegradable coronary scaffolds: their future and clinical and technological challenges. Cardiovasc Res 2018; 114:1063-1072. [DOI: 10.1093/cvr/cvy097] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 04/27/2018] [Indexed: 12/13/2022] Open
Abstract
Abstract
Angioplasty and stenting are standard treatment options for both stabile occlusive coronary artery disease and acute myocardial infarctions. Over the last years, several biodegradable stent systems have entered pre-clinical and clinical evaluation and into clinical practice. A strong supporting scaffold is necessary after angioplasty to prevent elastic recoil of the vessel but in the long term a permanent metallic stent will only impair normal physiology of the artery wall. Thus, the main advantage of a resorbable system is the potential for better vessel recovery and function in the long term. The new stent systems differ from traditional stents in size and biological responses and questions have risen regarding their mechanical strength and increased risk of stent thrombosis. Here, we present current treatment options with biodegradable scaffolds, discuss further key areas for improvements and review novel technological advances in the context of all up-to-date clinical trial information. New material choices are also covered as well as special considerations for pre-clinical testing.
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Affiliation(s)
- Jarkko P Hytönen
- Department of Biotechnology and Molecular Medicine, A.I.Virtanen Institute, University of Eastern Finland, Kuopio, Finland
| | - Jouni Taavitsainen
- Department of Biotechnology and Molecular Medicine, A.I.Virtanen Institute, University of Eastern Finland, Kuopio, Finland
| | - Santeri Tarvainen
- Department of Biotechnology and Molecular Medicine, A.I.Virtanen Institute, University of Eastern Finland, Kuopio, Finland
| | - Seppo Ylä-Herttuala
- Department of Biotechnology and Molecular Medicine, A.I.Virtanen Institute, University of Eastern Finland, Kuopio, Finland
- Heart Center
- Gene Therapy Unit, Kuopio University Hospital, Kuopio, Finland
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Cheng Y, Gasior P, Shibuya M, Ramzipoor K, Lee C, Estrada EA, Dokko D, McGregor JC, Conditt GB, Kaluza GL, Granada JF. Comparative Characterization of Biomechanical Behavior and Healing Profile of a Novel Ultra-High-Molecular-Weight Amorphous Poly-l-Lactic Acid Sirolimus-Eluting Bioresorbable Coronary Scaffold. Circ Cardiovasc Interv 2017; 9:CIRCINTERVENTIONS.116.004253. [PMID: 27694138 DOI: 10.1161/circinterventions.116.004253] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 08/26/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Clinically available bioresorbable scaffolds (BRS) rely on polymer crystallinity to achieve mechanical strength resulting in limited overexpansion capabilities and structural integrity when exposed to high-loading conditions. We aimed to evaluate the biomechanical behavior and vascular healing profile of a novel, sirolimus-eluting, high-molecular-weight, amorphous poly-l-lactic acid-based BRS (Amaranth BRS). METHODS AND RESULTS In vitro biomechanical testing was performed under static and cyclic conditions. A total of 99 devices (65 Amaranth BRS versus 34 Absorb bioresorbable vascular scaffold [BVS]) were implanted in 99 coronary arteries of 37 swine for pharmacokinetics and healing evaluation at various time points. In the Absorb BVS, the number of fractures per scaffold seen on light microscopy was 6.0 (5.0-10.5) when overexpanded 1.0 mm above nominal values (≈34%). No fractures were observed in the Amaranth BRS group at 1.3 mm above nominal values (≈48% overexpansion). The number of fractures was higher in the Absorb BVS on accelerated cycle testing over time (at 24K cycles=5.0 [5.0-9.0] Absorb BVS versus 0.0 [0.0-0.5] Amaranth BRS). Approximately 90% of sirolimus was found to be eluted by 90 days. Optical coherence tomography analysis demonstrated lower percentages of late scaffold recoil in the Amaranth BRS at 3 months (Amaranth BRS=-10±16.1% versus Absorb BVS=10.7±13.2%; P=0.004). Histopathology analysis revealed comparable levels of vascular healing and inflammatory responses between both BRSs up to 6 months. CONCLUSIONS New-generation high-molecular-weight amorphous poly-l-lactic acid scaffolds have the potential to improve the clinical performance of BRS and provide the ideal platform for the future miniaturization of the technology.
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Affiliation(s)
- Yanping Cheng
- From the CRF-Skirball Center for Innovation, Orangeburg, NY (Y.C., P.G., M.S., J.C.M., G.B.C., G.L.K., J.F.G.); Amaranth Medical, Inc, Mountain View, CA (K.R., C.L., E.A.E., D.D.); and 3rd Department of Cardiology, Medical University of Silesia, Katowice, Poland (P.G.)
| | - Pawel Gasior
- From the CRF-Skirball Center for Innovation, Orangeburg, NY (Y.C., P.G., M.S., J.C.M., G.B.C., G.L.K., J.F.G.); Amaranth Medical, Inc, Mountain View, CA (K.R., C.L., E.A.E., D.D.); and 3rd Department of Cardiology, Medical University of Silesia, Katowice, Poland (P.G.)
| | - Masahiko Shibuya
- From the CRF-Skirball Center for Innovation, Orangeburg, NY (Y.C., P.G., M.S., J.C.M., G.B.C., G.L.K., J.F.G.); Amaranth Medical, Inc, Mountain View, CA (K.R., C.L., E.A.E., D.D.); and 3rd Department of Cardiology, Medical University of Silesia, Katowice, Poland (P.G.)
| | - Kamal Ramzipoor
- From the CRF-Skirball Center for Innovation, Orangeburg, NY (Y.C., P.G., M.S., J.C.M., G.B.C., G.L.K., J.F.G.); Amaranth Medical, Inc, Mountain View, CA (K.R., C.L., E.A.E., D.D.); and 3rd Department of Cardiology, Medical University of Silesia, Katowice, Poland (P.G.)
| | - Chang Lee
- From the CRF-Skirball Center for Innovation, Orangeburg, NY (Y.C., P.G., M.S., J.C.M., G.B.C., G.L.K., J.F.G.); Amaranth Medical, Inc, Mountain View, CA (K.R., C.L., E.A.E., D.D.); and 3rd Department of Cardiology, Medical University of Silesia, Katowice, Poland (P.G.)
| | - Edward A Estrada
- From the CRF-Skirball Center for Innovation, Orangeburg, NY (Y.C., P.G., M.S., J.C.M., G.B.C., G.L.K., J.F.G.); Amaranth Medical, Inc, Mountain View, CA (K.R., C.L., E.A.E., D.D.); and 3rd Department of Cardiology, Medical University of Silesia, Katowice, Poland (P.G.)
| | - Daniell Dokko
- From the CRF-Skirball Center for Innovation, Orangeburg, NY (Y.C., P.G., M.S., J.C.M., G.B.C., G.L.K., J.F.G.); Amaranth Medical, Inc, Mountain View, CA (K.R., C.L., E.A.E., D.D.); and 3rd Department of Cardiology, Medical University of Silesia, Katowice, Poland (P.G.)
| | - Jenn C McGregor
- From the CRF-Skirball Center for Innovation, Orangeburg, NY (Y.C., P.G., M.S., J.C.M., G.B.C., G.L.K., J.F.G.); Amaranth Medical, Inc, Mountain View, CA (K.R., C.L., E.A.E., D.D.); and 3rd Department of Cardiology, Medical University of Silesia, Katowice, Poland (P.G.)
| | - Gerard B Conditt
- From the CRF-Skirball Center for Innovation, Orangeburg, NY (Y.C., P.G., M.S., J.C.M., G.B.C., G.L.K., J.F.G.); Amaranth Medical, Inc, Mountain View, CA (K.R., C.L., E.A.E., D.D.); and 3rd Department of Cardiology, Medical University of Silesia, Katowice, Poland (P.G.)
| | - Greg L Kaluza
- From the CRF-Skirball Center for Innovation, Orangeburg, NY (Y.C., P.G., M.S., J.C.M., G.B.C., G.L.K., J.F.G.); Amaranth Medical, Inc, Mountain View, CA (K.R., C.L., E.A.E., D.D.); and 3rd Department of Cardiology, Medical University of Silesia, Katowice, Poland (P.G.)
| | - Juan F Granada
- From the CRF-Skirball Center for Innovation, Orangeburg, NY (Y.C., P.G., M.S., J.C.M., G.B.C., G.L.K., J.F.G.); Amaranth Medical, Inc, Mountain View, CA (K.R., C.L., E.A.E., D.D.); and 3rd Department of Cardiology, Medical University of Silesia, Katowice, Poland (P.G.).
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11
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Bourantas C, Tenekecioglu E, Radu M, Räber L, Serruys P. State of the art: role of intravascular imaging in the evolution of percutaneous coronary intervention – a 30-year review. EUROINTERVENTION 2017; 13:644-653. [DOI: 10.4244/eij-d-17-00471] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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12
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Cheng Y, Gasior P, Xia JG, Ramzipoor K, Lee C, Estrada EA, Dokko D, McGregor JC, Conditt GB, McAndrew T, Kaluza GL, Granada JF. Comparative Biomechanical Behavior and Healing Profile of a Novel Thinned Wall Ultrahigh Molecular Weight Amorphous Poly-l-Lactic Acid Sirolimus-Eluting Bioresorbable Coronary Scaffold. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.117.005116. [PMID: 28701488 DOI: 10.1161/circinterventions.117.005116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 06/12/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Mechanical strength of bioresorbable scaffolds (BRS) is highly dependent on strut dimensions and polymer features. To date, the successful development of thin-walled BRS has been challenging. We compared the biomechanical behavior and vascular healing profile of a novel thin-walled (115 µm) sirolimus-eluting ultrahigh molecular weight amorphous poly-l-lactic acid-based BRS (APTITUDE, Amaranth Medical [AMA]) to Absorb (bioresorbable vascular scaffold [BVS]) using different experimental models. METHODS AND RESULTS In vitro biomechanical testing showed no fractures in the AMA-BRS when overexpanded 1.3 mm above nominal dilatation values (≈48%) and lower number of fractures on accelerated cycle testing over time (at 21 K cycles=20.0 [19.5-20.5] in BVS versus 4.0 [3.0-4.3] in AMA-BRS). In the healing response study, 35 AMA-BRS and 23 BVS were implanted in 58 coronary arteries of 23 swine and followed-up to 180 days. Scaffold strut healing was evaluated in vivo using weekly optical coherence tomography analysis. At 14 days, the AMA-BRS demonstrated a higher percentage of embedded struts (71.0% [47.6, 89.1] compared with BVS 40.3% [20.5, 63.2]; P=0.01). At 21 days, uncovered struts were still present in the BVS group (3.8% [2.1, 10.2]). Histopathology revealed lower area stenosis (AMA-BRS, 21.0±6.1% versus BVS 31.0±4.5%; P=0.002) in the AMA-BRS at 28 days. Neointimal thickness and inflammatory scores were comparable between both devices at 180 days. CONCLUSIONS A new generation thinned wall BRS displayed a more favorable biomechanical behavior and strut healing profile compared with BVS in normal porcine coronary arteries. This novel BRS concept has the potential to improve the clinical outcomes of current generation BRS.
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Affiliation(s)
- Yanping Cheng
- From the CRF-Skirball Center for Innovation, Orangeburg, NY (Y.C., P.G., J.-G.X., J.C.M., G.B.C., G.L.K., J.F.G.); Amaranth Medical, Inc, Mountain View, CA (K.R., C.L., E.A.E., D.D.); 3rd Department of Cardiology, Medical University of Silesia, Katowice, Poland (P.G.); and Cardiovascular Research Foundation, New York, NY (T.M.)
| | - Pawel Gasior
- From the CRF-Skirball Center for Innovation, Orangeburg, NY (Y.C., P.G., J.-G.X., J.C.M., G.B.C., G.L.K., J.F.G.); Amaranth Medical, Inc, Mountain View, CA (K.R., C.L., E.A.E., D.D.); 3rd Department of Cardiology, Medical University of Silesia, Katowice, Poland (P.G.); and Cardiovascular Research Foundation, New York, NY (T.M.)
| | - Jing-Gang Xia
- From the CRF-Skirball Center for Innovation, Orangeburg, NY (Y.C., P.G., J.-G.X., J.C.M., G.B.C., G.L.K., J.F.G.); Amaranth Medical, Inc, Mountain View, CA (K.R., C.L., E.A.E., D.D.); 3rd Department of Cardiology, Medical University of Silesia, Katowice, Poland (P.G.); and Cardiovascular Research Foundation, New York, NY (T.M.)
| | - Kamal Ramzipoor
- From the CRF-Skirball Center for Innovation, Orangeburg, NY (Y.C., P.G., J.-G.X., J.C.M., G.B.C., G.L.K., J.F.G.); Amaranth Medical, Inc, Mountain View, CA (K.R., C.L., E.A.E., D.D.); 3rd Department of Cardiology, Medical University of Silesia, Katowice, Poland (P.G.); and Cardiovascular Research Foundation, New York, NY (T.M.)
| | - Chang Lee
- From the CRF-Skirball Center for Innovation, Orangeburg, NY (Y.C., P.G., J.-G.X., J.C.M., G.B.C., G.L.K., J.F.G.); Amaranth Medical, Inc, Mountain View, CA (K.R., C.L., E.A.E., D.D.); 3rd Department of Cardiology, Medical University of Silesia, Katowice, Poland (P.G.); and Cardiovascular Research Foundation, New York, NY (T.M.)
| | - Edward A Estrada
- From the CRF-Skirball Center for Innovation, Orangeburg, NY (Y.C., P.G., J.-G.X., J.C.M., G.B.C., G.L.K., J.F.G.); Amaranth Medical, Inc, Mountain View, CA (K.R., C.L., E.A.E., D.D.); 3rd Department of Cardiology, Medical University of Silesia, Katowice, Poland (P.G.); and Cardiovascular Research Foundation, New York, NY (T.M.)
| | - Daniell Dokko
- From the CRF-Skirball Center for Innovation, Orangeburg, NY (Y.C., P.G., J.-G.X., J.C.M., G.B.C., G.L.K., J.F.G.); Amaranth Medical, Inc, Mountain View, CA (K.R., C.L., E.A.E., D.D.); 3rd Department of Cardiology, Medical University of Silesia, Katowice, Poland (P.G.); and Cardiovascular Research Foundation, New York, NY (T.M.)
| | - Jenn C McGregor
- From the CRF-Skirball Center for Innovation, Orangeburg, NY (Y.C., P.G., J.-G.X., J.C.M., G.B.C., G.L.K., J.F.G.); Amaranth Medical, Inc, Mountain View, CA (K.R., C.L., E.A.E., D.D.); 3rd Department of Cardiology, Medical University of Silesia, Katowice, Poland (P.G.); and Cardiovascular Research Foundation, New York, NY (T.M.)
| | - Gerard B Conditt
- From the CRF-Skirball Center for Innovation, Orangeburg, NY (Y.C., P.G., J.-G.X., J.C.M., G.B.C., G.L.K., J.F.G.); Amaranth Medical, Inc, Mountain View, CA (K.R., C.L., E.A.E., D.D.); 3rd Department of Cardiology, Medical University of Silesia, Katowice, Poland (P.G.); and Cardiovascular Research Foundation, New York, NY (T.M.)
| | - Thomas McAndrew
- From the CRF-Skirball Center for Innovation, Orangeburg, NY (Y.C., P.G., J.-G.X., J.C.M., G.B.C., G.L.K., J.F.G.); Amaranth Medical, Inc, Mountain View, CA (K.R., C.L., E.A.E., D.D.); 3rd Department of Cardiology, Medical University of Silesia, Katowice, Poland (P.G.); and Cardiovascular Research Foundation, New York, NY (T.M.)
| | - Greg L Kaluza
- From the CRF-Skirball Center for Innovation, Orangeburg, NY (Y.C., P.G., J.-G.X., J.C.M., G.B.C., G.L.K., J.F.G.); Amaranth Medical, Inc, Mountain View, CA (K.R., C.L., E.A.E., D.D.); 3rd Department of Cardiology, Medical University of Silesia, Katowice, Poland (P.G.); and Cardiovascular Research Foundation, New York, NY (T.M.)
| | - Juan F Granada
- From the CRF-Skirball Center for Innovation, Orangeburg, NY (Y.C., P.G., J.-G.X., J.C.M., G.B.C., G.L.K., J.F.G.); Amaranth Medical, Inc, Mountain View, CA (K.R., C.L., E.A.E., D.D.); 3rd Department of Cardiology, Medical University of Silesia, Katowice, Poland (P.G.); and Cardiovascular Research Foundation, New York, NY (T.M.).
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Wiktor DM, Waldo SW, Armstrong EJ. Coronary Stent Failure: Fracture, Compression, Recoil, and Prolapse. Interv Cardiol Clin 2017; 5:405-414. [PMID: 28582037 DOI: 10.1016/j.iccl.2016.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Current-generation coronary drug-eluting stents are associated with low rates of restenosis and target lesion revascularization. However, several mechanisms of stent failure remain clinically important. Stent fracture may occur in areas of excessive torsion or angulation. Longitudinal stent deformation is related to axial stent compression owing to extrinsic forces or secondary devices that disrupt stent architecture. Stent recoil occurs when a stent does not deploy at its optimal cross-sectional area. Tissue prolapse between stent struts may also predispose patients to adverse outcomes. Prevention, recognition, and treatment of these stent failures are necessary to optimize patient outcomes after percutaneous coronary interventions.
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Affiliation(s)
- Dominik M Wiktor
- Division of Cardiology, VA Eastern Colorado Healthcare System, University of Colorado, Denver, CO, USA
| | - Stephen W Waldo
- Division of Cardiology, VA Eastern Colorado Healthcare System, University of Colorado, Denver, CO, USA
| | - Ehrin J Armstrong
- Division of Cardiology, VA Eastern Colorado Healthcare System, University of Colorado, Denver, CO, USA.
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Lee CH, Hsieh MJ, Chang SH, Chiang CL, Fan CL, Liu SJ, Chen WJ, Wang CJ, Hsu MY, Hung KC, Chou CC, Chang PC. Biodegradable Cable-Tie Rapamycin-eluting Stents. Sci Rep 2017; 7:111. [PMID: 28273914 PMCID: PMC5427919 DOI: 10.1038/s41598-017-00131-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 02/08/2017] [Indexed: 12/03/2022] Open
Abstract
"Cable-tie" type biodegradable stents with drug-eluting nanofiber were developed to treat rabbit denuded arteries in this study. Biodegradable stents were fabricated using poly-L-lactide film following being cut and rolled into a cable-tie type stent. Additionally, drug-eluting biodegradable nanofiber tubes were electrospun from a solution containing poly (lactic-co-glycolic acid), rapamycin, and hexafluoroisopropanol, and then mounted onto the stents. The fabricated rapamycin-eluting cable-tie stents exhibited excellent mechanical properties on evaluation of compression test and collapse pressure, and less than 8% weight loss following being immersed in phosphate-buffered saline for 16 weeks. Furthermore, the biodegradable stents delivered high rapamycin concentrations for over 4 weeks and achieved substantial reductions in intimal hyperplasia associated with elevated heme oxygenase-1 and calponin level on the denuded rabbit arteries during 6 months of follow-up. The drug-eluting cable-tie type stents developed in this study might have high potential impacts for the local drug delivery to treat various vascular diseases.
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Affiliation(s)
- Cheng-Hung Lee
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital-Linkou, Chang Gung University College of Medicine, Taipei, Taiwan
| | - Ming-Jer Hsieh
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital-Linkou, Chang Gung University College of Medicine, Taipei, Taiwan
| | - Shang-Hung Chang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital-Linkou, Chang Gung University College of Medicine, Taipei, Taiwan
| | - Chang-Lin Chiang
- Department of Mechanical Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Lung Fan
- Department of Mechanical Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Jung Liu
- Department of Mechanical Engineering, Chang Gung University, Taoyuan, Taiwan.
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital-Linkou, Taoyuan, Taiwan.
| | - Wei-Jan Chen
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital-Linkou, Chang Gung University College of Medicine, Taipei, Taiwan
| | - Chao-Jan Wang
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital-Linkou, Taoyuan, Taiwan
| | - Ming-Yi Hsu
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital-Linkou, Taoyuan, Taiwan
| | - Kuo-Chun Hung
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital-Linkou, Chang Gung University College of Medicine, Taipei, Taiwan
| | - Chung-Chuan Chou
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital-Linkou, Chang Gung University College of Medicine, Taipei, Taiwan
| | - Po-Cheng Chang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital-Linkou, Chang Gung University College of Medicine, Taipei, Taiwan
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Vahl T, Gasior P, Gongora C, Ramzipoor K, Lee C, Cheng Y, McGregor J, Shibuya M, Estrada E, Conditt G, Kaluz G, Granada J. Four-year polymer biocompatibility and vascular healing profile of a novel ultrahigh molecular weight amorphous PLLA bioresorbable vascular scaffold: an OCT study in healthy porcine coronary arteries. EUROINTERVENTION 2016; 12:1510-1518. [DOI: 10.4244/eij-d-16-00308] [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] [Indexed: 11/23/2022]
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Dave B. Bioresorbable Scaffolds: Current Evidences in the Treatment of Coronary Artery Disease. J Clin Diagn Res 2016; 10:OE01-OE07. [PMID: 27891384 DOI: 10.7860/jcdr/2016/21915.8429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 08/10/2016] [Indexed: 01/12/2023]
Abstract
Percutaneous coronary revascularization strategies have gradually progressed over a period of last few decades. The advent of newer generation drug-eluting stents has significantly improved the outcomes of Percutaneous Coronary Intervention (PCI) by substantially reducing in-stent restenosis and stent thrombosis. However, vascular inflammation, restenosis, thrombosis, and neoatherosclerosis due to the permanent presence of a metallic foreign body within the artery limit their usage in complex Coronary Artery Disease (CAD). Bioresorbable Scaffolds (BRS) represent a novel approach in coronary stent technology. Complete resorption of the scaffold liberates the treated vessel from its cage and restores pulsatility, cyclical strain, physiological shear stress, and mechanotransduction. In this review article, we describe the advances in this rapidly evolving technology, present the evidence from the pre-clinical and clinical evaluation of these devices, and provide an overview of the ongoing clinical trials that were designed to examine the effectiveness of BRS in the clinical setting.
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Affiliation(s)
- Bhargav Dave
- Clinical Research Analyst and Professor, Srinivas University , Mangaluru, Karnataka, India
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Abstract
In the field of percutaneous coronary intervention, the evolution of coronary metal stents has been well established for the past three decades, but research on bioresorbable scaffolds has only gained momentum in the recent past. Although second-generation drug-eluting metal stents are the gold standard for the treatment of obstructive coronary artery disease, a few drawbacks exist. The development of bioresorbable scaffolds is an attempt to overcome the limitations of metal stents. This review highlights the rationale for the bioresorbable scaffold, its properties and potential applications. It also focuses on the current evidence and concerns regarding the application of the bioresorbable scaffold in day-to-day practice.
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Affiliation(s)
- Huay Cheem Tan
- Department of Cardiology, National University Heart Centre, Singapore
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Predictors of acute scaffold recoil after implantation of the everolimus-eluting bioresorbable scaffold: an optical coherence tomography assessment in native coronary arteries. Int J Cardiovasc Imaging 2016; 33:145-152. [PMID: 27761749 DOI: 10.1007/s10554-016-0997-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 10/03/2016] [Indexed: 01/16/2023]
Abstract
This study investigated the predictors of acute recoil after implantation of everolimus-eluting BRS based on optical coherence tomography (OCT). Thirty-nine patients (56 scaffolds) were enrolled. Acute absolute recoil by quantitative coronary angiography was defined as the difference between the mean diameter of the last inflated balloon (X) and the mean lumen diameter of BRS immediately after balloon deflation (Y). Acute percent recoil was defined as (X - Y) × 100/X. Plaque eccentricity (PE) and plaque composition (PC) were assessed by OCT. PC was classified into two different types: calcific (score = 1), fibrous and lipid (score = 0). Based on the mean acute scaffold recoil value of the present study, scaffolds were divided into two groups: the low acute recoil group (LAR, n = 34) and the high acute recoil group (HAR, n = 22). Acute percent and absolute recoil were 6.4 ± 3.0 % and 0.19 ± 0.11 mm. PE, PC score and scaffold/artery ratio were significantly higher in HAR than in LAR. In multivariate logistic regression analysis, PE > 1.49, PC score (score 1) and scaffold/artery ratio >1.07 were significant positive predictors for the occurrence of acute scaffold recoil (OR 10.7, 95 % CI 2.2-51.4, p < 0.01; OR 5.6, 95 % CI 1.9-22.0, p = 0.04; OR 12.4, 95 % CI 2.6-65.4, p < 0.01, respectively). Acute recoil of BRS is influenced by BRS sizing as well as OCT-derived plaque characteristics.
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Liao L, Peng C, Li S, Lu Z, Fan Z. Evaluation of bioresorbable polymers as potential stent material-In vivodegradation behavior and histocompatibility. J Appl Polym Sci 2016. [DOI: 10.1002/app.44355] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Lan Liao
- Department of Materials Science; Fudan University; Handan Road No. 220 Shanghai 200433 People's Republic of China
| | - Cheng Peng
- Sixth People's Hospital, Shanghai Jiaotong University; Shanghai 200233 People's Republic of China
| | - Suming Li
- Department of Interface Physicochemistry and Polymers; European Institute of Membranes, UMR CNRS 5635, University of Montpellier; Place Eugene Bataillon 34095 Montpellier France
| | - Zhiqian Lu
- Sixth People's Hospital, Shanghai Jiaotong University; Shanghai 200233 People's Republic of China
| | - Zhongyong Fan
- Department of Materials Science; Fudan University; Handan Road No. 220 Shanghai 200433 People's Republic of China
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The Development of Coronary Artery Stents: From Bare-Metal to Bio-Resorbable Types. METALS 2016. [DOI: 10.3390/met6070168] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Sotomi Y, Ishibashi Y, Suwannasom P, Nakatani S, Cho YK, Grundeken MJ, Zeng Y, Tateishi H, Smits PC, Barragan P, Kornowski R, Gershlick AH, Windecker S, van Geuns RJ, Bartorelli AL, de Winter RJ, Tijssen J, Serruys PW, Onuma Y. Acute Gain in Minimal Lumen Area Following Implantation of Everolimus-Eluting ABSORB Biodegradable Vascular Scaffolds or Xience Metallic Stents. JACC Cardiovasc Interv 2016; 9:1216-1227. [DOI: 10.1016/j.jcin.2016.03.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 02/29/2016] [Accepted: 03/21/2016] [Indexed: 12/01/2022]
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Schmidt W, Behrens P, Brandt-Wunderlich C, Siewert S, Grabow N, Schmitz KP. In vitro performance investigation of bioresorbable scaffolds - Standard tests for vascular stents and beyond. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2016; 17:375-83. [PMID: 27266902 DOI: 10.1016/j.carrev.2016.05.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 05/04/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND/PURPOSE Biodegradable polymers are the main materials for coronary scaffolds. Magnesium has been investigated as a potential alternative and was successfully tested in human clinical trials. However, it is still challenging to achieve mechanical parameters comparative to permanent bare metal (BMS) and drug-eluting stents (DES). As such, in vitro tests are required to assess mechanical parameters correlated to the safety and efficacy of the device. METHODS/MATERIALS In vitro bench tests evaluate scaffold profiles, length, deliverability, expansion behavior including acute elastic and time-dependent recoil, bending stiffness and radial strength. The Absorb GT1 (Abbott Vascular, Temecula, CA), DESolve (Elixir Medical Corporation, Sunnyvale, CA) and the Magmaris (BIOTRONIK AG, Bülach, Switzerland) that was previously tested in the BIOSOLVE II study, were tested. RESULTS Crimped profiles were 1.38±0.01mm (Absorb GT1), 1.39±0.01mm (DESolve) and 1.44±0.00mm (Magmaris) enabling 6F compatibility. Trackability was measured depending on stiffness and force transmission (pushability). Acute elastic recoil was measured at free expansion and within a mock vessel, respectively, yielding results of 5.86±0.76 and 5.22±0.38% (Absorb), 7.85±3.45 and 9.42±0.21% (DESolve) and 5.57±0.72 and 4.94±0.31% (Magmaris). Time-dependent recoil (after 1h) was observed for the Absorb and DESolve scaffolds but not for the Magmaris. The self-correcting wall apposition behavior of the DESolve did not prevent time-dependent recoil under vessel loading. CONCLUSIONS The results of the suggested test methods allow assessment of technical feasibility based on objective mechanical data and highlight the main differences between polymeric and metallic bioresorbable scaffolds.
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Affiliation(s)
- Wolfram Schmidt
- Institute for Biomedical Engineering, University Medicine Rostock, Friedrich-Barnewitz-Strasse 4, D-18119 Rostock-Warnemünde, Germany.
| | - Peter Behrens
- Institute for Biomedical Engineering, University Medicine Rostock, Friedrich-Barnewitz-Strasse 4, D-18119 Rostock-Warnemünde, Germany.
| | - Christoph Brandt-Wunderlich
- Institute for ImplantTechnology and Biomaterials - IIB e.V., Associated Institute of the University of Rostock, Friedrich-Barnewitz-Strasse 4, D-18119 Rostock-Warnemünde, Germany.
| | - Stefan Siewert
- Institute for ImplantTechnology and Biomaterials - IIB e.V., Associated Institute of the University of Rostock, Friedrich-Barnewitz-Strasse 4, D-18119 Rostock-Warnemünde, Germany.
| | - Niels Grabow
- Institute for Biomedical Engineering, University Medicine Rostock, Friedrich-Barnewitz-Strasse 4, D-18119 Rostock-Warnemünde, Germany.
| | - Klaus-Peter Schmitz
- Institute for ImplantTechnology and Biomaterials - IIB e.V., Associated Institute of the University of Rostock, Friedrich-Barnewitz-Strasse 4, D-18119 Rostock-Warnemünde, Germany.
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Kawamoto H, Panoulas VF, Sato K, Miyazaki T, Latib A, Colombo A. Two-Year Follow-Up OCT Images of 2 Bifurcation Lesions Treated With Bioresorbable Vascular Scaffolds. JACC Cardiovasc Imaging 2015; 8:617-618. [DOI: 10.1016/j.jcmg.2014.07.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 07/15/2014] [Accepted: 07/17/2014] [Indexed: 10/24/2022]
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Wiebe J, Nef HM, Hamm CW. Current status of bioresorbable scaffolds in the treatment of coronary artery disease. J Am Coll Cardiol 2015; 64:2541-51. [PMID: 25500240 DOI: 10.1016/j.jacc.2014.09.041] [Citation(s) in RCA: 169] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 09/23/2014] [Accepted: 09/26/2014] [Indexed: 01/13/2023]
Abstract
State-of-the-art drug-eluting metal stents are the gold standard for interventional treatment of coronary artery disease. Although they overcome some disadvantages and limitations of plain balloon angioplasty and bare-metal stents, some limitations apply, most notably a chronic local inflammatory reaction due to permanent implantation of a foreign body, restriction of vascular vasomotion due to a metal cage, and the risk of late and very late stent thrombosis. The development of biodegradable scaffolds is a new approach that attempts to circumvent these drawbacks. These devices provide short-term scaffolding of the vessel and then dissolve, which should theoretically circumvent the side effects of metal drug-eluting stents. Various types of these bioresorbable scaffolds are currently under clinical evaluation. This review discusses different concepts of bioresorbable scaffolds with respect to material, design, and drug elution and presents the most recent evidence.
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Affiliation(s)
- Jens Wiebe
- Department of Cardiology, Kerckhoff Heart Center, University of Giessen, Giessen, Germany
| | - Holger M Nef
- Department of Cardiology, Kerckhoff Heart Center, University of Giessen, Giessen, Germany
| | - Christian W Hamm
- Department of Cardiology, Kerckhoff Heart Center, University of Giessen, Giessen, Germany.
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Allahwala UK, Cockburn JA, Shaw E, Figtree GA, Hansen PS, Bhindi R. Clinical utility of optical coherence tomography (OCT) in the optimisation of Absorb bioresorbable vascular scaffold deployment during percutaneous coronary intervention. EUROINTERVENTION 2015; 10:1154-9. [DOI: 10.4244/eijv10i10a190] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Miyazaki T, Panoulas VF, Sato K, Kawamoto H, Naganuma T, Latib A, Colombo A. In-Scaffold Restenosis in a Previous Left Main Bifurcation Lesion Treated With Bioresorbable Scaffold V-Stenting. JACC Cardiovasc Interv 2015; 8:e7-e10. [DOI: 10.1016/j.jcin.2014.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 08/20/2014] [Accepted: 08/28/2014] [Indexed: 11/29/2022]
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Bae IH, Lim KS, Park JK, Park DS, Lee SY, Jang EJ, Ji MS, Sim DS, Hong YJ, Ahn Y, Park JC, Cho JG, Kang JC, Kim IS, Nah JW, Jeong MH. Mechanical behavior and in vivo properties of newly designed bare metal stent for enhanced flexibility. J IND ENG CHEM 2015. [DOI: 10.1016/j.jiec.2014.05.045] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Serruys PW, Onuma Y, Garcia-Garcia HM, Muramatsu T, van Geuns RJ, de Bruyne B, Dudek D, Thuesen L, Smits PC, Chevalier B, McClean D, Koolen J, Windecker S, Whitbourn R, Meredith I, Dorange C, Veldhof S, Hebert KM, Rapoza R, Ormiston JA. Dynamics of vessel wall changes following the implantation of the absorb everolimus-eluting bioresorbable vascular scaffold: a multi-imaging modality study at 6, 12, 24 and 36 months. EUROINTERVENTION 2014; 9:1271-84. [PMID: 24291783 DOI: 10.4244/eijv9i11a217] [Citation(s) in RCA: 194] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
AIMS To assess observations with multimodality imaging of the Absorb bioresorbable everolimus-eluting vascular scaffold performed in two consecutive cohorts of patients who were serially investigated either at 6 and 24 months or at 12 and 36 months. METHODS AND RESULTS In the ABSORB multicentre single-arm trial, 45 patients (cohort B1) and 56 patients (cohort B2) underwent serial invasive imaging, specifically quantitative coronary angiography (QCA), intravascular ultrasound (IVUS), radiofrequency backscattering (IVUS-VH) and optical coherence tomography (OCT). Between one and three years, late luminal loss remained unchanged (6 months: 0.19 mm, 1 year: 0.27 mm, 2 years: 0.27 mm, 3 years: 0.29 mm) and the in-segment angiographic restenosis rate for the entire cohort B (n=101) at three years was 6%. On IVUS, mean lumen, scaffold, plaque and vessel area showed enlargement up to two years. Mean lumen and scaffold area remained stable between two and three years whereas significant reduction in plaque behind the struts occurred with a trend toward adaptive restrictive remodelling of EEM. Hyperechogenicity of the vessel wall, a surrogate of the bioresorption process, decreased from 23.1% to 10.4% with a reduction of radiofrequency backscattering for dense calcium and necrotic core. At three years, the count of strut cores detected on OCT increased significantly, probably reflecting the dismantling of the scaffold; 98% of struts were covered. In the entire cohort B (n=101), the three-year major adverse cardiac event rate was 10.0% without any scaffold thrombosis. CONCLUSIONS The current investigation demonstrated the dynamics of vessel wall changes after implantation of a bioresorbable scaffold, resulting at three years in stable luminal dimensions, a low restenosis rate and a low clinical major adverse cardiac events rate. CLINICAL TRIAL REGISTRATION INFORMATION http://www.clinicaltrials.gov/ct2/show/NCT00856856.
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Garcia-Garcia HM, Serruys PW, Campos CM, Muramatsu T, Nakatani S, Zhang YJ, Onuma Y, Stone GW. Assessing Bioresorbable Coronary Devices. JACC Cardiovasc Imaging 2014; 7:1130-48. [DOI: 10.1016/j.jcmg.2014.06.018] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 06/11/2014] [Accepted: 06/26/2014] [Indexed: 11/29/2022]
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Lee CH, Yu CY, Chang SH, Hung KC, Liu SJ, Wang CJ, Hsu MY, Hsieh IC, Chen WJ, Ko YS, Wen MS. Promoting endothelial recovery and reducing neointimal hyperplasia using sequential-like release of acetylsalicylic acid and paclitaxel-loaded biodegradable stents. Int J Nanomedicine 2014; 9:4117-33. [PMID: 25206303 PMCID: PMC4157626 DOI: 10.2147/ijn.s67721] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION This work reports on the development of a biodegradable dual-drug-eluting stent with sequential-like and sustainable drug-release of anti-platelet acetylsalicylic acid and anti-smooth muscle cell (SMC) proliferative paclitaxel. METHODS To fabricate the biodegradable stents, poly-L-lactide strips are first cut from a solvent-casted film. They are rolled onto the surface of a metal pin to form spiral stents. The stents are then consecutively covered by acetylsalicylic acid and paclitaxel-loaded polylactide-polyglycolide nanofibers via electrospinning. RESULTS Biodegradable stents exhibit mechanical properties that are superior to those of metallic stents. Biodegradable stents sequentially release high concentrations of acetylsalicylic acid and paclitaxel for more than 30 and 60 days, respectively. In vitro, the eluted drugs promote endothelial cell numbers on days 3 and 7, and reduce the proliferation of SMCs in weeks 2, 4, and 8. The stents markedly inhibit the adhesion of platelets on days 3, 7, and 14 relative to a non-drug-eluting stent. In vivo, the implanted stent is intact, and no stent thrombosis is observed in the stent-implanted vessels without the administration of daily oral acetylsalicylic acid. Promotion of endothelial recovery and inhibition of neointimal hyperplasia are also observed on the stented vessels. CONCLUSION The work demonstrates the efficiency and safety of the biodegradable dual-drug-eluting stents with sequential and sustainable drug release to diseased arteries.
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Affiliation(s)
- Cheng-Hung Lee
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital-Linkou, Tao-Yuan, Taiwan
- Department of Mechanical Engineering, Chang Gung University, Tao-Yuan, Taiwan
| | - Chia-Ying Yu
- Department of Mechanical Engineering, Chang Gung University, Tao-Yuan, Taiwan
| | - Shang-Hung Chang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital-Linkou, Tao-Yuan, Taiwan
| | - Kuo-Chun Hung
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital-Linkou, Tao-Yuan, Taiwan
| | - Shih-Jung Liu
- Department of Mechanical Engineering, Chang Gung University, Tao-Yuan, Taiwan
| | - Chao-Jan Wang
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Tao-Yuan, Taiwan
| | - Ming-Yi Hsu
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Tao-Yuan, Taiwan
| | - I-Chang Hsieh
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital-Linkou, Tao-Yuan, Taiwan
| | - Wei-Jan Chen
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital-Linkou, Tao-Yuan, Taiwan
| | - Yu-Shien Ko
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital-Linkou, Tao-Yuan, Taiwan
| | - Ming-Shien Wen
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital-Linkou, Tao-Yuan, Taiwan
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Kraak RP, Grundeken MJ, Koch KT, de Winter RJ, Wykrzykowska JJ. Bioresorbable scaffolds for the treatment of coronary artery disease: current status and future perspective. Expert Rev Med Devices 2014; 11:467-80. [DOI: 10.1586/17434440.2014.941812] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Seth A, Kumar V. Bioresorbable scaffold: "looking at the 'real world' through a plastic tube". Catheter Cardiovasc Interv 2014; 84:53-4. [PMID: 24975262 DOI: 10.1002/ccd.25539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 05/05/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Ashok Seth
- Department of Interventional Cardiology, Fortis Escorts Heart Institute, New Delhi, India
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Onuma Y, Dudek D, Thuesen L, Webster M, Nieman K, Garcia-Garcia HM, Ormiston JA, Serruys PW. Five-year clinical and functional multislice computed tomography angiographic results after coronary implantation of the fully resorbable polymeric everolimus-eluting scaffold in patients with de novo coronary artery disease: the ABSORB cohort A trial. JACC Cardiovasc Interv 2014; 6:999-1009. [PMID: 24156961 DOI: 10.1016/j.jcin.2013.05.017] [Citation(s) in RCA: 135] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 05/03/2013] [Accepted: 05/24/2013] [Indexed: 12/18/2022]
Abstract
OBJECTIVES This study sought to demonstrate the 5-year clinical and functional multislice computed tomography angiographic results after implantation of the fully resorbable everolimus-eluting scaffold (Absorb BVS, Abbott Vascular, Santa Clara, California). BACKGROUND Multimodality imaging of the first-in-humans trial using a ABSORB BVS scaffold demonstrated at 2 years the bioresorption of the device while preventing restenosis. However, the long-term safety and efficacy of this therapy remain to be documented. METHODS In the ABSORB cohort A trial (ABSORB Clinical Investigation, Cohort A [ABSORB A] Everolimus-Eluting Coronary Stent System Clinical Investigation), 30 patients with a single de novo coronary artery lesion were treated with the fully resorbable everolimus-eluting Absorb scaffold at 4 centers. As an optional investigation in 3 of the 4 centers, the patients underwent multislice computed tomography (MSCT) angiography at 18 months and 5 years. Acquired MSCT data were analyzed at an independent core laboratory (Cardialysis, Rotterdam, the Netherlands) for quantitative analysis of lumen dimensions and was further processed for calculation of fractional flow reserve (FFR) at another independent core laboratory (Heart Flow, Redwood City, California). RESULTS Five-year clinical follow-up is available for 29 patients. One patient withdrew consent after 6 months, but the vital status of this patient remains available. At 46 days, 1 patient experienced a single episode of chest pain and underwent a target lesion revascularization with a slight troponin increase after the procedure. At 5 years, the ischemia-driven major adverse cardiac event rate of 3.4% remained unchanged. Clopidogrel was discontinued in all but 1 patient. Scaffold thrombosis was not observed in any patient. Two noncardiac deaths were reported, 1 caused by duodenal perforation and the other from Hodgkin's disease. At 5 years, 18 patients underwent MSCT angiography. All scaffolds were patent, with a median minimal lumen area of 3.25 mm(2) (interquartile range: 2.20 to 4.30). Noninvasive FFR analysis was feasible in 13 of 18 scans, which yielded a median distal FFR of 0.86 (interquartile range: 0.82 to 0.94). CONCLUSIONS The low event rate at 5 years suggests sustained safety after the implantation of a fully bioresorbable Absorb everolimus-eluting scaffold. Noninvasive assessment of the coronary artery with an option of functional assessment could be an alternative to invasive imaging after treatment of coronary narrowing with such a polymeric bioresorbable scaffold. (ABSORB Clinical Investigation, Cohort A [ABSORB A] Everolimus-Eluting Coronary Stent System Clinical Investigation [ABSORB]; NCT00300131).
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Affiliation(s)
- Yoshinobu Onuma
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
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Armstrong EJ, Waltenberger J, Rogers JH. Percutaneous coronary intervention in patients with diabetes: current concepts and future directions. J Diabetes Sci Technol 2014; 8:581-9. [PMID: 24876623 PMCID: PMC4455433 DOI: 10.1177/1932296813517058] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Patients with diabetes and coronary artery disease represent a challenging and growing subset of the population. Although surgical revascularization is the preferred treatment for patients with diabetes and multivessel coronary artery disease with stable angina, a significant proportion of diabetic patients undergo percutaneous revascularization due to comorbidities, presence of single-vessel disease, or presentation with myocardial infarction. The development of drug-eluting stents has significantly improved the results of percutaneous revascularization among diabetic patients, but a number of challenges remain, including higher rates of restenosis and stent thrombosis among diabetic patients. With current technologies, the outcomes of diabetic patients treated with noninsulin agents have approached that of nondiabetic patients. In comparison, patients with diabetes who require insulin therapy represent a high-risk cohort with increased rates of target vessel failure after coronary revascularization. The development of bioresorbable stents and new drug elution systems may provide additional future benefit among patients with diabetes undergoing percutaneous coronary artery revascularization.
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Affiliation(s)
- Ehrin J Armstrong
- Davis Medical Center, Division of Cardiovascular Medicine, University of California, Sacramento, CA, USA
| | - Johannes Waltenberger
- Department of Cardiovascular Medicine, Division of Cardiology University Hospital Munster, Münster, Germany
| | - Jason H Rogers
- Davis Medical Center, Division of Cardiovascular Medicine, University of California, Sacramento, CA, USA
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Jou LD, Mitchell BD, Shaltoni HM, Mawad ME. Effect of structural remodeling (retraction and recoil) of the pipeline embolization device on aneurysm occlusion rate. AJNR Am J Neuroradiol 2014; 35:1772-8. [PMID: 24722301 DOI: 10.3174/ajnr.a3920] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE During endovascular treatment of unruptured aneurysms with the Pipeline Embolization Device, an oversized device is often selected to achieve better wall apposition; however, this device oversizing could be related to overelongation and possible delayed enlargement of the stented region. The purpose of this study is to investigate the relationship between oversize and treatment outcome. MATERIALS AND METHODS The DynaCT images of 14 aneurysms treated by a single Pipeline Embolization Device were retrospectively analyzed. 3D images of the deployed device were compared with those acquired at the 6-month follow-up for qualitative and quantitative evaluation. The diameter and length of the Pipeline Embolization Device were measured at both time points and compared for determination of the device changes. RESULTS Structural changes of the device have been observed, and it was found that the Pipeline Embolization Device influences the vessel curvature in some cases. On average, it increases its diameter by 0.23 mm and decreases its length by 2.88 mm within 6 months of initial deployment. Excessive elongation beyond its nominal length is correlated with a lower aneurysm occlusion rate at the 6-month follow-up. CONCLUSIONS Not only does a Pipeline Embolization Device reconstruct the aneurysm and parent artery, but its entire structure goes through a gradual remodeling process. The relative deformation between the device and the artery indicates suboptimal wall apposition. Device oversizing does not have a direct effect on shortening or recoil. The aneurysm occlusion rate, however, is lowered by overelongation of the Pipeline Embolization Device.
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Affiliation(s)
- L-D Jou
- From the Departments of Radiology (L.-D.J., H.M.S., M.E.M.)
| | - B D Mitchell
- Neurosurgery (B.D.M.), Baylor College of Medicine, Houston, Texas
| | - H M Shaltoni
- From the Departments of Radiology (L.-D.J., H.M.S., M.E.M.)
| | - M E Mawad
- From the Departments of Radiology (L.-D.J., H.M.S., M.E.M.)
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Bourantas CV, Garcia-Garcia HM, Campos CAM, Zhang YJ, Muramatsu T, Morel MA, Nakatani S, Gao X, Cho YK, Isibashi Y, Gijsen FJH, Onuma Y, Serruys PW. Implications of a bioresorbable vascular scaffold implantation on vessel wall strain of the treated and the adjacent segments. Int J Cardiovasc Imaging 2014; 30:477-84. [DOI: 10.1007/s10554-014-0373-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 01/15/2014] [Indexed: 10/25/2022]
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Costopoulos C, Naganuma T, Latib A, Colombo A. Looking into the future with bioresorbable vascular scaffolds. Expert Rev Cardiovasc Ther 2014; 11:1407-16. [DOI: 10.1586/14779072.2013.839200] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Campos CAM, Zhang YJ, Bourantas CV, Muramatsu T, Garcia-Garcia HM, Lemos PA, Iqbal J, Onuma Y, Serruys PW. Bioresorbable vascular scaffolds in the clinical setting. Interv Cardiol 2013. [DOI: 10.2217/ica.13.72] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Bourantas CV, Onuma Y, Farooq V, Zhang Y, Garcia-Garcia HM, Serruys PW. Bioresorbable scaffolds: Current knowledge, potentialities and limitations experienced during their first clinical applications. Int J Cardiol 2013; 167:11-21. [DOI: 10.1016/j.ijcard.2012.05.093] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 05/27/2012] [Indexed: 12/21/2022]
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Muramatsu T, Onuma Y, Zhang YJ, Bourantas CV, Kharlamov A, Diletti R, Farooq V, Gogas BD, Garg S, García-García HM, Ozaki Y, Serruys PW. Progress in treatment by percutaneous coronary intervention: the stent of the future. ACTA ACUST UNITED AC 2013; 66:483-96. [PMID: 24776051 DOI: 10.1016/j.rec.2012.12.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 12/12/2012] [Indexed: 12/24/2022]
Abstract
First generation drug-eluting stents have considerably reduced in-stent restenosis and broadened the applications of percutaneous coronary interventions for the treatment of coronary artery disease. The polymer is an integral part of drug-eluting stents in that, it controls the release of an antiproliferative drug. The main safety concern of first generation drug-eluting stents with permanent polymers--stent thrombosis--has been caused by local hypersensitivity, delayed vessel healing, and endothelial dysfunction. This has prompted the development of newer generation drug-eluting stents with biodegradable polymers or even polymer-free drug-eluting stents. Recent clinical trials have shown the safety and efficacy of drug-eluting stents with biodegradable polymer, with proven reductions in very late stent thrombosis as compared to first generation drug-eluting stents. However, the concept of using a permanent metallic prosthesis implies major drawbacks, such as the presence of a foreign material within the native coronary artery that causes vascular inflammation and neoatherosclerosis, and also impedes the restoration of the vasomotor function of the stented segment. Bioresorbable scaffolds have been introduced to overcome these limitations, since they provide temporary scaffolding and then disappear, liberating the treated vessel from its cage. This update article presents the current status of these new technologies and highlights their future perspectives in interventional cardiology.
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Affiliation(s)
| | - Yoshinobu Onuma
- Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Yao-Jun Zhang
- Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | | | - Roberto Diletti
- Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Vasim Farooq
- Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Bill D Gogas
- Department of Interventional Cardiology, Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Scot Garg
- Department of Cardiology, East Lancashire, NHS Trust, Lancashire, United Kingdom
| | | | - Yukio Ozaki
- Department of Cardiology, Fujita Health University, Toyoake, Japan
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Lingsma H, Nauta S, van Leeuwen N, Borsboom G, Bruining N, Steyerberg E. Tools & Techniques: Analysis of clustered data in interventional cardiology: current practice and methodological advice. EUROINTERVENTION 2013; 9:162-4. [DOI: 10.4244/eijv9i1a23] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Zhang Y, Bourantas CV, Farooq V, Muramatsu T, Diletti R, Onuma Y, Garcia-Garcia HM, Serruys PW. Bioresorbable scaffolds in the treatment of coronary artery disease. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2013; 6:37-48. [PMID: 23662091 PMCID: PMC3647349 DOI: 10.2147/mder.s22547] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Indexed: 12/23/2022] Open
Abstract
Drug-eluting stents have reduced the risk of in-stent restenosis and have broadened the application in percutaneous coronary intervention in coronary artery disease. However, the concept of using a permanent metallic endovascular device to restore the patency of a stenotic artery has inherited pitfalls, namely the presence of a foreign body within the artery causing vascular inflammation, late complications such as restenosis and stent thrombosis, and impeding the restoration of the physiologic function of the stented segment. Bioresorbable scaffolds (BRS) were introduced to potentially overcome these limitations, as they provide temporary scaffolding and then disappear, liberating the treated vessel from its cage. Currently, several BRSs are available, undergoing evaluation either in clinical trials or in preclinical settings. The aim of this review is to present the new developments in BRS technology, describe the mechanisms involved in the resorption process, and discuss the potential future prospects of this innovative therapy.
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Affiliation(s)
- Yaojun Zhang
- Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands; ; Division of Cardiovascular Diseases, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China
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Freeing the vessel from metallic cage: what can we achieve with bioresorbable vascular scaffolds? Cardiovasc Interv Ther 2013; 27:141-54. [PMID: 22569783 DOI: 10.1007/s12928-012-0101-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Bourantas CV, Zhang Y, Farooq V, Garcia-Garcia HM, Onuma Y, Serruys PW. Bioresorbable scaffolds: current evidence and ongoing clinical trials. Curr Cardiol Rep 2013; 14:626-34. [PMID: 22810889 PMCID: PMC3432788 DOI: 10.1007/s11886-012-0295-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Bioresorbable scaffolds (BRS) represent a novel approach in coronary stent technology. In contrast to the metallic stents, they provide transient scaffolding, thereby safeguarding early vessel patency and acute gain. Subsequently a process of “decomposition” occurs, that results in the complete absorption of the scaffold. This reduces the risk of late complications, allowing the vessel to maintain its integrity and physiological function. This unique ability has attracted interest and nowadays several BRS are available. The aim of this review article is to describe the advances in the field, present the evidence from the preclinical and clinical evaluation of these devices, and provide an overview of the ongoing clinical trials that were designed to examine the effectiveness of BRS in the clinical setting.
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Affiliation(s)
- Christos V Bourantas
- Thoraxcenter, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
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Durand E, Lemitre M, Couty L, Sharkawi T, Brasselet C, Vert M, Lafont A. Adjusting a polymer formulation for an optimal bioresorbable stent: a 6-month follow-up study. EUROINTERVENTION 2012; 8:242-9. [PMID: 22717927 DOI: 10.4244/eijv8i2a38] [Citation(s) in RCA: 13] [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 To assess the impact of the composition in L- and D- of lactic acid stereo copolymers without drug elution on the in situ behaviour of prototype stents in terms of biomechanics and biocompatibility. METHODS AND RESULTS PLA50, 75, and 92 stereo-copolymer stents (L/D lactic acid ratio from 1 to 11.5) were processed using the injection moulding facilities of Arterial Remodeling Technologies (Noisy le Roi, France). The resulting 3 mm outer diameter tubes having a diameter at the desired nominal size were laser-cut and crimped on regular angioplasty balloons and chemically sterilised prior to implantation in iliac rabbit arteries. Acute recoil was higher in PLA50 and PLA75 stent-treated arteries than in those with PLA92 stents (17.4 ± 11.4 vs. 13.5 ± 7.6 vs. 4.1 ± 3.8 %, respectively, p=0.001). At one month, in-stent area was higher in PLA92 than in PLA50 and PLA75 stented arteries (5.9 ± 0.6 vs. 1.6 ± 1.6 vs. 2.6 ± 3.2 mm², respectively, p<0.001). Re-endothelialisation was complete, and inflammation was mild around the struts, similar among the three stents. Late lumen loss and neointimal area were low and similar in PLA92 stent-treated arteries one and six months after angioplasty (0.2 ± 0.2 vs. 0.3 ± 0.2 mm, p=0.60; 0.5 ± 0.5 vs. 0.5 ± 0.8 mm², p=0.72, respectively). At six months, inflammation decreased compared to one-month follow-up (1.4 ± 0.5 vs. 0.6 ± 0.5, p=0.006). CONCLUSIONS A stereo-copolymer composition strongly influences biomechanical properties of PLA bioresorbable stents in agreement with what has been known for a long time from other applications, but not biocompatibility. PLA92 stents appeared as presenting acceptable acute deployment and 6-month favourable outcome in the rabbit model despite the absence of drugs.
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Affiliation(s)
- Eric Durand
- University Paris-Descartes; INSERM; AP-HP; Paris Centre de Recherche Cardiovasculaire, Unité U970, Department of Cardiology of the European Georges Pompidou Hospital, Paris, France.
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ABSORB II randomized controlled trial: a clinical evaluation to compare the safety, efficacy, and performance of the Absorb everolimus-eluting bioresorbable vascular scaffold system against the XIENCE everolimus-eluting coronary stent system in the treatment of subjects with ischemic heart disease caused by de novo native coronary artery lesions: rationale and study design. Am Heart J 2012; 164:654-63. [PMID: 23137495 DOI: 10.1016/j.ahj.2012.08.010] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2012] [Accepted: 08/17/2012] [Indexed: 12/31/2022]
Abstract
BACKGROUND Currently, no data are available on the direct comparison between the Absorb everolimus-eluting bioresorbable vascular scaffold (Absorb BVS) and conventional metallic drug-eluting stents. METHODS The ABSORB II study is a randomized, active-controlled, single-blinded, multicenter clinical trial aiming to compare the second-generation Absorb BVS with the XIENCE everolimus-eluting metallic stent. Approximately 501 subjects will be enrolled on a 2:1 randomization basis (Absorb BVS/XIENCE stent) in approximately 40 investigational sites across Europe and New Zealand. Treated lesions will be up to 2 de novo native coronary artery lesions, each located in different major epicardial vessels, all with an angiographic maximal luminal diameter between 2.25 and 3.8 mm as estimated by online quantitative coronary angiography (QCA) and a lesion length of ≤48 mm. Clinical follow-up is planned at 30 and 180 days and at 1, 2, and 3 years. All subjects will undergo coronary angiography, intravascular ultrasound (IVUS) and IVUS-virtual histology at baseline (pre-device and post-device implantation) and at 2-year angiographic follow-up. The primary end point is superiority of the Absorb BVS vs XIENCE stent in terms of vasomotor reactivity of the treated segment at 2 years, defined as the QCA quantified change in the mean lumen diameter prenitrate and postnitrate administration. The coprimary end point is the noninferiority (reflex to superiority) of the QCA-derived minimum lumen diameter at 2 years postnitrate minus minimum lumen diameter postprocedure postnitrate by QCA. In addition, all subjects allocated to the Absorb BVS group will undergo multislice computed tomography imaging at 3 years. CONCLUSIONS The ABSORB II randomized controlled trial (ClinicalTrials.gov NCT01425281) is designed to compare the safety, efficacy, and performance of Absorb BVS against the XIENCE everolimus-eluting stent in the treatment of de novo native coronary artery lesions.
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Ormiston JA, Serruys PW, Onuma Y, van Geuns RJ, de Bruyne B, Dudek D, Thuesen L, Smits PC, Chevalier B, McClean D, Koolen J, Windecker S, Whitbourn R, Meredith I, Dorange C, Veldhof S, Hebert KM, Rapoza R, Garcia-Garcia HM. First serial assessment at 6 months and 2 years of the second generation of absorb everolimus-eluting bioresorbable vascular scaffold: a multi-imaging modality study. Circ Cardiovasc Interv 2012; 5:620-32. [PMID: 23048057 DOI: 10.1161/circinterventions.112.971549] [Citation(s) in RCA: 169] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Nonserial observations have shown this bioresorbable scaffold to have no signs of area reduction at 6 months and recovery of vasomotion at 1 year. Serial observations at 6 months and 2 years have to confirm the absence of late restenosis or unfavorable imaging outcomes. METHODS AND RESULTS The ABSORB trial is a multicenter single-arm trial assessing the safety and performance of an everolimus-eluting bioresorbable vascular scaffold. Forty-five patients underwent serial invasive imaging, such as quantitative coronary angiography, intravascular ultrasound, and optical coherence tomography at 6 and 24 months of follow-up. From 6 to 24 months, late luminal loss increased from 0.16±0.18 to 0.27±0.20 mm on quantitative coronary angiography, with an increase in neointima of 0.68±0.43 mm(2) on optical coherence tomography and 0.17±0.26 mm(2) on intravascular ultrasound. Struts still recognizable on optical coherence tomography at 2 years showed 99% of neointimal coverage with optical and ultrasonic signs of bioresorption accompanied by increase in mean scaffold area compared with baseline (0.54±1.09 mm(2) on intravascular ultrasound, P=0.003 and 0.77±1.33 m(2) on optical coherence tomography, P=0.016). Two-year major adverse cardiac event rate was 6.8% without any scaffold thrombosis. CONCLUSIONS This serial analysis of the second generation of the everolimus-eluting bioresorbable vascular scaffold confirmed, at medium term, the safety and efficacy of the new device. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00856856.
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