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Gao YN, Yang HT, Qiu ZF, Qi F, Lu QH, Zheng JF, Xi ZW, Wang X, Li L, Zhang G, Zhang DY, Lu YD, Qi HP, Qiu H, Gao RL, Zheng YF. Long-term efficacy, safety and biocompatibility of a novel sirolimus eluting iron bioresorbable scaffold in a porcine model. Bioact Mater 2024; 39:135-146. [PMID: 38783928 PMCID: PMC11112549 DOI: 10.1016/j.bioactmat.2024.05.027] [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: 03/23/2024] [Revised: 04/19/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024] Open
Abstract
Iron is considered as an attractive alternative material for bioresorbable scaffolds (BRS). The sirolimus eluting iron bioresorbable scaffold (IBS), developed by Biotyx Medical (Shenzhen, China), is the only iron-based BRS with an ultrathin-wall design. The study aims to investigate the long-term efficacy, safety, biocompatibility, and lumen changes during the biodegradation process of the IBS in a porcine model. A total of 90 IBSs and 70 cobalt-chromium everolimus eluting stents (EES) were randomly implanted into nonatherosclerotic coronary artery of healthy mini swine. The multimodality assessments including coronary angiography, optical coherence tomography, micro-computed tomography, magnetic resonance imaging, real-time polymerase chain reaction (PCR), and histopathological evaluations, were performed at different time points. There was no statistical difference in area stenosis between IBS group and EES group at 6 months, 1year, 2 years and 5 years. Although the scaffolded vessels narrowed at 9 months, expansive remodeling with increased mean lumen area was found at 3 and 5 years. The IBS struts remained intact at 6 months, and the corrosion was detectable at 9 months. At 5 years, the iron struts were completely degraded and absorbed in situ, without in-scaffold restenosis or thrombosis, lumen collapse, aneurysm formation, and chronic inflammation. No local or systemic toxicity and abnormal histopathologic manifestation were found in all experiments. Results from real-time PCR indicated that no sign of iron overload was reported in scaffolded segments. Therefore, the IBS shows comparable efficacy, safety, and biocompatibility with EES, and late lumen enlargement is considered as a unique feature in the IBS-implanted vessels.
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Affiliation(s)
- Ya-Nan Gao
- Department of Cardio-Metabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong-Tao Yang
- School of Engineering Medicine, Beihang University, Beijing, China
| | - Zi-Feng Qiu
- Peking University Health Science Center, Beijing, China
| | - Feng Qi
- Department of Cardiology, Fuwai Yunnan Hospital, Chinese Academy of Medical Sciences, Affiliated Cardiovascular Hospital of Kunming Medical University, Kunming, China
| | - Qian-Hong Lu
- Department of Cardiology, Coronary Artery Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian-Feng Zheng
- Department of Cardiology, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Zi-Wei Xi
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Xin Wang
- Beijing Key Laboratory of Pre-clinical Research and Evaluation for Cardiovascular Implant Materials, Animal Experimental Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li Li
- Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Gui Zhang
- R&D Center, Biotyx Medical (Shenzhen) Co. Ltd., Shenzhen, China
| | - De-Yuan Zhang
- R&D Center, Biotyx Medical (Shenzhen) Co. Ltd., Shenzhen, China
| | - Yu-Die Lu
- R&D Center, Biotyx Medical (Shenzhen) Co. Ltd., Shenzhen, China
| | - Hai-Ping Qi
- R&D Center, Biotyx Medical (Shenzhen) Co. Ltd., Shenzhen, China
| | - Hong Qiu
- Department of Cardio-Metabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Run-Lin Gao
- Department of Cardiology, Coronary Artery Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu-Feng Zheng
- School of Materials Science and Engineering, Peking University, Beijing, China
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Structural and Functional Evaluation of Coronary Arteries Treated With ABSORB Bioresorbable Vascular Scaffold at 5-Year Follow-Up. Am J Cardiol 2022; 182:1-7. [PMID: 36075756 DOI: 10.1016/j.amjcard.2022.07.038] [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] [Received: 04/30/2022] [Revised: 07/06/2022] [Accepted: 07/11/2022] [Indexed: 11/23/2022]
Abstract
Although complete bioresorbable vascular scaffold (BVS) resorption has been demonstrated at 5-year follow-up, whether corresponding vasomotor function restoration occurs remains unknown. The objective was to simultaneously assess the structural healing response along with vasomotor responses at 5-year follow-up of BVS implantation. We studied consecutive patients treated with ABSORB-BVS at 5-year follow-up (n = 31), who were recruited from a multicenter registry and were contacted to undergo a research protocol-driven repeat coronary angiogram involving intracoronary optical coherence tomography (OCT) and invasive coronary endothelial function testing. Epicardial endothelium-dependent vasomotion was defined as any vasodilatation after intracoronary acetylcholine (ACh), whereas endothelium-independent vasomotion was defined as any vasodilatation after intracoronary nitroglycerine (NTG), using quantitative coronary angiography. The mean implantation time point was 60.5 ± 4.6 months. OCT imaging demonstrated complete scaffold resorption in all patients. New coronary lesions (stenosis >50%) were found in 5 patients (16.1%), 3 of them underwent ad hoc percutaneous revascularization (9.7%). Intracoronary ACh (27 patients) and NTG testing (30 patients) was performed. Quantitative coronary angiography analysis demonstrated vasoconstriction after ACh administration and lack of response to NTG in BVS segments (mean lumen diameter = 2.00 ± 0.61 mm at baseline vs 1.74 ± 0.70 mm post-ACh, p <0.001; 2.05 ± 0.54 mm at baseline vs 2.03 ± 0.50 mm post-NTG, p = 0.69). OCT lumen analysis demonstrated similar vasoconstrictive responses to ACh (mean lumen area = 5.31 ± 2.26 mm2 at baseline vs 5.12 ± 2.55 mm2 post-ACh, p = 0.007) but had a vasodilatory response to NTG (5.96 ± 2.35 mm2 at baseline vs 6.17 ± 2.55 mm2 post-NTG, p<0.001). In conclusion, complete ABSORB-BVS resorption was demonstrated at 5-year follow-up. However, this healing response was associated with endothelium-dependent vasomotor dysfunction within the BVS segment.
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Liu Y, Zheng B, Zhang B, Ndondo-lay R, Nie F, Tang N, Miao Y, Li J, Huo Y. Five-year comparative study of thin-strut rapamycin-eluting bioabsorbable scaffold with metallic drug-eluting stent in porcine coronary artery. Front Cardiovasc Med 2022; 9:938519. [PMID: 35935636 PMCID: PMC9355424 DOI: 10.3389/fcvm.2022.938519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 06/30/2022] [Indexed: 11/21/2022] Open
Abstract
Objectives Using quantitative coronary angiography (QCA), optical coherence tomography (OCT), histomorphometry, and pharmacokinetics, this study tried to evaluate the safety and efficacy of Biomagic rapamycin-eluting bioabsorbable scaffold (BVS) in non-atherosclerotic porcine coronary arteries. Background Biomagic BVS is a new generation of thin-strut bioabsorbable scaffold. We conducted comparative study detailing pathological response, safety and efficacy of Biomagic BVS and the Firebird2 rapamycin-eluting cobalt-based alloy stent (DES) in a porcine coronary artery model. The animals were followed up at 14 days, 1, 3, 6, 12, 18, 24, 30, 36, 42, 48, 54, and 60 months after stent implantation. Methods A total of 143 devices (95 Biomagic and 48 Firebird2) were implanted in 2 or 3 main coronary arteries of 76 nonatherosclerotic swine and examined by QCA, OCT, light microscopy, and pharmacokinetics analyses at various time points. Results Vascular responses to Biomagic and Firebird2 were largely comparable at all time points, with struts being sequestered within the neointima. The degree of inflammation of both devices was mild to moderate, although the Biomagic score was higher at 14 days to 24 months. However, there was no statistical difference between the two groups except 14 days. At each follow-up time point, the percentage of area stenosis in the Biomagic group was greater than that in the Firebird 2 group, but there was no statistical difference between the two groups at 3 and 12 months. The extent of fibrin deposition was similar between Biomagic and Firebird2, which peaked at 1 month and decreased rapidly thereafter. Pharmacokinetic study showed that coronary tissue sirolimus concentration remained above 2 ng/mg of tissue at 28 day. Histomorphometry showed expansile remodeling of Biomagic-implanted arteries starting after 12 months, and lumen area was significantly greater in Biomagic than Firebird2 at 36 and 42 months. These changes correlated with dismantling of Biomagic seen after 12 months. OCT images confirmed that degradation of Biomagic was complete by 36 months. Conclusions Biomagic demonstrates comparable long-term safety to Firebird2 in porcine coronary arteries with mild to moderate inflammation. Although Biomagic was associated with greater percent stenosis relative to Firebird2 within 36 months, expansile remodeling was observed after 12 months in Biomagic with significantly greater lumen area at ≥36 months. Scaffold resorption is considered complete at 36 months.
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Affiliation(s)
- Yaokun Liu
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Bo Zheng
- Department of Cardiology, Peking University First Hospital, Beijing, China
- Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, China
| | - Bin Zhang
- Department of Cardiology, Peking University First Hospital, Beijing, China
- Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, China
| | | | - Fangfang Nie
- Shanghai Biomagic Medical Devices Company Limited, Shanghai, China
| | - Naijie Tang
- Shanghai Biomagic Medical Devices Company Limited, Shanghai, China
| | - Yongsheng Miao
- Shanghai Biomagic Medical Devices Company Limited, Shanghai, China
| | - Jianping Li
- Department of Cardiology, Peking University First Hospital, Beijing, China
- Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, China
- *Correspondence: Jianping Li
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
- Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, China
- Yong Huo
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Baruś P, Modrzewski J, Gumiężna K, Dunaj P, Głód M, Bednarek A, Wańha W, Roleder T, Kochman J, Tomaniak M. Comparative Appraisal of Intravascular Ultrasound and Optical Coherence Tomography in Invasive Coronary Imaging: 2022 Update. J Clin Med 2022; 11:jcm11144055. [PMID: 35887819 PMCID: PMC9324054 DOI: 10.3390/jcm11144055] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 02/04/2023] Open
Abstract
Although coronary angiography has been well established as a standard modality for percutaneous coronary intervention guidance, recent developments in intravascular imaging techniques, such as intravascular ultrasound and optical coherence tomography, have become increasingly adopted, enabling direct detailed lesion visualization, including lesions beyond the scope of assessment using exclusively angiography. Intravascular imaging modalities have been reported to potentially improve both short- and long-term percutaneous intervention outcomes. This review aims to provide a comparative summary of recent advancements in research regarding the clinical applications and outcomes of intravascular ultrasound and optical coherence tomography.
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Affiliation(s)
- Piotr Baruś
- First Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland; (P.B.); (J.M.); (K.G.); (P.D.); (M.G.); (A.B.); (J.K.)
| | - Jakub Modrzewski
- First Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland; (P.B.); (J.M.); (K.G.); (P.D.); (M.G.); (A.B.); (J.K.)
| | - Karolina Gumiężna
- First Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland; (P.B.); (J.M.); (K.G.); (P.D.); (M.G.); (A.B.); (J.K.)
| | - Piotr Dunaj
- First Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland; (P.B.); (J.M.); (K.G.); (P.D.); (M.G.); (A.B.); (J.K.)
| | - Marcin Głód
- First Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland; (P.B.); (J.M.); (K.G.); (P.D.); (M.G.); (A.B.); (J.K.)
| | - Adrian Bednarek
- First Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland; (P.B.); (J.M.); (K.G.); (P.D.); (M.G.); (A.B.); (J.K.)
| | - Wojciech Wańha
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-055 Katowice, Poland;
| | - Tomasz Roleder
- Department of Cardiology, Regional Specialist Hospital in Wrocław, 51-124 Wroclaw, Poland;
| | - Janusz Kochman
- First Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland; (P.B.); (J.M.); (K.G.); (P.D.); (M.G.); (A.B.); (J.K.)
| | - Mariusz Tomaniak
- First Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland; (P.B.); (J.M.); (K.G.); (P.D.); (M.G.); (A.B.); (J.K.)
- Correspondence: ; Tel.: +48-599-19-51
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Altisent OAJ, Goncalves-Ramírez LR, Fernández L, Viladés D, Gutiérrez E, Mitomo S, Latib A, Córdoba-Soriano JG, Adeliño R, Amat-Santos I, Muñoz JF, Elízaga J, Bezzera H, Pereira GTR, de Prado AP, Carrillo X, Fernández-Nofrerias E, Vilalta V, Rodríguez-Leor O, Llibre C, Fadeuilhe E, Trujillo A, Mauri J, de la Torre Hernández JM, Bayes-Genís A, Puri R. Long-Term Intracoronary Structural and Vasomotor Assessment of the ABSORB Bioresorbable Vascular Scaffold. Am J Cardiol 2022; 168:55-63. [PMID: 35058053 DOI: 10.1016/j.amjcard.2021.12.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/13/2021] [Accepted: 12/20/2021] [Indexed: 12/16/2022]
Abstract
We systematically categorized the longer-term (≥3 years) structural and functional characteristics of the ABSORB bioresorbable vascular scaffold (BVS) using optical coherence tomography imaging and coronary vasomotor reactivity testing and further compared the functional characteristics of BVS stented versus remote coronary segments. A total of 92 patients (mean age 56.4 ± 9.7 years, 22.8% women) who underwent percutaneous coronary intervention (76% with acute coronary syndrome) using the ABSORB BVS (112 lesions) were included. Optical coherence tomography analysis (38,790 visible struts) comprised in-segment quantitative lumen/plaque and semiquantitative plaque composition analysis of the neointimal pattern. Epicardial endothelium-dependent and-independent vasomotion was defined as any vasodilatation at low/intermediate intracoronary dose of acetylcholine (ACh) and nitroglycerine, assessed using quantitative coronary angiography. At a median time of 3.2 years follow-up, 79.8% of BVS segments still demonstrated visible struts with a predominant neointimal fibrotic healing pattern in 84% of BVS segments, with 99.5% of struts demonstrating coverage with apposition. Compared with remote segments, BVS segments demonstrated less endothelium-dependent vasodilatation at low (p = 0.06) and intermediate ACh doses (p = 0.04). Hypertension, longer time interval from index percutaneous coronary intervention, and the degree of in-BVS segment neointimal volume (p <0.03 for all) were each independently associated with abnormal BVS endothelium-dependent vasomotor function. Endothelium-independent function was more likely preserved in non-BVS (remote) segments compared with BVS segments (p = 0.06). In conclusion, at 3+ years post-ABSORB BVS insertion, the rate of complete scaffold resorption was low and residual strut presence was high, with a dominant fibrous healing response contributing toward neointimal hyperplasia and endothelium-dependent and-independent vasomotor dysfunction.
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Selvakumar PP, Rafuse MS, Johnson R, Tan W. Applying Principles of Regenerative Medicine to Vascular Stent Development. Front Bioeng Biotechnol 2022; 10:826807. [PMID: 35321023 PMCID: PMC8936177 DOI: 10.3389/fbioe.2022.826807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 01/17/2022] [Indexed: 11/16/2022] Open
Abstract
Stents are a widely-used device to treat a variety of cardiovascular diseases. The purpose of this review is to explore the application of regenerative medicine principles into current and future stent designs. This review will cover regeneration-relevant approaches emerging in the current research landscape of stent technology. Regenerative stent technologies include surface engineering of stents with cell secretomes, cell-capture coatings, mimics of endothelial products, surface topography, endothelial growth factors or cell-adhesive peptides, as well as design of bioresorable materials for temporary stent support. These technologies are comparatively analyzed in terms of their regenerative effects, therapeutic effects and challenges faced; their benefits and risks are weighed up for suggestions about future stent developments. This review highlights two unique regenerative features of stent technologies: selective regeneration, which is to selectively grow endothelial cells on a stent but inhibit the proliferation and migration of smooth muscle cells, and stent-assisted regeneration of ischemic tissue injury.
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Affiliation(s)
| | | | | | - Wei Tan
- University of Colorado Boulder, Boulder, CO, United States
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Singh S, Bruder-Nascimento A, Belin de Chantemele EJ, Bruder-Nascimento T. CCR5 antagonist treatment inhibits vascular injury by regulating NADPH oxidase 1. Biochem Pharmacol 2022; 195:114859. [PMID: 34843718 PMCID: PMC8914050 DOI: 10.1016/j.bcp.2021.114859] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/29/2021] [Accepted: 11/22/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Chemokine (C- Cmotif) ligand 5 (CCL5) and its receptor C-C motif chemokine receptor 5 (CCR5), have been broadly studied in conjunction with infectious pathogens, however, their involvement in cardiovascular disease is not completely understood. NADPH oxidases (Noxs) are the major source of reactive oxygen species (ROS) in the vasculature. Whether the activation of Noxs is CCL5/CCR5 sensitive and whether such interaction initiates vascular injury is unknown. We investigated whether CCL5/CCR5 leads to vascular damage by activating Noxs. MATERIAL AND METHODS We used rat aortic smooth muscle cells (RASMC) to investigate the molecular mechanisms by which CCL5 leads to vascular damage and carotid ligation (CL) to analyze the effects of blocking CCR5 on vascular injury. RESULTS CCL5 induced Nox1 expression in concentration and time-dependent manners, with no changes in Nox2 or Nox4. Maraviroc pre-treatment (CCR5 antagonist, 40uM) blunted CCL5-induced Nox1 expression. Furthermore, CCL5 incubation led to ROS production and activation of Erk1/2 and NFkB, followed by increased vascular cell migration, proliferation, and inflammatory markers. Notably, Nox1 inhibition (GKT771, 10uM) blocked CCL5-dependent effects. In vivo, CL induced pathological vascular remodeling and inflammatory genes and increased Nox1 and CCR5 expression. Maraviroc treatment (25 mg/Kg/day) reduced pathological vascular growth and Nox1 expression. CONCLUSIONS Our findings suggest that CCL5 activates Nox1 in the vasculature, leading to vascular injury likely via NFkB and Erk1/2. Herein, we place CCR5 antagonists and/or Nox1 inhibitors might be preeminent antiproliferative compounds to reduce the cardiovascular risk associated with medical procedures (e.g. angioplasty) and vascular diseases associated with vascular hyperproliferation.
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Affiliation(s)
- Shubhnita Singh
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA; Center for Pediatrics Research in Obesity and Metabolism (CPROM), University of Pittsburgh, Pittsburgh, PA, USA
| | - Ariane Bruder-Nascimento
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA; Center for Pediatrics Research in Obesity and Metabolism (CPROM), University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Thiago Bruder-Nascimento
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA; Center for Pediatrics Research in Obesity and Metabolism (CPROM), University of Pittsburgh, Pittsburgh, PA, USA; Richard King Mellon Institute for Pediatric Research, University of Pittsburgh, Pittsburgh, PA, USA; Vascular Medicine Institute (VMI), University of Pittsburgh, Pittsburgh, PA, USA.
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Vasculature-on-chip for Assessment of Bioresorbable Scaffolds and Endothelial Barrier Integrity. J Cardiovasc Pharmacol 2021; 78:515-522. [PMID: 34651600 DOI: 10.1097/fjc.0000000000001086] [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] [Received: 03/09/2021] [Accepted: 05/29/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Endothelial cells adhere to one another through junctional structures formed by intercellular adhesion molecules. These intercellular proteins regulate barrier function in response to the hemodynamic shear rate and enable the selective passage of solutes and fluids across the endothelium. After endovascular device implantation, the endothelial barrier is compromised and becomes discontinuous, which increases permeability, allowing transmigration of leukocytes and lipoproteins and leading to the accumulation of lipid-laden foamy macrophages in the subendothelial space. Drug-coated bioresorbable vascular scaffold implants have been associated with unexpected thrombotic complications, which were not predicted in animals because of dissimilarities in endothelial regeneration and realignment between animals and humans. The development of a microengineered, microfluidics-based system of patterned channels lined with human endothelial and smooth muscle cells perfused with blood allows for the evaluation of endothelial function and barrier integrity. This review highlights the translational potential of vasculature-on-chip, which recreates the microphysiological milieu to evaluate the impact of drug-eluting bioresorbable vascular scaffolds on endothelial barrier integrity and to characterize polymer biodegradation behavior and drug release kinetic profiles over time.
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Schukraft S, Arroyo D, Togni M, Goy JJ, Wenaweser P, Stadelmann M, Baeriswyl G, Muller O, Stauffer JC, Puricel S, Cook S. Five-year angiographic, OCT and clinical outcomes of a randomized comparison of everolimus and biolimus-eluting coronary stents with everolimus-eluting bioresorbable vascular scaffolds. Catheter Cardiovasc Interv 2021; 99:523-532. [PMID: 34173699 PMCID: PMC9544452 DOI: 10.1002/ccd.29837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 05/16/2021] [Accepted: 06/05/2021] [Indexed: 11/29/2022]
Abstract
Aims To compare 5‐year angiographic, optical coherence tomography (OCT), and clinical outcomes between patients treated with bioresorbable vascular scaffolds (BVS) and drug‐eluting stents (DES). Methods The EverBio‐2 trial (Comparison of Everolimus‐ and Biolimus‐Eluting Coronary Stents with Everolimus‐Eluting Bioresorbable Vascular Scaffold) was a single‐center, assessor‐blinded, randomized controlled trial in which 240 patients were randomly allocated (1:1:1) to BVS, everolimus‐eluting (EES) or biolimus‐eluting (BES) DES. Clinical follow‐up was scheduled up to 5 years. All patients, alive and who did not have repeat revascularization of the target lesion during follow‐up were asked to return for angiographic follow‐up at 5 years. Results Five‐year angiographic follow‐up was completed in 122 patients (51%) and OCT analysis was performed in 86 (36%) patients. In‐stent late lumen loss was similar in both groups with 0.50 ± 0.38 mm in BVS versus 0.58 ± 0.36 mm in EES/BES, p = 0.20. Clinical follow‐up was complete in 232 patients (97%) at 5 years. The rate of the device‐oriented endpoint was 22% in the BVS and 18% in the EES/BES group (p = 0.49). The patient‐oriented composite endpoint occurred in 40% of BVS‐ and 43% of EES/BES‐treated patients (p = 0.72) at 5 years. No acute coronary syndrome due to stent thrombosis was detected after 2 years. Complete BVS strut resorption was observed at 5 years in the OCT subgroup. Conclusion Five‐year clinical outcomes were similar between BVS and DES patients as well as angiographic outcomes in a selected subgroup. However, a definitive conclusion cannot be drawn because the EverBio‐2 trial was not powered for clinical and angiographic endpoints at 5 years of follow‐up.
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Affiliation(s)
- Sara Schukraft
- Cardiology, University & Hospital Fribourg, Fribourg, Switzerland
| | - Diego Arroyo
- Cardiology, University & Hospital Fribourg, Fribourg, Switzerland
| | - Mario Togni
- Cardiology, University & Hospital Fribourg, Fribourg, Switzerland
| | - Jean-Jacques Goy
- Cardiology, University & Hospital Fribourg, Fribourg, Switzerland
| | - Peter Wenaweser
- Cardiology, University & Hospital Fribourg, Fribourg, Switzerland
| | | | - Gerard Baeriswyl
- Cardiology, University & Hospital Fribourg, Fribourg, Switzerland
| | - Olivier Muller
- Cardiology, University & Hospital Fribourg, Fribourg, Switzerland
| | | | - Serban Puricel
- Cardiology, University & Hospital Fribourg, Fribourg, Switzerland
| | - Stéphane Cook
- Cardiology, University & Hospital Fribourg, Fribourg, Switzerland
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Wei H, Yan S, Menary G. Modelling Stretch Blow Moulding of Poly (l-lactic acid) for the Manufacture of Bioresorbable Vascular Scaffold. Polymers (Basel) 2021; 13:polym13060967. [PMID: 33809921 PMCID: PMC8004264 DOI: 10.3390/polym13060967] [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: 02/20/2021] [Revised: 03/09/2021] [Accepted: 03/16/2021] [Indexed: 11/25/2022] Open
Abstract
Stretch blow moulding (SBM) has been employed to manufacture bioresorbable vascular scaffold (BVS) from poly (l-lactic acid) (PLLA), whilst an experience-based method is used to develop the suitable processing conditions by trial-and-error. FEA modelling can be used to predict the forming process by the scientific understanding on the mechanical behaviour of PLLA materials above the glass transition temperature (Tg). The applicability of a constitutive model, the ‘glass-rubber’ (GR) model with material parameters from biaxial stretch was examined on PLLA sheets replicating the biaxial strain history of PLLA tubes during stretch blow moulding. The different stress–strain relationship of tubes and sheets under equivalent deformation suggested the need of re-calibration of the GR model for tubes. A FEA model was developed for PLLA tubes under different operation conditions, incorporating a virtual cap and rod to capture the suppression of axial stretch. The reliability of the FEA modelling on tube blowing was validated by comparing the shape evolution, strain history and stress–strain relationship from modelling to the results from the free stretch blow test.
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Affiliation(s)
- Huidong Wei
- College of Health and Life Sciences, Aston University, Birmingham B4 7ET, UK;
| | - Shiyong Yan
- School of Mechanical and Aerospace Engineering, Queen’s University Belfast, Belfast BT9 5AH, UK;
| | - Gary Menary
- School of Mechanical and Aerospace Engineering, Queen’s University Belfast, Belfast BT9 5AH, UK;
- Correspondence:
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Positive Remodeling – a Major Feature of Vulnerability in Patients with Non-Obstructive Coronary Artery Disease. JOURNAL OF INTERDISCIPLINARY MEDICINE 2021. [DOI: 10.2478/jim-2021-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
The most common cause of acute coronary syndrome is thrombosis of an atheromatous plaque. Positive remodeling is the compensatory dilatation of the plaque-containing section of the vessel wall. Plaques are most commonly characterized as vulnerable when possessing some of the following features: fibrous cap thickness <65 µm, large necrotic lipid core, high degrees of inflammatory infiltrates, positive remodeling, intraplaque hemorrhage, or neoangio-genesis. The presence of these plaque features is associated with high cardiovascular risk. In the initial stage of vasculopathy, due to positive remodeling, lumen reduction is not typical; it only develops in the advanced phase of the disease, due to which, based on a lumenogram, the vascular system may appear intact. Therefore, coronary angiography can easily miss the diagnosis or underestimate its extent, since it does not inform us of the composition of the arterial wall, because the contrast agent is just filling the vessel lumen. Coronary CT angiography may fill this diagnostic gap, since changes of the vessel wall can directly be visualized. To increase diagnostic accuracy, invasive coronary angiography can be completed by intravascular ultrasound and optical coherence tomography.
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Buono A, Ielasi A, Colombo A. Latest generation stents: is it time to revive the bioresorbable scaffold? Minerva Cardioangiol 2020; 68:415-435. [DOI: 10.23736/s0026-4725.20.05188-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Long-Term Arterial Remodeling After Bioresorbable Scaffold Implantation 4-Year Follow-up of Quantitative Coronary Angiography, Histology and Optical Coherence Tomography. Cardiovasc Eng Technol 2020; 11:636-645. [PMID: 33108646 DOI: 10.1007/s13239-020-00495-7] [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: 07/14/2020] [Accepted: 10/10/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Our previous studies have confirmed the safety and efficacy of the novel fully bioresorbable PLLA scaffold (PowerScaffold®) at 12 months implantation. In the present study, the scaffold absorption and coronary vessel remodeling at 4 years were evaluated. METHODS After PowerScaffold® were implanted into 13 coronary arteries of 6 miniature pigs, quantitative coronary angiography (QCA) was performed at 15 days and 4 years follow-up to measure the mean lumen diameter (MLD), late lumen loss (LLL), and % stenosis of the coronary arteries. Optical coherence tomography (OCT) was performed to obtain the strut footprints at 4 years before euthanization for histological analysis. In addition, 2 PowerScaffold® were implanted into 2 miniature pigs for 2 years as supplementary data. All stented arteries were dissected and stained with HE, Masson, EVG, and Alcian blue to observe struts, cells, fibrinoid, elastin, and proteoglycans, respectively. RESULTS There were no significant differences in MLD, LLL and % stenosis in stented coronary arteries between 15 days and 4 years by QCA. At 4 years, most strut sites were indiscernible and replaced by extracellular matrix and connective tissue by histology. Both strut/vessel wall interaction and strut coverage were shown 100% by OCT. CONCLUSION At 4 years, the scaffold struts were completely embedded into vessel wall and mostly replaced by regenerated tissue. There was no sign of in-stent stenosis in all stented arteries.
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Randomized Comparison Between Everolimus-Eluting Bioresorbable Scaffold and Metallic Stent: Multimodality Imaging Through 3 Years. JACC Cardiovasc Interv 2020; 13:116-127. [PMID: 31918929 DOI: 10.1016/j.jcin.2019.09.047] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 09/09/2019] [Accepted: 09/23/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the vascular responses and fates of the scaffold after bioresorbable vascular scaffold (BVS) implantation using multimodality imaging. BACKGROUND Serial comprehensive image assessments after BVS implantation in the context of a randomized trial have not yet been reported. METHODS In the ABSORB Japan trial, 400 patients were randomized to a BVS (n = 266) or a cobalt-chromium everolimus-eluting stent (n = 134). Through 3 years, patients underwent serial angiography and intravascular ultrasound or optical coherence tomography (OCT). RESULTS Luminal dimension at 3 years was consistently smaller with the BVS than with the cobalt-chromium everolimus-eluting stent (mean angiographic minimal luminal diameter 2.04 ± 0.63 mm vs. 2.40 ± 0.56 mm, mean difference -0.37 mm [95% confidence interval: -0.50 to -0.24 mm]; p < 0.001), mainly because of smaller device area (6.13 ± 2.03 mm2 vs. 7.15 ± 2.16 mm2, mean difference -1.04 mm2 [95% confidence interval: -1.66 to -0.42 mm2]; p < 0.001), and larger neointimal area (2.10 ± 0.61 mm2 vs. 1.86 ± 0.64 mm2, mean difference 0.24 mm2 [95% confidence interval: 0.06 to 0.43 mm2]; p = 0.01) by OCT. BVS-treated vessels did not show previously reported favorable vessel responses, such as positive vessel remodeling, late luminal enlargement, and restoration of vasomotion, although the OCT-based healing score was on average zero (interquartile range: 0.00 to 0.00). At 3 years, intraluminal scaffold dismantling (ISD) was observed in 14% of BVS. On serial OCT, ISD was observed in 6 lesions at 2 years, where the struts had been fully apposed at post-procedure, while ISD was observed in 12 lesions at 3 years, where 8 lesions were free from ISD on 2-year OCT. In 5 cases of very late scaffold thrombosis, strut discontinuities were detected in all 4 cases with available OCT immediately before reintervention. CONCLUSIONS In this multimodality serial imaging study, luminal dimension at 3 years was smaller with the BVS than with the cobalt-chromium everolimus-eluting stent. ISD, suspected to be one of the mechanisms of very late BVS thrombosis, was observed in a substantial proportion of cases at 3 years, which developed between post-procedure and 2 years and even beyond 2 years. (AVJ-301 Clinical Trial: A Clinical Evaluation of AVJ-301 [Absorb™ BVS] in Japanese Population [ABSORB JAPAN]; NCT01844284).
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Tenekecioglu E, Katagiri Y, Takahashi K, Tomaniak M, Dudek D, Cequier A, Carrié D, Iñiguez A, Johannes van der Schaaf R, Dominici M, Boven AJV, Helqvist S, Sabaté M, Baumbach A, Piek JJ, Wykrzykowska JJ, Kitslaar P, Dijkstra J, Reiber JHC, Chevalier B, Ural D, Pekkan K, Bourantas CV, Gijsen F, Onuma Y, Torii R, Serruys PW. Endothelial shear stress and vascular remodeling in bioresorbable scaffold and metallic stent. Atherosclerosis 2020; 312:79-89. [PMID: 32979635 DOI: 10.1016/j.atherosclerosis.2020.08.031] [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: 10/21/2019] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND AIMS The impact of endothelial shear stress (ESS) on vessel remodeling in vessels implanted with bioresorbable scaffold (BRS) as compared to metallic drug-eluting stent (DES) remains elusive. The aim of this study was to determine whether the relationship between ESS and remodeling patterns differs in BRS from those seen in metallic DES at 3-year follow-up. METHODS In the ABSORB II randomized trial, lesions were investigated by serial coronary angiography and intravascular ultrasound (IVUS). Three-dimensional reconstructions of coronary arteries post-procedure and at 3 years were performed. ESS was quantified using non-Newtonian steady flow simulation. IVUS cross-sections in device segment were matched using identical landmarks. RESULTS Paired ESS calculations post-procedure and at 3 years were feasible in 57 lesions in 56 patients. Post-procedure, median ESS at frame level was higher in BRS than in DES, with marginal statistical significance (0.97 ± 0.48 vs. 0.75 ± 0.39 Pa, p = 0.063). In the BRS arm, vessel area and lumen area showed larger increases in the highest tercile of median ESS post-procedure as compared to the lowest tercile. In contrast, in DES, no significant relationship between median ESS post-procedure and remodeling was observed. In multivariate analysis, smaller vessel area, larger lumen area, higher plaque burden post-procedure, and higher median ESS post-procedure were independently associated with expansive remodeling in matched frames. Only in BRS, younger age was an additional significant predictor of expansive remodeling. CONCLUSIONS In a subset of lesions with large plaque burden, shear stress could be associated with expansive remodeling and late lumen enlargement in BRS, while ESS had no impact on vessel dimension in metallic DES.
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Affiliation(s)
- Erhan Tenekecioglu
- Department of Interventional Cardiology, Erasmus University Medical Center. Thoraxcenter, Rotterdam, the Netherlands
| | - Yuki Katagiri
- Department of Cardiology Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Kuniaki Takahashi
- Department of Cardiology Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Mariusz Tomaniak
- Department of Interventional Cardiology, Erasmus University Medical Center. Thoraxcenter, Rotterdam, the Netherlands; First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Dariusz Dudek
- Department of Interventional Cardiology, Jagiellonian University, Krakow, Poland
| | | | | | - Andrés Iñiguez
- Interventional Cardiology Unit, Cardiology Department, Hospital Alvaro Cunqueiro, University Hospital of Vigo, Vigo, Spain
| | | | | | | | | | - Manel Sabaté
- Biomédiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain
| | | | - Jan J Piek
- Department of Cardiology Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Joanna J Wykrzykowska
- Department of Cardiology Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Pieter Kitslaar
- LKEB-Division of Image Processing, Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Jouke Dijkstra
- LKEB-Division of Image Processing, Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Johan H C Reiber
- LKEB-Division of Image Processing, Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Bernard Chevalier
- Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France
| | - Dilek Ural
- Department of Cardiology, Koç University, Istanbul, Turkey
| | - Kerem Pekkan
- Department of Mechanical Engineering, Koç University, Istanbul, Turkey
| | - Christos V Bourantas
- Department of Cardiology, University College of London Hospitals, London, United Kingdom; Department of Cardiology, Barts Heart Centre, London, United Kingdom
| | - Frank Gijsen
- Department of Biomedical Engineering, Erasmus University Medical Center, Thoraxcenter, Rotterdam, the Netherlands
| | - Yoshinobu Onuma
- Department of Interventional Cardiology, Erasmus University Medical Center. Thoraxcenter, Rotterdam, the Netherlands
| | - Ryo Torii
- Department of Mechanical Engineering, University College London, United Kingdom
| | - Patrick W Serruys
- Imperial College London, London, United Kingdom; Department of cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland.
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Kawashima H, Zocca P, Buiten RA, Smits PC, Onuma Y, Wykrzykowska JJ, de Winter RJ, von Birgelen C, Serruys PW. The 2010s in clinical drug-eluting stent and bioresorbable scaffold research: a Dutch perspective. Neth Heart J 2020; 28:78-87. [PMID: 32780336 PMCID: PMC7419418 DOI: 10.1007/s12471-020-01442-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Dutch researchers were among the first to perform clinical studies in bare metal coronary stents, the use of which was initially limited by a high incidence of in-stent restenosis. This problem was greatly solved by the introduction of drug-eluting stents (DES). Nevertheless, enthusiasm about first-generation DES was subdued by discussions about a higher risk of very-late stent thrombosis and mortality, which stimulated the development, refinement, and rapid adoption of new DES with more biocompatible durable polymer coatings, biodegradable polymer coatings, or no coating at all. In terms of clinical DES research, the 2010s were characterised by numerous large-scale randomised trials in all-comers and patients with minimal exclusion criteria. Bioresorbable scaffolds (BRS) were developed and investigated. The Igaki-Tamai scaffold without drug elution was clinically tested in the Netherlands in 1999, followed by an everolimus-eluting BRS (Absorb) which showed favourable imaging and clinical results. Afterwards, multiple clinical trials comparing Absorb and its metallic counterpart were performed, revealing an increased rate of scaffold thrombosis during follow-up. Based on these studies, the commercialisation of the device was subsequently halted. Novel technologies are being developed to overcome shortcomings of first-generation BRS. In this narrative review, we look back on numerous devices and on the DES and BRS trials reported by Dutch researchers.
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Affiliation(s)
- H Kawashima
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - P Zocca
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - R A Buiten
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands.,Health Technology and Services Research, Faculty of Behavioural Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - P C Smits
- Department of Cardiology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Y Onuma
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - J J Wykrzykowska
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - R J de Winter
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - C von Birgelen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands.,Health Technology and Services Research, Faculty of Behavioural Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - P W Serruys
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland. .,Imperial College London, London, UK.
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Ochijewicz D, Tomaniak M, Kołtowski L, Rdzanek A, Pietrasik A, Proniewska K, Partyka L, Dijsktra J, Huczek Z, Filipiak K, Opolski G, Kochman J. Peri-strut low intensity areas and in-scaffold neointima growth after bioresorbable scaffold implantation in STEMI. A serial optical coherence tomography study. Int J Cardiol 2020; 312:27-32. [PMID: 32315682 DOI: 10.1016/j.ijcard.2020.04.051] [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: 11/02/2019] [Revised: 04/10/2020] [Accepted: 04/16/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Peri-strut low intensity areas (PLIA) visualized by optical coherence tomography (OCT) have been related to neointimal proliferation and increased incidence of target lesion revascularization in stable coronary artery disease. The aim of this study was to determine the association between PLIA by OCT and the long-term vascular healing response after bioresorbable scaffold (BRS) implantation in the setting of ST-segment elevation myocardial infarction (STEMI). METHODS This is a single-centre, longitudinal, cohort study with a serial: baseline, 1, 2 and 5 years OCT evaluation of neointimal response (lumen area and neoatherosclerosis) after percutaneous coronary intervention (PCI) with BRS Absorb™ 1.0 implantation in patients presenting with STEMI. PLIA was analyzed in every cross section and scored: 0-no PLIA; 1-PLIA < 1 quadrant; 2-PLIA ≥ 1 and <2 quadrants; 3-PLIA ≥ 2 and <3 quadrants; 4-PLIA in ≥3 quadrants. RESULTS Of the 23 patients implanted BRS, 18 completed 2-year follow-up, whereas complete OCT data up to 5 years were available in 12 patients. Presence of PLIA was identified in 100% patients at 1 and 2 years, whereas at 5 years neither PLIA nor scaffold struts were visualized by OCT. Neoatherosclerosis was identified in 73,68% patients after 1 year and in all patients at 2 and 5 years. The mean PLIA score > 1 at 2 years was associated with greater percentage of minimum lumen area decrease after 2 years from index procedure. CONCLUSIONS The extent of PLIA by OCT at 2 years after primary PCI with BRS was associated with lumen area decrease. Neoatherosclerosis formation was detected in all patients at 2 and 5 years. PLIA assessment could serve as an additive means to predict neointimal healing pattern after next generation BRS implantation.
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Affiliation(s)
- Dorota Ochijewicz
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Mariusz Tomaniak
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
| | - Lukasz Kołtowski
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Adam Rdzanek
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | | | | | - Lukasz Partyka
- Krakow Cardiovascular Research Institute, Krakow, Poland
| | - Jouke Dijsktra
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Zenon Huczek
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Krzysztof Filipiak
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Grzegorz Opolski
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Janusz Kochman
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
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19
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Ono M, Kawashima H, Hara H, Gao C, Wang R, Kogame N, Takahashi K, Chichareon P, Modolo R, Tomaniak M, Wykrzykowska JJ, Piek JJ, Mori I, Courtney BK, Wijns W, Sharif F, Bourantas C, Onuma Y, Serruys PW. Advances in IVUS/OCT and Future Clinical Perspective of Novel Hybrid Catheter System in Coronary Imaging. Front Cardiovasc Med 2020; 7:119. [PMID: 32850981 PMCID: PMC7411139 DOI: 10.3389/fcvm.2020.00119] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/05/2020] [Indexed: 12/14/2022] Open
Abstract
Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) have been developed and improved as both diagnostic and guidance tools for interventional procedures over the past three decades. IVUS has a resolution of 100 μm with a high tissue penetration and capability of assessing the entire structure of a coronary artery including the external elastic membrane, whereas OCT has a higher resolution of 10–20 μm to assess endoluminal structures with a limited tissue penetration compared to IVUS. Recently, two companies, CONAVI and TERUMO, integrated IVUS and OCT into a single catheter system. With their inherent strength and limitations, the combined IVUS and OCT probes are complementary and work synergistically to enable a comprehensive depiction of coronary artery. In this review, we summarize the performance of the two intracoronary imaging modalities—IVUS and OCT—and discuss the expected potential of the novel hybrid IVUS–OCT catheter system in the clinical field.
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Affiliation(s)
- Masafumi Ono
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.,Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Hideyuki Kawashima
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.,Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Hironori Hara
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.,Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Chao Gao
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland.,Department of Cardiology, Radboud University, Nijmegen, Netherlands.,Depatrment of Cardiology, Xijing hospital, Xi'an, China
| | - Rutao Wang
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland.,Department of Cardiology, Radboud University, Nijmegen, Netherlands.,Depatrment of Cardiology, Xijing hospital, Xi'an, China
| | - Norihiro Kogame
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Kuniaki Takahashi
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Ply Chichareon
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.,Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Rodrigo Modolo
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.,Cardiology Division, Department of Internal Medicine, University of Campinas (UNICAMP), Campinas, Brazil
| | - Mariusz Tomaniak
- Thoraxcentre, Erasmus Medical Centre, Rotterdam, Netherlands.,First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Joanna J Wykrzykowska
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Jan J Piek
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | | | - Brian K Courtney
- Schulich Heart Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.,Conavi Medical, North York, ON, Canada
| | - William Wijns
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Faisal Sharif
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | | | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
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Capranzano P, Francaviglia B. Exploring reasons for different bioresorbable scaffolds outcomes in women versus men: The research must go on. Int J Cardiol 2020; 310:34-36. [PMID: 31983464 DOI: 10.1016/j.ijcard.2020.01.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 01/15/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Piera Capranzano
- Division of Cardiology, Policlinico Hospital, University of Catania, Catania, Italy.
| | - Bruno Francaviglia
- Division of Cardiology, Policlinico Hospital, University of Catania, Catania, Italy
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Impact of Coronary Atherosclerosis on Bioresorbable Vascular Scaffold Resorption and Vessel Wall Integration. JACC Basic Transl Sci 2020; 5:619-629. [PMID: 32613147 PMCID: PMC7315185 DOI: 10.1016/j.jacbts.2020.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/02/2020] [Accepted: 04/06/2020] [Indexed: 11/20/2022]
Abstract
The bioresorption process of the Absorb BVS has been directly characterized only in a normal swine model and indirectly (by imaging surrogates) in clinical studies. Using multimodality imaging and histology, this study indicates that in a diseased animal model, the resorption and integration of BVS into the arterial wall is not affected by the presence of untreated hyperlipidemia and atherosclerosis progression. Imaging and histology suggest that BVS degradation progresses similarly in the presence of atherosclerosis compared with earlier data from nonatherosclerotic arteries. However, BVS is not immune to the development of neoatherosclerosis.
The integration of the Absorb bioresorbable vascular scaffold (BVS) into the arterial wall has never been tested in an in vivo model of atherosclerosis. This study aimed to compare the long-term (up to 4 years) vascular healing responses of BVS to an everolimus-eluting metallic stent in the familial hypercholesterolemic swine model of atherosclerosis. The multimodality imaging and histology approaches indicate that the resorption and vascular integration profile of BVS is not affected by the presence of atherosclerosis. BVS demonstrated comparable long-term vascular healing and anti-restenotic efficacy to everolimus-eluting metallic stent but resulted in lower late lumen loss at 4 years.
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22
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Song K, Bi Y, Zhao H, Wu T, Xu F, Zhao G. Structural optimization and finite element analysis of poly‐
l
‐lactide acid coronary stent with improved radial strength and acute recoil rate. J Biomed Mater Res B Appl Biomater 2020; 108:2754-2764. [DOI: 10.1002/jbm.b.34605] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 02/02/2020] [Accepted: 03/01/2020] [Indexed: 02/02/2023]
Affiliation(s)
- Kai Song
- Key Laboratory for Liquid‐Solid Structural Evolution and Processing of Materials (Ministry of Education), School of Materials Science and Engineering Shandong University Jinan China
| | - Yuying Bi
- Dongguan TT Medical Inc. Guangdong China
- Biomedical Engineering and Biotechnology University of Massachusetts Lowell Massachusetts
| | - Haibin Zhao
- Key Laboratory for Liquid‐Solid Structural Evolution and Processing of Materials (Ministry of Education), School of Materials Science and Engineering Shandong University Jinan China
- Shenzhen Research Institute of Shandong University, Shenzhen Guangdong China
| | - Tim Wu
- Dongguan TT Medical Inc. Guangdong China
- Biomedical Engineering and Biotechnology University of Massachusetts Lowell Massachusetts
| | - Feng Xu
- Department of Emergency Medicine, Qilu Hospital, Shandong University Jinan China
| | - Guoqun Zhao
- Key Laboratory for Liquid‐Solid Structural Evolution and Processing of Materials (Ministry of Education), School of Materials Science and Engineering Shandong University Jinan China
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A paradox in sex-specific clinical outcomes after bioresorbable scaffold implantation: 2-year results from the AIDA trial. Int J Cardiol 2020; 300:93-98. [PMID: 31511193 DOI: 10.1016/j.ijcard.2019.08.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/09/2019] [Accepted: 08/20/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Females are underrepresented in clinical trials evaluating new stent technologies whilst results may differ between the sexes. Females are known to have smaller, more tortuous coronary arteries and have generally more comorbidities. On the other hand, they may have smaller plaque burden. This subgroup-analysis sought to assess sex-specific outcomes after Absorb bioresorbable vascular scaffold (BVS) or XIENCE everolimus-eluting stent (EES) implantation. METHODS The AIDA trial was an investigator-initiated, non-inferiority, all-comers trial, in which 1845 patients were randomly assigned to either Absorb BVS or XIENCE EES. Baseline clinical, angiography and procedural variables, as well as 2-year clinical outcomes were analyzed by sex and device modality. RESULTS Of the 1845 randomized patients, 475 (25.7%) were females. The 2-year rates of target vessel failure (TVF) with Absorb BVS versus XIENCE EES in females were 6.4% versus 10.6% (HR 0.59; 95% CI: 0.31-1.11; p = 0.10) and in males 12.7% versus 9.7% (HR 1.34; 95% CI: 0.98-1.85; p = 0.07). Males treated with Absorb BVS were at higher risk for TVF compared to females treated with Absorb BVS (HR 2.06; 95% CI 1.21-3.53; p = 0.007). Definite/probable device thrombosis occurred in females with Absorb BVS versus XIENCE EES in 1.6% versus 1.4% (HR 1.15; 95% CI: 0.26-5.12; p = 0.86) and in males 3.9% versus 0.7% (HR 5.55; 95% CI: 2.11-14.35; p < 0.001). A statistical significant interaction between sex and device was present for TVF (p = 0.02), but was not seen for definite/probable device thrombosis (p = 0.08). CONCLUSIONS In this subgroup analysis, Absorb BVS used in routine practice tends to result in better clinical outcomes in females compared to males.
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PCI and CABG for Treating Stable Coronary Artery Disease: JACC Review Topic of the Week. J Am Coll Cardiol 2020; 73:964-976. [PMID: 30819365 DOI: 10.1016/j.jacc.2018.11.053] [Citation(s) in RCA: 239] [Impact Index Per Article: 59.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 11/09/2018] [Accepted: 11/26/2018] [Indexed: 11/22/2022]
Abstract
Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are considered revascularization procedures, but only CABG can prolong life in stable coronary artery disease. Thus, PCI and CABG mechanisms may differ. Viability and/or ischemia detection to guide revascularization have been unable to accurately predict treatment effects of CABG or PCI, questioning a revascularization mechanism for improving survival. By contrast, preventing myocardial infarction may save lives. However, the majority of infarcts are generated by non-flow-limiting stenoses, but PCI is solely focused on treating flow-limiting lesions. Thus, PCI cannot be expected to significantly limit new infarcts, but CABG may do so through providing flow distal to vessel occlusions. All comparisons of CABG to PCI or medical therapy that demonstrate survival effects with CABG also demonstrate infarct reduction. Thus, CABG may differ from PCI by providing "surgical collateralization," prolonging life by preventing myocardial infarctions. The evidence is reviewed here.
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25
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Understanding the Bioresorbable Vascular Scaffold Achilles Heel. JACC Cardiovasc Interv 2020; 13:128-131. [DOI: 10.1016/j.jcin.2019.10.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 10/29/2019] [Indexed: 12/30/2022]
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26
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Jeżewski MP, Kubisa MJ, Eyileten C, De Rosa S, Christ G, Lesiak M, Indolfi C, Toma A, Siller-Matula JM, Postuła M. Bioresorbable Vascular Scaffolds-Dead End or Still a Rough Diamond? J Clin Med 2019; 8:E2167. [PMID: 31817876 PMCID: PMC6947479 DOI: 10.3390/jcm8122167] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/02/2019] [Accepted: 12/04/2019] [Indexed: 02/06/2023] Open
Abstract
Percutaneous coronary interventions with stent-based restorations of vessel patency have become the gold standard in the treatment of acute coronary states. Bioresorbable vascular scaffolds (BVS) have been designed to combine the efficiency of drug-eluting stents (DES) at the time of implantation and the advantages of a lack of foreign body afterwards. Complete resolution of the scaffold was intended to enable the restoration of vasomotor function and reduce the risk of device thrombosis. While early reports demonstrated superiority of BVS over DES, larger-scale application and longer observation exposed major concerns about their use, including lower radial strength and higher risk of thrombosis resulting in higher rate of major adverse cardiac events. Further focus on procedural details and research on the second generation of BVS with novel properties did not allow to unequivocally challenge position of DES. Nevertheless, BVS still have a chance to present superiority in distinctive indications. This review presents an outlook on the available first and second generation BVS and a summary of results of clinical trials on their use. It discusses explanations for unfavorable outcomes, proposed enhancement techniques and a potential niche for the use of BVS.
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Affiliation(s)
- Mateusz P. Jeżewski
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology, Medical University of Warsaw, 02091 Warsaw, Poland; (M.P.J.); (M.J.K.); (C.E.); (M.P.)
| | - Michał J. Kubisa
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology, Medical University of Warsaw, 02091 Warsaw, Poland; (M.P.J.); (M.J.K.); (C.E.); (M.P.)
| | - Ceren Eyileten
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology, Medical University of Warsaw, 02091 Warsaw, Poland; (M.P.J.); (M.J.K.); (C.E.); (M.P.)
| | - Salvatore De Rosa
- Department of Medical and Surgical Sciences, Division of Cardiology, “Magna Graecia” University, 88100 Catanzaro, Italy; (S.D.R.); (C.I.)
| | - Günter Christ
- Department of Cardiology, 5th Medical Department with Cardiology, Kaiser Franz Josef Hospital, 31100 Vienna, Austria;
| | - Maciej Lesiak
- 1st Department of Cardiology, Poznan University of Medical Sciences, 1061701 Poznań, Poland;
| | - Ciro Indolfi
- Department of Medical and Surgical Sciences, Division of Cardiology, “Magna Graecia” University, 88100 Catanzaro, Italy; (S.D.R.); (C.I.)
| | - Aurel Toma
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 231090 Vienna, Austria;
| | - Jolanta M. Siller-Matula
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology, Medical University of Warsaw, 02091 Warsaw, Poland; (M.P.J.); (M.J.K.); (C.E.); (M.P.)
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 231090 Vienna, Austria;
| | - Marek Postuła
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology, Medical University of Warsaw, 02091 Warsaw, Poland; (M.P.J.); (M.J.K.); (C.E.); (M.P.)
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27
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Blachutzik F, Achenbach S, Marwan M, Tröbs M, Boeder N, Doerr O, Weissner M, Bauer T, Nef H, Hamm C, Schlundt C. OCT-assessment of scaffold resorption: Analysis of strut intensity by a new resorption index for poly-l-lactic acid bioresorbable vascular scaffolds. Catheter Cardiovasc Interv 2019; 94:928-935. [PMID: 30945432 DOI: 10.1002/ccd.28223] [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: 11/20/2018] [Revised: 02/09/2019] [Accepted: 03/23/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND The aim of this study was to analyze individual differences in resorption of bioresorbable vascular scaffolds (BRS) through optical coherence tomography (OCT) analysis and to identify factors potentially influencing the resorption process. METHODS Between April 2016 and July 2017 clinically driven invasive coronary angiography and OCT examinations were performed in 36 patients who had previously been treated with a total of 48 BRS (ABSORB BVS, Abbott Vascular, Santa Clara, CA). For each scaffold, a new BRS-RESORB-INDEX (BRI) was calculated. RESULTS The mean time interval since implantation was 789 ± 321 days. In OCT, BRS struts remained detectable in all 48 BRS. Normalized light intensity as a marker for the resorption of BRS struts increased with time in a linear fashion (Spearman Rho: p < .001, correlation coefficient = .90; R2 [linear] = .91). Multivariable analysis identified diabetes (BRI of patients with diabetes vs. patients without diabetes: 0.34 ± 0.13 vs. 0.58 ± 0.22; p = .002) and presence of Peri-strut low intensity areas (PSLIA, BRI of 10 patients with PSLIA vs. 26 patients without PSLIA: 0.44 ± 0.21 vs. 0.61 ± 18; p = .027) as independent predictors for a prolonged BRS resorption, whereas the resorption rate in ACS patients (STEMI, NSTEMI, and unstable angina; n = 13) was significantly higher as compared to patients without ACS (0.62 ± 0.17 vs. 0.43 ± 0.24; p = .012). CONCLUSION In humans, BRS resorption rate is significantly influenced by numerous factors. Our data suggest that diabetes and PSLIA are associated with a prolonged resorption process, whereas in ACS patients, BRS resorption appears to be significantly faster.
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Affiliation(s)
- Florian Blachutzik
- Department of Cardiology, Friedrich-Alexander Universität (FAU) Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany.,Department of Cardiology, Justus-Liebig University Giessen, Giessen, Germany
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander Universität (FAU) Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - Mohamed Marwan
- Department of Cardiology, Friedrich-Alexander Universität (FAU) Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - Monique Tröbs
- Department of Cardiology, Friedrich-Alexander Universität (FAU) Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - Niklas Boeder
- Department of Cardiology, Justus-Liebig University Giessen, Giessen, Germany
| | - Oliver Doerr
- Department of Cardiology, Justus-Liebig University Giessen, Giessen, Germany
| | - Melissa Weissner
- Zentrum für Kardiologie, University Hospital Mainz, Mainz, Germany.,German Center for Cardiac and Vascular Research (DZHK), Mainz, Germany
| | - Timm Bauer
- Department of Cardiology, Justus-Liebig University Giessen, Giessen, Germany
| | - Holger Nef
- Department of Cardiology, Justus-Liebig University Giessen, Giessen, Germany
| | - Christian Hamm
- Department of Cardiology, Justus-Liebig University Giessen, Giessen, Germany
| | - Christian Schlundt
- Department of Cardiology, Friedrich-Alexander Universität (FAU) Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
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28
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Moriyama N, Shishido K, Tanaka Y, Laine M, Saito S. Neoatherosclerosis - Long-Term Assessment of Bioresorbable Vascular Scaffold. Circ Rep 2019; 1:543-549. [PMID: 33693100 PMCID: PMC7897685 DOI: 10.1253/circrep.cr-19-0100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Although metallic stents improved the safety and efficacy of percutaneous coronary intervention (PCI), even the latest generation of drug-eluting stents (DES) is still limited by several factors. The limitations of DES are mainly related to the permanent metallic caging in vessel, chronic inflammatory response to the polymer and adverse effects of antiproliferative drug on endothelial tissue, leading to impaired physiological vasomotor response and late stent-related adverse events such as stent thrombosis and neoatherosclerosis. Bioresorbable vascular scaffold (Absorb BVS; Abbott Vascular) was designed to overcome these drawbacks of DES by disappearing from the vessel wall. Absorb BVS, however, was withdrawn from the world market because of increased incidence of scaffold thrombosis compared with DES. Importantly, only very limited long-term post-BVS implantation data are available, especially with regard to neoatherosclerosis, which can lead to very late adverse events even after resorption of the scaffold. Therefore, the goal of this review was to highlight the mid to long term clinical outcomes published to date, and to describe the features of the intimal healing process and neoatherosclerosis in the 5 years following Absorb BVS implantation, mainly based on our previous study. This may provide important information on the pathophysiology of the scaffolded vessel for clinicians, and promote identification of future bioresorbable materials for PCI that will minimize the stimulus for neoatherosclerosis.
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Affiliation(s)
- Noriaki Moriyama
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital Kamakura Japan.,Department of Cardiology, Heart and Lung Center, Helsinki University and Helsinki University Central Hospital Helsinki Finland
| | - Koki Shishido
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital Kamakura Japan
| | - Yutaka Tanaka
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital Kamakura Japan
| | - Mika Laine
- Department of Cardiology, Heart and Lung Center, Helsinki University and Helsinki University Central Hospital Helsinki Finland
| | - Shigeru Saito
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital Kamakura Japan
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29
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Tanaka A, Jabbour RJ, Colombo A. What are the remaining lessons to be learnt from 1st-generation bioresorbable scaffolds? Int J Cardiol 2019; 293:103-104. [DOI: 10.1016/j.ijcard.2019.07.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 07/10/2019] [Indexed: 11/27/2022]
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30
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Katagiri Y, Serruys PW, Tenekecioglu E, Asano T, Collet C, Miyazaki Y, Katsikis A, Piek JJ, Wykrzykowska JJ, Chevalier B, Mintz GS, Stone GW, Onuma Y. Acute and long-term relocation of minimal lumen area after bioresorbable scaffold or metallic stent implantation. EUROINTERVENTION 2019; 15:594-602. [PMID: 29969433 DOI: 10.4244/eij-d-18-00422] [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: 11/23/2022]
Abstract
AIMS The aim of this study was to investigate relocation of minimal lumen area (MLA) after implantation of a bioresorbable scaffold (BRS). METHODS AND RESULTS In the ABSORB II randomised trial (BRS vs everolimus-eluting stent [EES]), lesions were investigated by serial intravascular ultrasound pre procedure, post procedure, and at three years. MLA relocation was defined as an axial MLA shift of more than 2.4 mm. MLA relocation from post procedure to three years was observed in 163/237 (68.8%) and 75/129 (58.1%) of lesions treated by BRS and EES, respectively (p=0.041). When matching preprocedural MLA site with the same topographical sites post procedure and at three years, BRS showed significant late lumen enlargement and expansive remodelling compensating for significant plaque increase, whereas EES showed significant late lumen narrowing with significant plaque growth not compensated for by expansive remodelling from post procedure to three years. In the multivariate analysis, female gender, previous PCI, BRS implantation, total device length, and maximal pressure (either at device implantation or post-dilatation) were independently associated with MLA relocation from post procedure to three years. CONCLUSIONS MLA relocation from post procedure to three years was more frequent in BRS than EES. Late lumen enlargement and expansive vessel remodelling at the preprocedural MLA site was observed in BRS, but not in EES.
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Affiliation(s)
- Yuki Katagiri
- Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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31
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Moriyama N, Shishido K, Tanaka Y, Yokota S, Hayashi T, Miyashita H, Koike T, Yokoyama H, Takada T, Nishimoto T, Ochiai T, Tobita K, Yamanaka F, Mizuno S, Murakami M, Takahashi S, Saito S. Neoatherosclerosis 5 Years After Bioresorbable Vascular Scaffold Implantation. J Am Coll Cardiol 2019; 71:1882-1893. [PMID: 29699614 DOI: 10.1016/j.jacc.2018.02.051] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 02/14/2018] [Accepted: 02/15/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Data regarding neoatherosclerosis after everolimus-eluting bioresorbable vascular scaffold (BVS) (ABSORB BVS Rev. 1.1, Abbott Vascular, Santa Clara, California) implantation are limited. OBJECTIVES This study investigated the findings of neoatherosclerosis at 5 years after BVS 1.1 implantation by using multi-imaging modalities, including optical coherence tomography (OCT). METHODS Patients included in the ABSORB EXTEND (ABSORB EXTEND Clinical Investigation) trial at Shonan Kamakura General Hospital underwent OCT at baseline after the index procedure and at 1 and 5 years. Intimal plaque distributions in the in-scaffold and out-scaffold segments were analyzed. RESULTS Twenty patients (22 lesions) with stable angina pectoris were enrolled. The median follow-up duration was 67 months (interquartile range: 65 to 69 months), and the mean age was 69 ± 8 years. Patients with diabetes mellitus (25%) were included. Based on the baseline angiogram, 10 (46%) lesions were type B2/C lesions. At 1 and 5 years of follow-up, significant differences in the prevalence of in-scaffold lipid-laden neointima (17% vs. 61%; p = 0.04), calcification (28% vs. 94%; p < 0.01), neovascularization (6% vs. 78%; p < 0.01), and thin-cap fibroatheroma (0% vs. 22%; p = 0.02) were found. In the out-scaffold segments, no significant difference in the plaque prevalence between 1 and 5 years was noted. CONCLUSIONS The occurrence and progression of in-scaffold neoatherosclerosis with luminal narrowing was observed at 5 years after BVS 1.1 implantation. The small size of the current study warrants confirmation in larger study. (ABSORB EXTEND Clinical Investigation [ABSORB EXTEND]; NCT01023789).
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Affiliation(s)
- Noriaki Moriyama
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura, Japan.
| | - Koki Shishido
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Yutaka Tanaka
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Shohei Yokota
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Takahiro Hayashi
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Hirokazu Miyashita
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Tatsuya Koike
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Hiroaki Yokoyama
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Takuma Takada
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Takashi Nishimoto
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Tomoki Ochiai
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Kazuki Tobita
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Futoshi Yamanaka
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Shingo Mizuno
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Masato Murakami
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Saeko Takahashi
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Shigeru Saito
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura, Japan
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32
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Affiliation(s)
- Sergio Buccheri
- Department of Cardiology, Ferrarotto Hospital - Cardio-Thoracic-Vascular Department, Azienda Ospedaliero Universitaria "Policlinico-Vittorio Emanuele", Catania, Italy.,Department of General Surgery and Medical-Surgical Specialties, Università degli Studi di Catania, Italy
| | - Davide Capodanno
- Department of General Surgery and Medical-Surgical Specialties, Università degli Studi di Catania, Italy
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33
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Asano T, Hytönen J, Chichareon P, Taavitsainen J, Kogame N, Katagiri Y, Miyazaki Y, Takahashi K, Modolo R, Komiyama H, Tenekecioglu E, Sotomi Y, Wykrzykowska JJ, Piek JJ, Martin J, Baumbach A, Mathur A, Onuma Y, Ylä-Herttuala S, Serruys PW. Serial Optical Coherence Tomography at Baseline, 7 Days, and 1, 3, 6 and 12 Months After Bioresorbable Scaffold Implantation in a Growing Porcine Model. Circ J 2019; 83:556-566. [PMID: 30700665 DOI: 10.1253/circj.cj-18-0855] [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] [Indexed: 11/09/2022]
Abstract
BACKGROUND Little is known about serial changes in lumen and device dimensions after bioresorbable scaffold implantation in a growing animal model. Methods and Results: ABSORB (n=14) or bare metal stents (ICROS amg [Abbott Vascular, Santa Clara, CA, USA], Winsen-Luhe, Germany; n=15) were implanted in the coronary arteries of domestic swine (a hybrid of Finnish-Norwegian Landrace swine) weighing 30-35 kg. Angiography and optical coherence tomography (OCT) were performed immediately after implantation and repeated at 7 days, 1, 3, 6 and 12 months after the index procedure. One month after implantation, mean lumen area decreased relative to baseline in both groups (relative area change from baseline, -41.4±15.6% for ABSORB vs. -20.9±18.6% for ICROS) while mean device area decreased only in the ABSORB group (relative area change: -11.1±9.4% vs. +0.14±7.95%, respectively). At 12 months, mean lumen area increased relative to baseline in both groups (relative area change from baseline, +55.6±22.4% vs. +32.3±83.6%, respectively) in accordance with the swine growth weighing up to 260-300 kg. Mean device area in the ICROS group remained stable whereas that in the ABSORB group began to increase between 3 and 6 months along with the vessel growth (relative area change: +107.8±25.7% vs. +0.14±7.95%). CONCLUSIONS In the growing porcine model, ABSORB was associated with greater extent of recoil 1 month after implantation compared with ICROS but demonstrated substantial adaptability to vessel growth in late phase.
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Affiliation(s)
- Taku Asano
- Department of Cardiology, Academic Medical Center, University of Amsterdam.,Department of Cardiology, St. Luke's International Hospital
| | - Jarkko Hytönen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland
| | - Ply Chichareon
- Department of Cardiology, Academic Medical Center, University of Amsterdam
| | - Jouni Taavitsainen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland
| | - Norihiro Kogame
- Department of Cardiology, Academic Medical Center, University of Amsterdam
| | - Yuki Katagiri
- Department of Cardiology, Academic Medical Center, University of Amsterdam
| | | | - Kuniaki Takahashi
- Department of Cardiology, Academic Medical Center, University of Amsterdam
| | - Rodrigo Modolo
- Department of Cardiology, Academic Medical Center, University of Amsterdam
| | - Hidenori Komiyama
- Department of Cardiology, Academic Medical Center, University of Amsterdam
| | | | - Yohei Sotomi
- Department of Cardiology, Academic Medical Center, University of Amsterdam
| | | | - Jan J Piek
- Department of Cardiology, Academic Medical Center, University of Amsterdam
| | - John Martin
- Division of Medicine, University College London
| | - Andreas Baumbach
- Department of Cardiology, Barts Health NHS Trust.,Department of Cardiology, Queen Mary University of London
| | - Anthony Mathur
- Department of Cardiology, Barts Health NHS Trust.,Department of Cardiology, Queen Mary University of London
| | | | - Seppo Ylä-Herttuala
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland
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Byrne RA, Alfonso F, Schneider S, Maeng M, Wiebe J, Kretov E, Bradaric C, Rai H, Cuesta J, Rivero F, Hoppmann P, Schlichtenmaier J, Christiansen EH, Cassese S, Joner M, Schunkert H, Laugwitz KL, Kastrati A. Prospective, randomized trial of bioresorbable scaffolds vs. everolimus-eluting stents in patients undergoing coronary stenting for myocardial infarction: the Intracoronary Scaffold Assessment a Randomized evaluation of Absorb in Myocardial Infarction (ISAR-Absorb MI) trial. Eur Heart J 2018; 40:167-176. [DOI: 10.1093/eurheartj/ehy710] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 10/15/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Robert A Byrne
- Department of Cardiovascular Diseases, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Fernando Alfonso
- Cardiac Department, Hospital Universitario de La Princesa Madrid, Madrid, Spain
| | - Simon Schneider
- Clinic and Policlinic Internal Medicine I (Cardiology and Angiology), Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Wiebe
- Department of Cardiovascular Diseases, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, Munich, Germany
| | - Evgeny Kretov
- E.N. Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - Christian Bradaric
- Clinic and Policlinic Internal Medicine I (Cardiology and Angiology), Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Himanshu Rai
- Department of Cardiovascular Diseases, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, Munich, Germany
| | - Javier Cuesta
- Cardiac Department, Hospital Universitario de La Princesa Madrid, Madrid, Spain
| | - Fernando Rivero
- Cardiac Department, Hospital Universitario de La Princesa Madrid, Madrid, Spain
| | - Petra Hoppmann
- Clinic and Policlinic Internal Medicine I (Cardiology and Angiology), Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Jana Schlichtenmaier
- Clinic and Policlinic Internal Medicine I (Cardiology and Angiology), Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | | | - Salvatore Cassese
- Department of Cardiovascular Diseases, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, Munich, Germany
| | - Michael Joner
- Department of Cardiovascular Diseases, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Heribert Schunkert
- Department of Cardiovascular Diseases, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Karl-Ludwig Laugwitz
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
- Clinic and Policlinic Internal Medicine I (Cardiology and Angiology), Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Adnan Kastrati
- Department of Cardiovascular Diseases, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
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35
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Tesfamariam B. Bioresorbable Scaffold-Based Controlled Drug Delivery for Restenosis. J Cardiovasc Transl Res 2018; 12:193-203. [DOI: 10.1007/s12265-018-9841-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 10/17/2018] [Indexed: 12/22/2022]
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36
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Kharlamov AN. Undiscovered pathology of transient scaffolding t1remains a driver of failures in clinical trials. World J Cardiol 2018; 10:165-186. [PMID: 30386494 PMCID: PMC6205848 DOI: 10.4330/wjc.v10.i10.165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 05/21/2018] [Accepted: 08/26/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To statistically examine the released clinical trials and meta-analyses of polymeric bioresorbable scaffolds resuming the main accomplishments in the field with a translation to the routine clinical practice. METHODS The statistical power in clinical trials such as ABSORB Japan, ABSORB China, EVERBIO II, AIDA, and few meta-analyses by the post hoc odds ratio-based sample size calculation, and the patterns of artery remodeling published in papers from ABSORB A and B trials were evaluated. RESULTS The phenomenal admiration from the first ABSORB studies in 2006-2013 was replaced by the tremendous disappointment in 2014-2017 due to reported relatively higher rates of target lesion failure (a mean prevalence of 9.16%) and device thrombosis (2.38%) in randomized controlled trials. Otherwise, bioresorbable vascular scaffold (BVS) performs as well as the metallic drug-eluting stent (DES) with a trend toward some benefits for cardiac mortality [risk ratio (RR), 0.58-0.94, P > 0.05]. The underpowered design was confirmed for some studies such as ABSORB Japan, ABSORB China, EVERBIO II, AIDA trials, and meta-analyses of Polimeni, Collet, and Mahmoud with some unintentional bias (judged by the asymmetrical Funnel plot). Scaffold thrombosis rates with Absorb BRS were comparable with DES performed with a so-called strategy of the BVS implantation with optimized pre-dilation (P), sizing (S) and post-dilation (P) (PSP) implantation (RR, PSP vs no PSP 0.37) achieving 0.35 per 100 patient-years, which is comparable to the RR 0.49 with bare-metal stents and the RR 1.06 with everolimus DES. Both ABSORB II and ABSORB III trials were powered enough for a five-year follow-up, but the results were not entirely conclusive due to the mostly non-significant fashion of data. The powered meta-analyses were built mostly on statistically poor findings. CONCLUSION The misunderstanding of the pathology of transient scaffolding drives the failures of the clinical trials. More bench studies of the vascular response are required. Several next-generation BVS including multifunctional electronic scaffold grant cardiology with a huge promise to make BVS technology great again.
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Affiliation(s)
- Alexander N Kharlamov
- Department of Interventional Cardiovascular Biomedicine, De Haar Research Foundation, Amsterdam 1069CD, The Netherlands
- Research Division, Transfiguration Clinic, Yekaterinburg 620078, Russia.
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Katagiri Y, Onuma Y, Asano T, Chichareon P, Collet C, Miyazaki Y, Piek JJ, Wykrzykowska JJ, Abizaid A, Ormiston JA, Chevalier B, Serruys PW. Relation between bioresorbable scaffold sizing using QCA-Dmax and long-term clinical outcomes in 1,232 patients from three study cohorts (ABSORB Cohort B, ABSORB EXTEND, and ABSORB II). EUROINTERVENTION 2018; 14:e1057-e1066. [PMID: 29667581 DOI: 10.4244/eij-d-18-00301] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS This study sought to investigate the long-term clinical outcomes related to scaffold sizing based on quantitative coronary angiography. METHODS AND RESULTS A total of 1,248 patients who received Absorb bioresorbable scaffolds in the ABSORB Cohort B, ABSORB EXTEND, and ABSORB II trials were included in the analysis. The incidence of MACE (a composite of cardiac death, any myocardial infarction [MI], and ischaemia-driven target lesion revascularisation [ID-TLR]) was analysed according to the Dmax subclassification of oversized scaffold group versus non-oversized (any undersize) scaffold group. At three years, event rates were similar in both groups in MACE (9.4% vs. 9.8%, p=0.847), target vessel MI (5.2% vs. 4.8%, p=0.795), and ID-TLR (4.8% vs. 5.8%, p=0.445). Landmark analysis after one year showed that the non-oversized scaffold group had higher rates of MACE (3.2% vs. 6.9%, log-rank p=0.004), target vessel MI (0.7% vs. 2.7%, log-rank p=0.007), and ID-TLR (2.5% vs. 4.7%, log-rank p=0.041). CONCLUSIONS Implantation of an undersized scaffold was associated with a higher risk of MACE between one and three years, while in the previous report an oversized scaffold was associated with a higher risk of MACE up to one year. This implies different mechanisms for early and late events after scaffold implantation.
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Affiliation(s)
- Yuki Katagiri
- Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Katagiri Y, Serruys PW, Macaya C, Ormiston JA, Hill J, Lang IM, Egred M, Fajadet J, Lesiak M, Wykrzykowska JJ, Piek JJ, Sabaté M, Windecker S, Chevalier B, Onuma Y. The Long-Term Impact of Post-Procedural Asymmetry and Eccentricity of Bioresorbable Everolimus-Eluting Scaffold and Metallic Everolimus-Eluting Stent on Clinical Outcomes in the ABSORB II Trial. JACC Cardiovasc Interv 2018; 11:1013-1015. [DOI: 10.1016/j.jcin.2018.02.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 02/09/2018] [Indexed: 11/28/2022]
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Tarantini G, Masiero G, Barioli A, Paradies V, Vlachojannis G, Tellaroli P, Cortese B, di Palma G, Varricchio A, Ielasi A, Loi B, Steffenino G, Ueshima D, Mojoli M, Smits P. Absorb bioresorbable vascular scaffold vs. everolimus-eluting metallic stent in small vessel disease: A propensity matched analysis of COMPARE II, RAI, and MAASSTAD-ABSORB studies. Catheter Cardiovasc Interv 2018. [DOI: 10.1002/ccd.27522] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences; University of Padua Medical School; Padua Italy
| | - Giulia Masiero
- Department of Cardiac, Thoracic and Vascular Sciences; University of Padua Medical School; Padua Italy
| | - Alberto Barioli
- Department of Cardiac, Thoracic and Vascular Sciences; University of Padua Medical School; Padua Italy
| | | | | | - Paola Tellaroli
- Biostatistics, Epidemiology and Public Health Unit of Department of Cardiac, Thoracic and Vascular Sciences; University of Padua Medical School; Padua Italy
| | - Bernardo Cortese
- Unità Operativa di Cardiologia, ASST Fatebenefratelli-Sacco; P.O. Fatebenefratelli Italy
| | - Gaetano di Palma
- Unità Operativa di Cardiologia, ASST Fatebenefratelli-Sacco; P.O. Fatebenefratelli Italy
| | - Attilio Varricchio
- Cardiology Division; Santa Maria della Pietà Hospital; Nola Naples Italy
| | - Alfonso Ielasi
- Cardiology Division; A.O. Bolognini; Seriate Bergamo Italy
| | - Bruno Loi
- Cardiology Division; A.O. Brotzu; Cagliari Italy
| | | | - Daisuke Ueshima
- Department of Cardiac, Thoracic and Vascular Sciences; University of Padua Medical School; Padua Italy
| | - Marco Mojoli
- Department of Cardiac, Thoracic and Vascular Sciences; University of Padua Medical School; Padua Italy
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Amrute JM, Athanasiou LS, Rikhtegar F, de la Torre Hernández JM, Camarero TG, Edelman ER. Polymeric endovascular strut and lumen detection algorithm for intracoronary optical coherence tomography images. JOURNAL OF BIOMEDICAL OPTICS 2018; 23:1-14. [PMID: 29560624 PMCID: PMC5859384 DOI: 10.1117/1.jbo.23.3.036010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 02/23/2018] [Indexed: 05/03/2023]
Abstract
Polymeric endovascular implants are the next step in minimally invasive vascular interventions. As an alternative to traditional metallic drug-eluting stents, these often-erodible scaffolds present opportunities and challenges for patients and clinicians. Theoretically, as they resorb and are absorbed over time, they obviate the long-term complications of permanent implants, but in the short-term visualization and therefore positioning is problematic. Polymeric scaffolds can only be fully imaged using optical coherence tomography (OCT) imaging-they are relatively invisible via angiography-and segmentation of polymeric struts in OCT images is performed manually, a laborious and intractable procedure for large datasets. Traditional lumen detection methods using implant struts as boundary limits fail in images with polymeric implants. Therefore, it is necessary to develop an automated method to detect polymeric struts and luminal borders in OCT images; we present such a fully automated algorithm. Accuracy was validated using expert annotations on 1140 OCT images with a positive predictive value of 0.93 for strut detection and an R2 correlation coefficient of 0.94 between detected and expert-annotated lumen areas. The proposed algorithm allows for rapid, accurate, and automated detection of polymeric struts and the luminal border in OCT images.
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Affiliation(s)
- Junedh M. Amrute
- California Institute of Technology, Division of Biology and Biological Engineering, Pasadena, California, United States
- Massachusetts Institute of Technology, Institute for Medical Engineering and Sciences, Cambridge, Massachusetts, United States
| | - Lambros S. Athanasiou
- Massachusetts Institute of Technology, Institute for Medical Engineering and Sciences, Cambridge, Massachusetts, United States
- Brigham and Women’s Hospital, Harvard Medical School, Cardiovascular Division, Boston, Massachusetts, United States
- Address all correspondence to: Lambros S. Athanasiou, E-mail:
| | - Farhad Rikhtegar
- Massachusetts Institute of Technology, Institute for Medical Engineering and Sciences, Cambridge, Massachusetts, United States
| | - José M. de la Torre Hernández
- Hospital Universitario Marques de Valdecilla, Unidad de Cardiologia Intervencionista, Servicio de Cardiologia, Santander, Spain
| | - Tamara García Camarero
- Hospital Universitario Marques de Valdecilla, Unidad de Cardiologia Intervencionista, Servicio de Cardiologia, Santander, Spain
| | - Elazer R. Edelman
- Massachusetts Institute of Technology, Institute for Medical Engineering and Sciences, Cambridge, Massachusetts, United States
- Brigham and Women’s Hospital, Harvard Medical School, Cardiovascular Division, Boston, Massachusetts, United States
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Coronary calcification as a mechanism of plaque/media shrinkage in vessels treated with bioresorbable vascular scaffold: A multimodality intracoronary imaging study. Atherosclerosis 2017; 269:6-13. [PMID: 29247976 DOI: 10.1016/j.atherosclerosis.2017.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 09/26/2017] [Accepted: 11/01/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND AIMS Whether coronary calcification is correlated with plaque/media shrinkage (PS) remains unclear. The aim of this study was to assess the relationship between the calcification process and PS, combining serial optical coherence tomography (OCT) and intravascular ultrasound (IVUS) in vessels treated with bioresorbable vascular scaffolds (BVS). METHODS In 15 patients (16 vessels), OCT and IVUS images were matched using anatomic landmarks at post-procedure and five years. PS was defined as relative decrease in plaque/media area >5%. The association between the calcification process and PS was investigated. Mixed effect models were used to assess correlations and changes over time. RESULTS Seventy-two OCT and IVUS paired cross sections in- and out-scaffolded segments were matched at baseline and follow-up (432 images). In total, 35 out of the 72 cross sections showed PS, and 37 cross sections showed no PS (non-PS) at 5-year follow-up. Delta (Δ) plaque/media area showed negative correlation with Δ OCT calcium area (r = -0.29, p = 0.004), Δ OCT calcium arc (r = -0.42, p < 0.001), Δ OCT calcium length (r = -0.5, p < 0.001), and Δ IVUS calcium arc (r = -0.31, p = 0.024), respectively. On echogenicity analysis, Δ plaque/media area was positively associated with Δ hypoechogenic area (r = 0.47, p = 0.002). An increase in calcium area was negatively correlated to Δ hypoechogenicity (r = -0.29, p < 0.016). The increase in calcium area was positively correlated with Δ lumen area (r = 0.24, p = 0.044). CONCLUSIONS In segments treated with BVS, the calcification process was associated with PS, decrease in the hypoechogenic tissue and late luminal enlargement. Combining IVUS and OCT provides a unique method to assess the correlation between the calcification process and plaque/media shrinkage.
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Yamaji K, Ueki Y, Souteyrand G, Daemen J, Wiebe J, Nef H, Adriaenssens T, Loh JP, Lattuca B, Wykrzykowska JJ, Gomez-Lara J, Timmers L, Motreff P, Hoppmann P, Abdel-Wahab M, Byrne RA, Meincke F, Boeder N, Honton B, O’Sullivan CJ, Ielasi A, Delarche N, Christ G, Lee JK, Lee M, Amabile N, Karagiannis A, Windecker S, Räber L. Mechanisms of Very Late Bioresorbable Scaffold Thrombosis. J Am Coll Cardiol 2017; 70:2330-2344. [DOI: 10.1016/j.jacc.2017.09.014] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 09/06/2017] [Accepted: 09/06/2017] [Indexed: 10/18/2022]
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Ahn JM, Park DW, Hong SJ, Ahn YK, Hahn JY, Kim WJ, Hong SJ, Nam CW, Kang DY, Lee SY, Chun WJ, Heo JH, Cho DK, Kim JW, Her SH, Kim SW, Yoo SY, Hong MK, Tahk SJ, Kim KS, Kim MH, Jang Y, Park SJ. Bioresorbable Vascular Scaffold Korean Expert Panel Report. Korean Circ J 2017; 47:795-810. [PMID: 29171214 PMCID: PMC5711671 DOI: 10.4070/kcj.2017.0300] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 09/12/2017] [Indexed: 12/31/2022] Open
Abstract
Bioresorbable vascular scaffold (BRS) is an innovative device that provides structural support and drug release to prevent early recoil or restenosis, and then degrades into nontoxic compounds to avoid late complications related with metallic drug-eluting stents (DESs). BRS has several putative advantages. However, recent randomized trials and registry studies raised clinical concerns about the safety and efficacy of first generation BRS. In addition, the general guidance for the optimal practice with BRS has not been suggested due to limited long-term clinical data in Korea. To address the safety and efficacy of BRS, we reviewed the clinical evidence of BRS implantation, and suggested the appropriate criteria for patient and lesion selection, scaffold implantation technique, and management.
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Affiliation(s)
- Jung Min Ahn
- Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Duk Woo Park
- Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sung Jin Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Keun Ahn
- Division of Cardiology, Department of Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Joo Yong Hahn
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Jang Kim
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Soon Jun Hong
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Seoul, Korea
| | - Chang Wook Nam
- Department of Medicine, Keimyung University College of Medicine, Daegu, Korea
| | - Do Yoon Kang
- Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seung Yul Lee
- Department of Internal Medicine, Wonkwang University Sanbon Hospital, Sanbon, Korea
| | - Woo Jung Chun
- Division of Cardiology, Department of Internal Medicine, Sungkyunkwan University Samsung Changwon Hospital, Changwon, Korea
| | - Jung Ho Heo
- Division of Cardiology, Department of Internal Medicine, Kosin University Gospel Hospital, Busan, Korea
| | - Deok Kyu Cho
- Department of Cardiology, Myongji Hospital, Goyang, Korea
| | - Jin Won Kim
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Sung Ho Her
- Division of Cardiology, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea
| | - Sang Wook Kim
- Department of Cardiology, Chung-Ang University Hospital, Seoul, Korea
| | - Sang Yong Yoo
- Cardiovascular Center, GangNeung Asan Hospital, Gangneung, Korea
| | - Myeong Ki Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Jea Tahk
- Division of Cardiology, Ajou University Medical Center, Suwon, Korea
| | - Kee Sik Kim
- Division of Cardiology, Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea
| | - Moo Hyun Kim
- Department of Cardiology, Dong-A University Medical Center, Busan, Korea
| | - Yangsoo Jang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Jung Park
- Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
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Stone GW, Abizaid A, Onuma Y, Seth A, Gao R, Ormiston J, Kimura T, Chevalier B, Ben-Yehuda O, Dressler O, McAndrew T, Ellis SG, Kereiakes DJ, Serruys PW. Effect of Technique on Outcomes Following Bioresorbable Vascular Scaffold Implantation: Analysis From the ABSORB Trials. J Am Coll Cardiol 2017; 70:2863-2874. [PMID: 29100704 DOI: 10.1016/j.jacc.2017.09.1106] [Citation(s) in RCA: 119] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 09/25/2017] [Accepted: 09/26/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Procedural technique may affect clinical outcomes after bioresorbable vascular scaffold (BVS) implantation. Prior studies suggesting such a relationship have not adjusted for baseline patient and lesion characteristics that may have influenced operator choice of technique and outcomes. OBJECTIVES This study sought to determine whether target lesion failure (TLF) (cardiac death, target-vessel myocardial infarction, or ischemia-driven target lesion revascularization) and scaffold thrombosis (ScT) rates within 3 years of BVS implantation are affected by operator technique (vessel size selection and pre- and post-dilation parameters). METHODS TLF and ScT rates were determined in 2,973 patients with 3,149 BVS-treated coronary artery lesions from 5 prospective studies (ABSORB II, ABSORB China, ABSORB Japan, ABSORB III, and ABSORB Extend). Outcomes through 3 years (and between 0 to 1 and 1 to 3 years) were assessed according to pre-specified definitions of optimal technique (pre-dilation, vessel sizing, and post-dilation). Multivariable analysis was used to adjust for differences in up to 18 patient and lesion characteristics. RESULTS Optimal pre-dilation (balloon to core laboratory-derived reference vessel diameter ratio ≥1:1), vessel size selection (reference vessel diameter ≥2.25 mm and ≤3.75 mm), and post-dilation (with a noncompliant balloon at ≥18 atm and larger than the nominal scaffold diameter, but not by >0.5 mm larger) in all BVS-treated lesions were performed in 59.2%, 81.6%, and 12.4% of patients, respectively. BVS implantation in properly sized vessels was an independent predictor of freedom from TLF through 1 year (hazard ratio [HR]: 0.67; p = 0.01) and through 3 years (HR: 0.72; p = 0.01), and of freedom from ScT through 1 year (HR: 0.36; p = 0.004). Aggressive pre-dilation was an independent predictor of freedom from ScT between 1 and 3 years (HR: 0.44; p = 0.03), and optimal post-dilation was an independent predictor of freedom from TLF between 1 and 3 years (HR: 0.55; p = 0.05). CONCLUSIONS In the present large-scale analysis from the major ABSORB studies, after multivariable adjustment for baseline patient and lesion characteristics, vessel sizing and operator technique were strongly associated with BVS-related outcomes during 3-year follow-up. (ABSORB II Randomized Controlled Trial [ABSORB II]; NCT01425281; ABSORB III Randomized Controlled Trial [RCT] [ABSORB-III]; NCT01751906; A Clinical Evaluation of Absorb Bioresorbable Vascular Scaffold [Absorb BVS] System in Chinese Population-ABSORB CHINA Randomized Controlled Trial [RCT] [ABSORB CHINA]; NCT01923740; ABSORB EXTEND Clinical Investigation [ABSORB EXTEND]; NCT01023789; AVJ-301 Clinical Trial: A Clinical Evaluation of AVJ-301 [Absorb BVS] in Japanese Population [ABSORB JAPAN]; NCT01844284).
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Affiliation(s)
- Gregg W Stone
- New York Presbyterian Hospital, Columbia University Medical Center, New York, New York; The Cardiovascular Research Foundation, New York, New York.
| | | | - Yoshinobu Onuma
- Thoraxcenter, Erasmus Medical Center and Cardialysis, Rotterdam, the Netherlands
| | - Ashok Seth
- Fortis Escorts Heart Institute, New Delhi, India
| | - Runlin Gao
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - John Ormiston
- University of Auckland School of Medicine, Auckland, New Zealand
| | | | | | - Ori Ben-Yehuda
- New York Presbyterian Hospital, Columbia University Medical Center, New York, New York; The Cardiovascular Research Foundation, New York, New York
| | | | - Tom McAndrew
- The Cardiovascular Research Foundation, New York, New York
| | | | - Dean J Kereiakes
- The Christ Hospital, Heart and Vascular Center, Lindner Research Center, Cincinnati, Ohio
| | - Patrick W Serruys
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, United Kingdom
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Giustino G, Dangas GD. Bioresorbable Vascular Scaffolds in Women. JACC Cardiovasc Interv 2017; 10:1891-1893. [PMID: 28935082 DOI: 10.1016/j.jcin.2017.08.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 08/17/2017] [Indexed: 01/11/2023]
Affiliation(s)
- Gennaro Giustino
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - George D Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
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Schütz T, Krönig FP, Karmeinsky C, Weingärtner O. Bioresorbable vascular scaffold implantation to bail out nail gun injury in ST-segment myocardial infarction. Clin Res Cardiol 2017; 107:87-90. [PMID: 28905244 DOI: 10.1007/s00392-017-1160-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 09/07/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Torsten Schütz
- Klinik für Kardiologie, Klinikum Oldenburg, European Medical School Oldenburg-Groningen, Medizinischer Campus der Universität Oldenburg, Rahel-Straus-Str. 10, 26133, Oldenburg, Germany
| | - Friedrich P Krönig
- Universitätsklinik für Herzchirurgie, Klinikum Oldenburg, European Medical School Oldenburg-Groningen, Oldenburg, Germany
| | - Christoph Karmeinsky
- Universitätsklinik für Anästhesie, Intensiv-, Notfall- und Schmerzmedizin, Klinikum Oldenburg, European Medical School Oldenburg-Groningen, Oldenburg, Germany
| | - Oliver Weingärtner
- Klinik für Kardiologie, Klinikum Oldenburg, European Medical School Oldenburg-Groningen, Medizinischer Campus der Universität Oldenburg, Rahel-Straus-Str. 10, 26133, Oldenburg, Germany.
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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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Katagiri Y, Stone G, Onuma Y, Serruys P. State of the art: the inception, advent and future of fully bioresorbable scaffolds. EUROINTERVENTION 2017; 13:734-750. [DOI: 10.4244/eij-d-17-00499] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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The Promise of Vascular Restoration Is Still Alive. J Am Coll Cardiol 2017; 70:75-77. [PMID: 28662809 DOI: 10.1016/j.jacc.2017.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 05/18/2017] [Accepted: 05/21/2017] [Indexed: 11/21/2022]
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