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Nieman K, García-García HM, Hideo-Kajita A, Collet C, Dey D, Pugliese F, Weissman G, Tijssen JGP, Leipsic J, Opolski MP, Ferencik M, Lu MT, Williams MC, Bruining N, Blanco PJ, Maurovich-Horvat P, Achenbach S. Standards for quantitative assessments by coronary computed tomography angiography (CCTA): An expert consensus document of the society of cardiovascular computed tomography (SCCT). J Cardiovasc Comput Tomogr 2024:S1934-5925(24)00341-1. [PMID: 38849237 DOI: 10.1016/j.jcct.2024.05.232] [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: 03/31/2023] [Revised: 05/18/2024] [Accepted: 05/23/2024] [Indexed: 06/09/2024]
Abstract
In current clinical practice, qualitative or semi-quantitative measures are primarily used to report coronary artery disease on cardiac CT. With advancements in cardiac CT technology and automated post-processing tools, quantitative measures of coronary disease severity have become more broadly available. Quantitative coronary CT angiography has great potential value for clinical management of patients, but also for research. This document aims to provide definitions and standards for the performance and reporting of quantitative measures of coronary artery disease by cardiac CT.
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Affiliation(s)
- Koen Nieman
- Stanford University School of Medicine and Cardiovascular Institute, Stanford, CA, United States.
| | - Hector M García-García
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States.
| | | | - Carlos Collet
- Onze Lieve Vrouwziekenhuis, Cardiovascular Center Aalst, Aalst, Belgium
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Francesca Pugliese
- NIHR Cardiovascular Biomedical Research Unit at Barts, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London & Department of Cardiology, Barts Health NHS Trust, London, UK
| | - Gaby Weissman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States
| | - Jan G P Tijssen
- Department of Cardiology, Academic Medical Center, Room G4-230, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Jonathon Leipsic
- Department of Radiology and Medicine (Cardiology), University of British Columbia, Vancouver, BC, Canada
| | - Maksymilian P Opolski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland
| | - Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, United States
| | - Michael T Lu
- Cardiovascular Imaging Research Center, Massachusetts General Hospital & Harvard Medical School, Boston, MA, United States
| | - Michelle C Williams
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Nico Bruining
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Pal Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
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Garcia-Garcia HM, Waksman R, Melaku GD, Garg M, Beyene S, Wlodarczak A, Kerai A, Levine MB, van der Schaaf RJ, Torzewski J, Ferdinande B, Escaned J, Iglesias JF, Bennett J, Toth GG, Joner M, Toelg R, Wiemer M, Olivecrona G, Vermeersch P, Haude M. Temporal changes in coronary plaque as assessed by an artificial intelligence-based optical coherence tomography: from the first-in-human trial on DREAMS 3G scaffold. Eur Heart J Cardiovasc Imaging 2024; 25:491-497. [PMID: 37936296 DOI: 10.1093/ehjci/jead299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 10/06/2023] [Accepted: 10/15/2023] [Indexed: 11/09/2023] Open
Abstract
AIMS The aim of the study is to assess the impact of the baseline plaque composition on the DREAMS 3G luminal late loss and to compare the serial plaque changes between baseline and 6 and 12 months (M) follow-up. METHODS AND RESULTS A total of 116 patients were enrolled in the BIOMAG-I trial. Patients were imaged with optical coherence tomography (OCT) pre- and post-DREAMS 3G implantation and at 6 and 12 M. OCTPlus software uses artificial intelligence to assess composition (i.e. lipid, calcium, and fibrous tissue) of the plaque. The differences between the OCT-derived minimum lumen area (MLA) post-percutaneous coronary intervention and 12 M were grouped into three terciles. Patients with larger MLA differences at 12 M (P = 0.0003) had significantly larger content of fibrous tissue at baseline. There was a reduction of 24.8% and 20.9% in lipid area, both P < 0.001, between the pre-DREAMS 3G OCT and the 6 and 12 M follow-up. Conversely, the fibrous tissue increased by 48.4% and 36.0% at 6 and 12 M follow-up, both P < 0.001. CONCLUSION The larger the fibrous tissue in the lesion at baseline, the larger the luminal loss seen at 6 and 12 M. Following the implantation of DREAMS 3G, favourable healing of the vessel coronary wall occurs as shown by a decrease in the lipid area and an increase in fibrous tissue.
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Affiliation(s)
- Hector M Garcia-Garcia
- Interventional Cardiology, MedStar Washington Hospital Center, 110 Irving Street NW, Suite 4B-1, Washington, DC 20010, USA
| | - Ron Waksman
- Interventional Cardiology, MedStar Washington Hospital Center, 110 Irving Street NW, Suite 4B-1, Washington, DC 20010, USA
| | - Gebremedhin D Melaku
- Interventional Cardiology, MedStar Washington Hospital Center, 110 Irving Street NW, Suite 4B-1, Washington, DC 20010, USA
| | - Mohil Garg
- Interventional Cardiology, MedStar Washington Hospital Center, 110 Irving Street NW, Suite 4B-1, Washington, DC 20010, USA
| | - Solomon Beyene
- Interventional Cardiology, MedStar Washington Hospital Center, 110 Irving Street NW, Suite 4B-1, Washington, DC 20010, USA
| | - Adrian Wlodarczak
- Department of Cardiology, Miedziowe Centrum Zdrowia SA, Lubin, Poland
| | - Ajay Kerai
- Interventional Cardiology, MedStar Washington Hospital Center, 110 Irving Street NW, Suite 4B-1, Washington, DC 20010, USA
| | - Molly B Levine
- Interventional Cardiology, MedStar Washington Hospital Center, 110 Irving Street NW, Suite 4B-1, Washington, DC 20010, USA
| | | | - Jan Torzewski
- Cardiovascular Center Oberallgäu-Kempten, Kempten, Germany
| | - Bert Ferdinande
- Department of Cardiology, Ziekenhuis Oost Limburg (ZOL), Genk, Belgium
| | - Javier Escaned
- Division of Cardiology, Hospital Clinico San Carlos IDISSC, Complutense University of Madrid, Madrid, Spain
| | - Juan F Iglesias
- Cardiology Division, University Hospital of Geneva, Geneva, Switzerland
| | - Johan Bennett
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Gabor G Toth
- Division Cardiology, Medical University Graz, Graz, Austria
| | - Michael Joner
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, München, Germany
- Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Ralph Toelg
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
| | - Marcus Wiemer
- Department of Cardiology and Intensive Care, Johannes Wesling University Hospital, Ruhr University Bochum, Minden, Germany
| | - Göran Olivecrona
- Department of Cardiology, Skane University Hospital, Lund, Sweden
| | - Paul Vermeersch
- Interventional Cardiology, ZNA Middelheim, Antwerpen, Belgium
| | - Michael Haude
- Medical Clinic I, Rheinland Klinikum Neuss GmbH, Lukaskrankenhaus, Neuss, Germany
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Shi Q, Zhang B, Wang X, Fei J, Qin Q, Zheng B, Chen M. Safety and efficacy of a novel 3D-printed bioresorbable sirolimus-eluting scaffold in a porcine model. ASIAINTERVENTION 2023; 9:133-142. [PMID: 37736208 PMCID: PMC10507451 DOI: 10.4244/aij-d-22-00051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 12/19/2022] [Indexed: 09/23/2023]
Abstract
Background The effect of 3D-printed bioresorbable vascular scaffolds (BRS) in coronary heart disease has not been clarified. Aims We aimed to compare the safety and efficacy of 3D-printed BRS with that of metallic sirolimus-eluting stents (SES). Methods Thirty-two BRS and 32 SES were implanted into 64 porcine coronary arteries. Quantitative coronary angiography (QCA) and optical coherence tomography (OCT) were performed at 14, 28, 97, and 189 days post-implantation. Scanning electron microscopy (SEM) and histopathological analyses were performed at each assessment. Results All stents/scaffolds were successfully implanted. All animals survived for the duration of the study. QCA showed the two devices had a similar stent/scaffold-to-artery ratio and acute percent recoil. OCT showed the lumen area (LA) and scaffold/stent area (SA) of the BRS were significantly smaller than those of the SES at 14 and 28 days post-implantation (14-day LA: BRS vs SES 4.52±0.41 mm2 vs 5.69±1.11 mm2; p=0.03; 14-day SA: BRS vs SES 4.99±0.45 mm2 vs 6.11±1.06 mm2; p=0.03; 28-day LA: BRS vs SES 2.93±1.03 mm2 vs 4.82±0.74 mm2; p=0.003; 28-day SA: BRS vs SES 3.86±0.98 mm2 vs 5.75±0.71 mm2; p=0.03). Both the LA and SA of the BRS increased over time and were similar to those of the SES at the 97-day and 189-day assessments. SEM and histomorphological analyses showed no significant between-group differences in endothelialisation at each assessment. Conclusions The novel 3D-printed BRS showed safety and efficacy similar to that of SES in a porcine model. The BRS also showed a long-term positive remodelling effect.
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Affiliation(s)
- Qiuping Shi
- Department of Cardiology, Peking University First Hospital, Beijing, People's Republic of China
| | - Bin Zhang
- Department of Cardiology, Peking University First Hospital, Beijing, People's Republic of China
| | - Xingang Wang
- Department of Cardiology, Peking University First Hospital, Beijing, People's Republic of China
| | - Jintao Fei
- Department of Cardiology, Peking University First Hospital, Beijing, People's Republic of China
| | - Qiao Qin
- Department of Cardiology, Peking University First Hospital, Beijing, People's Republic of China
| | - Bo Zheng
- Department of Cardiology, Peking University First Hospital, Beijing, People's Republic of China
- Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, People's Republic of China
| | - Ming Chen
- Department of Cardiology, Peking University First Hospital, Beijing, People's Republic of China
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Wu X, Renkens MPL, Kerkmeijer L, Lunardi M, Huang J, Ding D, O'Leary N, de Winter RJ, Onuma Y, Serruys PW, Wykrzykowska J, Tu S, Wijns W. Angiography-Based Superficial Wall Strain of De Novo Stenotic Coronary Arteries: Serial Assessment of Vessels Treated with Bioresorbable Scaffold or Drug-Eluting Stent. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 53:51-60. [PMID: 37005105 DOI: 10.1016/j.carrev.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 03/14/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVES This study sought to present an angiography-based computational model for serial assessment of superficial wall strain (SWS, dimensionless) of de-novo coronary stenoses treated with either bioresorbable scaffold (BRS) or drug-eluting stent (DES). BACKGROUND A novel method for SWS allows the assessment of the mechanical status of arteries in-vivo, which may help for predicting cardiovascular outcomes. METHODS Patients with arterial stenosis treated with BRS (n = 21) or DES (n = 21) were included from ABSORB Cohort B1 and AIDA trials. The SWS analyses were performed along with quantitative coronary angiography (QCA) at pre-PCI, post-PCI, and 5-year follow-up. Measurements of QCA and SWS parameters were quantified at the treated segment and adjacent 5-mm proximal and distal edges. RESULTS Before PCI, the peak SWS on the 'to be treated' segment (0.79 ± 0.36) was significantly higher than at both virtual edges (0.44 ± 0.14 and 0.45 ± 0.21; both p < 0.001). The peak SWS in the treated segment significantly decreased by 0.44 ± 0.13 (p < 0.001). The surface area of high SWS decreased from 69.97mm2 to 40.08mm2 (p = 0.002). The peak SWS in BRS group decreased to a similar extent (p = 0.775) from 0.81 ± 0.36 to 0.41 ± 0.14 (p < 0.001), compared with DES group from 0.77 ± 0.39 to 0.47 ± 0.13 (p = 0.001). Relocation of high SWS to device edges was often observed in both groups after PCI (35 of 82 cases, 41.7 %). At follow-up of BRS, the peak SWS remained unchanged compared to post-PCI (0.40 ± 0.12 versus 0.36 ± 0.09, p = 0.319). CONCLUSION Angiography-based SWS provided valuable information about the mechanical status of coronary arteries. Device implantation led to a significant decrease of SWS to a similar extent with either polymer-based scaffolds or permanent metallic stents.
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Affiliation(s)
- Xinlei Wu
- The Lambe Institute for Translational Medicine, Smart Sensors Laboratory, Corrib Core Laboratory and Curam, University of Galway, Ireland
| | - Mick P L Renkens
- Amsterdam UMC, Heart Center, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Mattia Lunardi
- The Lambe Institute for Translational Medicine, Smart Sensors Laboratory, Corrib Core Laboratory and Curam, University of Galway, Ireland
| | - Jiayue Huang
- The Lambe Institute for Translational Medicine, Smart Sensors Laboratory, Corrib Core Laboratory and Curam, University of Galway, Ireland
| | - Daixin Ding
- The Lambe Institute for Translational Medicine, Smart Sensors Laboratory, Corrib Core Laboratory and Curam, University of Galway, Ireland
| | - Neil O'Leary
- The Lambe Institute for Translational Medicine, Smart Sensors Laboratory, Corrib Core Laboratory and Curam, University of Galway, Ireland
| | - Robbert J de Winter
- Amsterdam UMC, Heart Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Yoshinobu Onuma
- The Lambe Institute for Translational Medicine, Smart Sensors Laboratory, Corrib Core Laboratory and Curam, University of Galway, Ireland
| | - Patrick W Serruys
- The Lambe Institute for Translational Medicine, Smart Sensors Laboratory, Corrib Core Laboratory and Curam, University of Galway, Ireland
| | - Joanna Wykrzykowska
- Amsterdam UMC, Heart Center, University of Amsterdam, Amsterdam, the Netherlands; UMC Groningen, Thorax Center, University of Groningen, Groningen, the Netherlands
| | - Shengxian Tu
- Med-X Research Institute, Shanghai Jiao Tong University, China
| | - William Wijns
- The Lambe Institute for Translational Medicine, Smart Sensors Laboratory, Corrib Core Laboratory and Curam, University of Galway, Ireland.
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Liu W, Huang J, He S, Du R, Shi W, Wang Y, Du D, Du Y, Liu Q, Wang Y, Wang G, Yin T. Senescent endothelial cells' response to the degradation of bioresorbable scaffold induces intimal dysfunction accelerating in-stent restenosis. Acta Biomater 2023; 166:266-277. [PMID: 37211308 DOI: 10.1016/j.actbio.2023.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/16/2023] [Accepted: 05/16/2023] [Indexed: 05/23/2023]
Abstract
Atherosclerotic cardiovascular disease is a typical age-related disease accompanied by stiffening arteries. We aimed to elucidate the influence of aged arteries on in-stent restenosis (ISR) after the implantation of bioresorbable scaffolds (BRS). Histology and optical coherence tomography showed increased lumen loss and ISR in the aged abdominal aorta of Sprague-Dawley rats, with apparent scaffold degradation and deformation, which induce lower wall shear stress (WSS). This was also the case at the distal end of BRS, where the scaffolds degraded faster, and significant lumen loss was followed by a lower WSS. In addition, early thrombosis, inflammation, and delayed re-endothelialization were presented in the aged arteries. Degradation of BRS causes more senescent cells in the aged vasculature, increasing endothelial cell dysfunction and the risk of ISR. Thus, profoundly understanding the mechanism between BRS and senescent cells may give a meaningful guide for the age-related scaffold design. STATEMENT OF SIGNIFICANCE: The degradation of bioresorbable scaffolds aggravates senescent endothelial cells and a much lower wall shear stress areas in the aged vasculature, lead to intimal dysfunction and increasing in-stent restenosis risk. Early thrombosis and inflammation, as well as delayed re-endothelialization, are presented in the aged vasculature after bioresorbable scaffolds implantation. Age stratification during the clinical evaluation and senolytics in the design of new bioresorbable scaffolds should be considered, especially for old patients.
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Affiliation(s)
- Wanling Liu
- Key Laboratory of Biorheological and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Modern Life Science Experiment Teaching Center, Bioengineering College of Chongqing University, Chongqing 400030, PR China
| | - Junyang Huang
- Key Laboratory of Biorheological and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Modern Life Science Experiment Teaching Center, Bioengineering College of Chongqing University, Chongqing 400030, PR China
| | - Shicheng He
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, China
| | - Ruolin Du
- Key Laboratory of Biorheological and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Modern Life Science Experiment Teaching Center, Bioengineering College of Chongqing University, Chongqing 400030, PR China
| | - Wen Shi
- Key Laboratory of Biorheological and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Modern Life Science Experiment Teaching Center, Bioengineering College of Chongqing University, Chongqing 400030, PR China
| | - Yang Wang
- Key Laboratory of Biorheological and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Modern Life Science Experiment Teaching Center, Bioengineering College of Chongqing University, Chongqing 400030, PR China
| | - Dingyuan Du
- Department of Traumatology, and Department of Cardiothoracic Surgery, Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing 400014, China
| | - Yan Du
- Ultrasonography Department, Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing 400014, China
| | - Qing Liu
- Beijing Advanced Medical Technologies Inc., Beijing 102609, China
| | - Yazhou Wang
- School of Medicine, Chongqing University, Chongqing 400044, PR China.
| | - Guixue Wang
- Key Laboratory of Biorheological and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Modern Life Science Experiment Teaching Center, Bioengineering College of Chongqing University, Chongqing 400030, PR China.
| | - Tieying Yin
- Key Laboratory of Biorheological and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Modern Life Science Experiment Teaching Center, Bioengineering College of Chongqing University, Chongqing 400030, PR China.
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Intravascular Imaging During Percutaneous Coronary Intervention: JACC State-of-the-Art Review. J Am Coll Cardiol 2023; 81:590-605. [PMID: 36754518 DOI: 10.1016/j.jacc.2022.11.045] [Citation(s) in RCA: 41] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 02/09/2023]
Abstract
Coronary angiography has historically served as the gold standard for diagnosis of coronary artery disease and guidance of percutaneous coronary intervention (PCI). Adjunctive use of contemporary intravascular imaging (IVI) technologies has emerged as a complement to conventional angiography-to further characterize plaque morphology and optimize the performance of PCI. IVI has utility for preintervention lesion and vessel assessment, periprocedural guidance of lesion preparation and stent deployment, and postintervention assessment of optimal endpoints and exclusion of complications. The role of IVI in reducing major adverse cardiac events in complex lesion subsets is emerging, and further studies evaluating broader use are underway or in development. This paper provides an overview of currently available IVI technologies, reviews data supporting their utilization for PCI guidance and optimization across a variety of lesion subsets, proposes best practices, and advocates for broader use of these technologies as a part of contemporary practice.
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3D Printing of Polymeric Bioresorbable Stents: A Strategy to Improve Both Cellular Compatibility and Mechanical Properties. Polymers (Basel) 2022; 14:polym14061099. [PMID: 35335430 PMCID: PMC8954590 DOI: 10.3390/polym14061099] [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: 01/25/2022] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 12/04/2022] Open
Abstract
One of the leading causes of death is cardiovascular disease, and the most common cardiovascular disease is coronary artery disease. Percutaneous coronary intervention and vascular stents have emerged as a solution to treat coronary artery disease. Nowadays, several types of vascular stents share the same purpose: to reduce the percentage of restenosis, thrombosis, and neointimal hyperplasia and supply mechanical support to the blood vessels. Despite the numerous efforts to create an ideal stent, there is no coronary stent that simultaneously presents the appropriate cellular compatibility and mechanical properties to avoid stent collapse and failure. One of the emerging approaches to solve these problems is improving the mechanical performance of polymeric bioresorbable stents produced through additive manufacturing. Although there have been numerous studies in this field, normalized control parameters for 3D-printed polymeric vascular stents fabrication are absent. The present paper aims to present an overview of the current types of stents and the main polymeric materials used to fabricate the bioresorbable vascular stents. Furthermore, a detailed description of the printing parameters' influence on the mechanical performance and degradation profile of polymeric bioresorbable stents is presented.
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Gutiérrez-Barrios A, Gheorghe LL, Camacho Freire S, Silva E, Gómez Menchero A, Francisco Jose MP, Cañadas Pruaño D, Martínez Capoccioni U, Gomez Lara J, Bretones Del Pino T, Calle Perez G. Long-term clinical, angiographic, and optical coherence tomography findings of Mg-based bioresorbable scaffold in patients with acute coronary syndrome. Catheter Cardiovasc Interv 2021; 98:E69-E77. [PMID: 33600069 DOI: 10.1002/ccd.29557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 01/12/2021] [Accepted: 02/02/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND This study sought to evaluate the clinical outcomes of patients treated with magnesium-based bioresorbable scaffolds (MgBRS) in the context of acute coronary syndromes (ACS) at long-term follow-up (24 months). The study also aims to investigate the MgBRS performance by angiography and the healing and bioresorption pattern by optical coherence tomography (OCT) at 18 months. METHODS Between December 2016 and December 2018, a total of 90 patients admitted for ACS and treated with MgBRS (Magmaris, Biotronik AG, Bülach, Switzerland) were enrolled in a multicenter prospective study. Clinical follow-up was performed in all patients at 24 months and angiographic and OCT follow-up in 51.5% of patients at 18 months. Serial OCT was available in 33 patients (36.7%). RESULTS At a 2-year follow-up, 88.8% were free of symptoms, no cardiac death was reported, and the device-oriented composite event (DOCE): consisting of cardiac death, target vessel myocardial infarction, and target lesion revascularization (TLR) was 13.3%. Stent thrombosis and TLR were observed in 2.2 and 11.1%, respectively. Binary restenosis was observed in 21.7% of cases and in-stent late lumen loss was 0.61 ± 0.75 mm. By serial OCT imaging, the minimal lumen area was significantly reduced greater than 40% (from 6.12 ± 1.59 to 3.5 ± 1.55 mm2, p < .001). At follow-up, area stenosis was 44.33 ± 23.07% and half of the patients presented indiscernible struts. The principal observed mechanism of restenosis was scaffold collapse. CONCLUSIONS At long-term follow-up, MgBRS implantation in ACS patients showed a high rate of DOCE, mainly caused by clinically driven TLR. MgBRS restenosis was caused by scaffold collapse in most of the cases.
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Affiliation(s)
| | | | | | - Etel Silva
- Institute of Biomedical Research and Innovation of Cádiz (INiBICA), Research Unit University Hospital Puerta del Mar, University of Cádiz, Cádiz, Spain
| | | | | | | | | | - Josep Gomez Lara
- Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - German Calle Perez
- Department of Cardiology, University Hospital Puerta del Mar, Cádiz, Spain
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Interaction of Poly L-Lactide and Tungsten Disulfide Nanotubes Studied by in Situ X-ray Scattering during Expansion of PLLA/WS 2NT Nanocomposite Tubes. Polymers (Basel) 2021; 13:polym13111764. [PMID: 34072208 PMCID: PMC8198810 DOI: 10.3390/polym13111764] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/19/2021] [Accepted: 05/24/2021] [Indexed: 11/27/2022] Open
Abstract
In situ synchrotron X-ray scattering was used to reveal the transient microstructure of poly(L-lactide) (PLLA)/tungsten disulfide inorganic nanotubes (WS2NTs) nanocomposites. This microstructure is formed during the blow molding process (“tube expansion”) of an extruded polymer tube, an important step in the manufacturing of PLLA-based bioresorbable vascular scaffolds (BVS). A fundamental understanding of how such a microstructure develops during processing is relevant to two unmet needs in PLLA-based BVS: increasing strength to enable thinner devices and improving radiopacity to enable imaging during implantation. Here, we focus on how the flow generated during tube expansion affects the orientation of the WS2NTs and the formation of polymer crystals by comparing neat PLLA and nanocomposite tubes under different expansion conditions. Surprisingly, the WS2NTs remain oriented along the extrusion direction despite significant strain in the transverse direction while the PLLA crystals (c-axis) form along the circumferential direction of the tube. Although WS2NTs promote the nucleation of PLLA crystals in nanocomposite tubes, crystallization proceeds with largely the same orientation as in neat PLLA tubes. We suggest that the reason for the unusual independence of the orientations of the nanotubes and polymer crystals stems from the favorable interaction between PLLA and WS2NTs. This favorable interaction leads WS2NTs to disperse well in PLLA and strongly orient along the axis of the PLLA tube during extrusion. As a consequence, the nanotubes are aligned orthogonally to the circumferential stretching direction, which appears to decouple the orientations of PLLA crystals and WS2NTs.
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10
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Song L, Xu B, Chen Y, Zhou Y, Jia S, Zhong Z, Su X, Ma Y, Zhang Q, Liu J, Wang Y, Guan C, Zheng M, Qiao S, Gao R. Thinner Strut Sirolimus-Eluting BRS Versus EES in Patients With Coronary Artery Disease: FUTURE-II Trial. JACC Cardiovasc Interv 2021; 14:1450-1462. [PMID: 34238555 DOI: 10.1016/j.jcin.2021.04.048] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/28/2021] [Accepted: 04/28/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of the present study was to evaluate the safety and efficacy of thinner strut Firesorb (100/125 μm) sirolimus-eluting bioresorbable scaffolds (BRS) versus cobalt-chromium everolimus-eluting stents (CoCr-EES) in patients with coronary artery disease. BACKGROUND First-generation thicker strut BRS were associated with unexpected device-related adverse outcomes at long-term follow-up. METHODS Eligible patients with 1 or 2 de novo noncomplex coronary lesions were randomized to the Firesorb BRS group or CoCr-EES group in a 1:1 ratio. The primary endpoint was 1-year angiographic in-segment late loss (LL), powered for noninferiority testing. The key secondary endpoint was the 1-year proportion of covered struts assessed on optical coherence tomography, powered for noninferiority and subsequent superiority testing. RESULTS A total of 433 participants from 28 Chinese centers were randomized to the Firesorb BRS group (n = 215) or CoCr-EES group (n = 218). Patient-level 1-year in-segment LL was 0.17 ± 0.27 mm in the Firesorb BRS group and 0.18 ± 0.37 mm in the CoCr-EES group (difference -0.01 mm; 95% confidence interval [CI]: -0.07 to 0.06; pnoninferiority < 0.0001) in the intention-to-treat population and was 0.17 ± 0.27 mm in the Firesorb BRS group and 0.19 ± 0.37 mm in the CoCr-EES group (difference -0.005 mm; 95% CI: -0.07 to 0.06; pnoninferiority < 0.0001) in the per-protocol set. The proportion of covered struts was 99.3% in the Firesorb BRS group and 98.8% in the CoCr-EES group (difference 0.8%; 95% CI: -0.5% to 2.1%; pnoninferiority < 0.0001; psuperiority = 0.21). One-year clinical outcomes were similar between groups. CONCLUSIONS The thinner strut Firesorb BRS was noninferior to the CoCr-EES for the primary endpoint of 1-year angiographic in-segment LL and the key secondary endpoint of 1-year proportion of covered struts by optical coherence tomography. (A Trial of Firesorb in Patients With Coronary Artery Disease: FUTURE-II [FUTURE-II]; NCT02890160).
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Affiliation(s)
- Lei Song
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Bo Xu
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China; Catheterization Laboratories, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Yundai Chen
- Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yujie Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shaobin Jia
- Department of Cardiology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Zhixiong Zhong
- Department of Cardiology, Meizhou People's Hospital, Meizhou, China
| | - Xi Su
- Department of Cardiology, Wuhan Asian Heart Hospital, Wuhan, China
| | - Yitong Ma
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Qi Zhang
- Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jian Liu
- Department of Cardiology, Peking University People's Hospital, Beijing, China
| | - Yang Wang
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Beijing, China
| | - Changdong Guan
- Catheterization Laboratories, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ming Zheng
- Shanghai MicroPort Medical (Group), Shanghai, China
| | - Shubin Qiao
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Runlin Gao
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Beijing, China.
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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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In vivo degradation and endothelialization of an iron bioresorbable scaffold. Bioact Mater 2020; 6:1028-1039. [PMID: 33102944 PMCID: PMC7566209 DOI: 10.1016/j.bioactmat.2020.09.020] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/22/2020] [Accepted: 09/22/2020] [Indexed: 12/18/2022] Open
Abstract
Detection of in vivo biodegradation is critical for development of next-generation medical devices such as bioresorbable stents or scaffolds (BRSs). In particular, it is urgent to establish a nondestructive approach to examine in vivo degradation of a new-generation coronary stent for interventional treatment based on mammal experiments; otherwise it is not available to semi-quantitatively monitor biodegradation in any clinical trial. Herein, we put forward a semi-quantitative approach to measure degradation of a sirolimus-eluting iron bioresorbable scaffold (IBS) based on optical coherence tomography (OCT) images; this approach was confirmed to be consistent with the present weight-loss measurements, which is, however, a destructive approach. The IBS was fabricated by a metal-polymer composite technique with a polylactide coating on an iron stent. The efficacy as a coronary stent of this new bioresorbable scaffold was compared with that of a permanent metal stent with the name of trade mark Xience, which has been widely used in clinic. The endothelial coverage on IBS was found to be greater than on Xience after implantation in a rabbit model; and our well-designed ultrathin stent exhibited less individual variation. We further examined degradation of the IBSs in both minipig coronary artery and rabbit abdominal aorta models. The present result indicated much faster iron degradation of IBS in the rabbit model than in the porcine model. The semi-quantitative approach to detect biodegradation of IBS and the finding of the species difference might be stimulating for fundamental investigation of biodegradable implants and clinical translation of the next-generation coronary stents. A semi-quantitative OCT method was suggested to evaluate in vivo biodegradation of an iron based coronary stent IBS in a nondestructive manner. The in vivo biodegradation of IBS exhibited dependence on animal species. The endothelial coverage on the biodegradable stent IBS was better than on the commercialized nonbiodegradable stent Xience in rabbits.
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Toong DWY, Toh HW, Ng JCK, Wong PEH, Leo HL, Venkatraman S, Tan LP, Ang HY, Huang Y. Bioresorbable Polymeric Scaffold in Cardiovascular Applications. Int J Mol Sci 2020; 21:E3444. [PMID: 32414114 PMCID: PMC7279389 DOI: 10.3390/ijms21103444] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/06/2020] [Accepted: 05/08/2020] [Indexed: 12/12/2022] Open
Abstract
Advances in material science and innovative medical technologies have allowed the development of less invasive interventional procedures for deploying implant devices, including scaffolds for cardiac tissue engineering. Biodegradable materials (e.g., resorbable polymers) are employed in devices that are only needed for a transient period. In the case of coronary stents, the device is only required for 6-8 months before positive remodelling takes place. Hence, biodegradable polymeric stents have been considered to promote this positive remodelling and eliminate the issue of permanent caging of the vessel. In tissue engineering, the role of the scaffold is to support favourable cell-scaffold interaction to stimulate formation of functional tissue. The ideal outcome is for the cells to produce their own extracellular matrix over time and eventually replace the implanted scaffold or tissue engineered construct. Synthetic biodegradable polymers are the favoured candidates as scaffolds, because their degradation rates can be manipulated over a broad time scale, and they may be functionalised easily. This review presents an overview of coronary heart disease, the limitations of current interventions and how biomaterials can be used to potentially circumvent these shortcomings in bioresorbable stents, vascular grafts and cardiac patches. The material specifications, type of polymers used, current progress and future challenges for each application will be discussed in this manuscript.
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Affiliation(s)
- Daniel Wee Yee Toong
- School of Materials Science and Engineering, Nanyang Technological University, Nanyang Avenue, Singapore 639798, Singapore; (D.W.Y.T.); (L.P.T.)
| | - Han Wei Toh
- National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore; (H.W.T.); (J.C.K.N.); (P.E.H.W.)
- Department of Biomedical Engineering, National University of Singapore, 4 Engineering Drive 3, Singapore 117583, Singapore;
| | - Jaryl Chen Koon Ng
- National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore; (H.W.T.); (J.C.K.N.); (P.E.H.W.)
- Department of Biomedical Engineering, National University of Singapore, 4 Engineering Drive 3, Singapore 117583, Singapore;
| | - Philip En Hou Wong
- National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore; (H.W.T.); (J.C.K.N.); (P.E.H.W.)
- Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore 169857, Singapore
| | - Hwa Liang Leo
- Department of Biomedical Engineering, National University of Singapore, 4 Engineering Drive 3, Singapore 117583, Singapore;
| | - Subramanian Venkatraman
- Materials Science and Engineering, National University of Singapore, 9 Engineering Drive 1, Singapore 117575, Singapore;
| | - Lay Poh Tan
- School of Materials Science and Engineering, Nanyang Technological University, Nanyang Avenue, Singapore 639798, Singapore; (D.W.Y.T.); (L.P.T.)
| | - Hui Ying Ang
- National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore; (H.W.T.); (J.C.K.N.); (P.E.H.W.)
- Department of Biomedical Engineering, National University of Singapore, 4 Engineering Drive 3, Singapore 117583, Singapore;
| | - Yingying Huang
- School of Materials Science and Engineering, Nanyang Technological University, Nanyang Avenue, Singapore 639798, Singapore; (D.W.Y.T.); (L.P.T.)
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Comparison of clinical outcomes between Magmaris and Orsiro drug eluting stent at 12 months: Pooled patient level analysis from BIOSOLVE II–III and BIOFLOW II trials. Int J Cardiol 2020; 300:60-65. [DOI: 10.1016/j.ijcard.2019.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/30/2019] [Accepted: 11/04/2019] [Indexed: 11/23/2022]
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Kočka V, Toušek P, Kozel M, Buono A, Hajšl M, Lisa L, Buděšínský T, Malý M, Widimský P. Bioresorbable scaffold implantation in STEMI patients: 5 years imaging subanalysis of PRAGUE-19 study. J Transl Med 2020; 18:33. [PMID: 32000796 PMCID: PMC6993315 DOI: 10.1186/s12967-020-02230-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 01/14/2020] [Indexed: 11/10/2022] Open
Abstract
Background Bioresorbable scaffold (BRS) Absorb™ clinical use has been stopped due to higher rate of device thrombosis. Scaffold struts persist longer than 2 years in the vessel wall. Second generation devices are being developed. This study evaluates long-term invasive imaging in STEMI patients. Methods PRAGUE-19 study is an academic study enrolling consecutive STEMI patients with intention to implant Absorb™ BRS. A total of 83 STEMI patients between December 2012 and March 2014 fulfilled entry criteria. Coronary angiography and optical coherence tomography at 5 year follow-up was performed in 25 patients. Results Primary combined clinical endpoint (death, myocardial infarction or target vessel revascularization) occurred in 12.6% during the five-year follow-up with overall mortality 6.3%. Definite scaffold thrombosis occurred in 2 patients in the early phase after BRS implantation. Quantitative coronary angiography after 5 years demonstrated low late lumen loss of 0.11 ± 0.35 mm with binary restenosis rate of 0%. Optical coherence tomography demonstrated complete resorption of scaffold struts and mean lumen diameter of 3.25 ± 0.30 and 3.22 ± 0.49 (P = 0.73) at baseline and after 5 years, respectively. Three patients developed small coronary artery aneurysm in the treated segment. Conclusion Invasive imaging results 5 years after BRS implantation in STEMI showed complete resorption of scaffold struts and stable lumen vessel diameter. Trial registration ISRCTN43696201 (retrospectivelly registred, June 7th, 2019). https://www.isrctn.com/ISRCTN43696201.
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Affiliation(s)
- Viktor Kočka
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovské Vinohrady, Šrobárova 50, Prague 10, 100 34, Czech Republic
| | - Petr Toušek
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovské Vinohrady, Šrobárova 50, Prague 10, 100 34, Czech Republic.
| | - Martin Kozel
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovské Vinohrady, Šrobárova 50, Prague 10, 100 34, Czech Republic
| | - Andrea Buono
- Department of Cardiology, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Martin Hajšl
- Cardiovascular Center, First Faculty of Medicine, Charles University and Central Military Hospital Prague, Prague, Czech Republic
| | - Libor Lisa
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovské Vinohrady, Šrobárova 50, Prague 10, 100 34, Czech Republic
| | - Tomáš Buděšínský
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovské Vinohrady, Šrobárova 50, Prague 10, 100 34, Czech Republic
| | - Martin Malý
- Cardiovascular Center, First Faculty of Medicine, Charles University and Central Military Hospital Prague, Prague, Czech Republic
| | - Petr Widimský
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovské Vinohrady, Šrobárova 50, Prague 10, 100 34, Czech Republic
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Song L, Sun Z, Guan C, Yan H, Yu M, Cui J, Mu C, Qiu H, Tang Y, Zhao Y, Qiao S, Suryapranata H, Gao R, Xu B. First-in-man study of a thinner-strut sirolimus-eluting bioresorbable scaffold (FUTURE-I): Three-year clinical and imaging outcomes. Catheter Cardiovasc Interv 2020; 95 Suppl 1:648-657. [PMID: 31909884 DOI: 10.1002/ccd.28722] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 12/25/2019] [Accepted: 12/31/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The FUTURE-I study aimed to assess preliminary safety and effectiveness with the long-term clinical and imaging follow-up for the Firesorb (MicroPort, Shanghai, China), a thinner-strut sirolimus-eluting bioresorbable scaffold (BRS). BACKGROUND First-generation BRS has been associated with unexpected device-related adverse outcomes at long-term follow-up. METHODS In this prospective, open-label, first-in-man study, patients with single de novo lesions in native coronary arteries were randomized 2:1 into two cohorts after successful Firesorb implantation: cohort 1 (n = 30) underwent multimodality imaging assessment at 6 and 24 months; and cohort 2 (n = 15) at 12 and 36 months. All patients underwent clinical follow-up at 1, 6, and 12 months and annually up to 5 years. RESULTS Between January and March 2016, 45 patients were enrolled. At 3-year follow-up, one patient had experienced target lesion failure and none scaffold thrombosis. In-scaffold minimal lumen diameter decreased significantly from 6-month to 2-year (2.53 ± 0.24 mm vs. 2.27 ± 0.37 mm, p = .0003), and only numerically from 1-year to 3-year follow-up (2.48 ± 0.28 mm vs. 2.22 ± 0.13 mm, p = .08). By optical coherence tomography, neointimal strut coverage at 3-year follow-up was 99.8%, and very low rate of late scaffold discontinuity was observed, only in one patient on two cross sections with three malapposed struts. CONCLUSIONS At 3-year follow-up of the FUTURE-I study, implantation of the thinner-strut Firesorb BRS appeared preliminary feasible and effective in the treatment of patients with noncomplex coronary lesions.
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Affiliation(s)
- Lei Song
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhongwei Sun
- Catheterization Laboratories, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Changdong Guan
- Catheterization Laboratories, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Hongbing Yan
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China.,National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Mengyue Yu
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Jingang Cui
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Chaowei Mu
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Hong Qiu
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Yida Tang
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China.,National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Yanyan Zhao
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Beijing, China
| | - Shubin Qiao
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China.,National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Harry Suryapranata
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Runlin Gao
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China.,National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Bo Xu
- Catheterization Laboratories, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China.,National Clinical Research Center for Cardiovascular Diseases, Beijing, China
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Caixeta A, Campos CM, Felix C, Chieffo A, Capranzano P, Kawamoto H, Tamburino C, Diletti R, de Ribamar Costa J, Onuma Y, van Geuns RJ, Bartorelli AL, Colombo A, Tamburino C, Serruys PW, Abizaid A. Predictors of long-term adverse events after Absorb bioresorbable vascular scaffold implantation: a 1,933-patient pooled analysis from international registries. EUROINTERVENTION 2019; 15:623-630. [DOI: 10.4244/eij-d-16-00796] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Gheorghe L, Millán X, Jimenez-Kockar M, Gomez-Lara J, Arzamendi D, Danduch L, Agudelo V, Serra A. Bioresorbable vascular scaffolds in coronary chronic total occlusions: clinical, vasomotor and optical coherence tomography findings at three-year follow-up (ABSORB-CTO study). EUROINTERVENTION 2019; 15:99-107. [DOI: 10.4244/eij-d-18-00567] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Ozaki Y, Garcia-Garcia HM, Hideo-Kajita A, Kuku KO, Haude M, Ince H, Abizaid A, Tölg R, Lemos PA, von Birgelen C, Christiansen EH, Wijns W, Escaned J, Dijkstra J, Waksman R. Impact of procedural characteristics on coronary vessel wall healing following implantation of second-generation drug-eluting absorbable metal scaffold in patients with de novo coronary artery lesions: an optical coherence tomography analysis. Eur Heart J Cardiovasc Imaging 2018; 20:916-924. [DOI: 10.1093/ehjci/jey210] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 11/27/2018] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
Second-generation drug-eluting absorbable metal scaffold (DREAMS 2G) is an alternative novel device for treating coronary lesions. However, the relationship between in-scaffold dimensions after implantation of DREAMS 2G and vessel healing and luminal results at follow-up is unknown. The aim of this study is, therefore, to investigate whether the expansion index after implantation of DREAMS 2G as assessed by optical coherence tomography (OCT) impacts late luminal status and healing of the vessel wall.
Methods and results
This study comprises of a total 65 out of 123 patients who were enrolled in the BIOSOLVE-II trial. We assessed both qualitative and quantitative OCT findings and the expansion index of DREAMS 2G after implantation frame by frame using OCT. Expansion index was defined as minimum scaffold area/mean reference lumen area. The over-expansion group was also defined with expansion index >1.0. The total number of analysed frames at post-procedure and 6-month follow-up was 8243 and 8263 frames, respectively. At 6-month follow-up, in-scaffold healing was documented by the reduction of 82% in dissections, 93% in attached intra-luminal mass (ILM), 65% in non-attached ILM, and 76% in jailed side branch. The over-expansion group had significantly greater in-scaffold luminal volume loss (LVL) compared with the non-over-expansion group [over-expansion: 35.0 (18.5–52.1) mm3 vs. non-over-expansion: 21.0 (11.6–37.9) mm3, P = 0.039].
Conclusion
Excellent in vivo healing process after implantation of DREAMS 2G was observed at 6 months. We found that higher expansion indices were associated with higher in-scaffold LVL at 6 months assessed by OCT.
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Affiliation(s)
- Yuichi Ozaki
- Section of Interventional Cardiology, MedStar Washington Hospital Center, 110 Irving Street NW, Suite 4B-1, Washington, DC, USA
- Section of Interventional Cardiology, MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, Washington, DC, USA
| | - Hector M Garcia-Garcia
- Section of Interventional Cardiology, MedStar Washington Hospital Center, 110 Irving Street NW, Suite 4B-1, Washington, DC, USA
- Section of Interventional Cardiology, MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, Washington, DC, USA
| | - Alexandre Hideo-Kajita
- Section of Interventional Cardiology, MedStar Washington Hospital Center, 110 Irving Street NW, Suite 4B-1, Washington, DC, USA
- Section of Interventional Cardiology, MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, Washington, DC, USA
| | - Kayode O Kuku
- Section of Interventional Cardiology, MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, Washington, DC, USA
| | - Michael Haude
- Medical Clinic I, Städtische Kliniken Neuss, Lukaskrankenhaus GmbH, Neuss, Germany
| | - Hüseyin Ince
- Department of Cardiology, Vivantes Klinikum im Friedrichschain and Am Urban, Berlin, Germany
| | | | - Ralph Tölg
- Herzzentrum Segeberger Kliniken GmbH, Bad Segeberg, Germany
| | - Pedro Alves Lemos
- Instituto do Coração – HCFMUSP, University of Sao Paulo, São Paulo, Brazil
| | - Clemens von Birgelen
- Department of Cardiology, Medisch Spectrum Twente, Thoraxcentrum Twente, Enschede, the Netherlands
| | | | - William Wijns
- Cardiology Department, Cardiovascular Research Center Aalst, OLV Hospital, Aalst, Belgium
| | - Javier Escaned
- Department of Cardiology, Hospital Clinico San Carlos, Madrid, Spain
| | | | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, 110 Irving Street NW, Suite 4B-1, Washington, DC, USA
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In vivo serial invasive imaging of the second-generation drug-eluting absorbable metal scaffold (Magmaris — DREAMS 2G) in de novo coronary lesions: Insights from the BIOSOLVE-II First-In-Man Trial. Int J Cardiol 2018; 255:22-28. [DOI: 10.1016/j.ijcard.2017.12.053] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 12/07/2017] [Accepted: 12/16/2017] [Indexed: 02/04/2023]
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Scaffold thrombosis following implantation of the ABSORB BVS in routine clinical practice: Insight into possible mechanisms from optical coherence tomography. Catheter Cardiovasc Interv 2018; 92:E106-E114. [DOI: 10.1002/ccd.27475] [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] [Received: 08/01/2017] [Revised: 10/28/2017] [Accepted: 11/25/2017] [Indexed: 11/07/2022]
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Qiu TY, Song M, Zhao LG. A computational study of crimping and expansion of bioresorbable polymeric stents. MECHANICS OF TIME-DEPENDENT MATERIALS 2017; 22:273-290. [PMID: 29962898 PMCID: PMC6003387 DOI: 10.1007/s11043-017-9371-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 10/12/2017] [Indexed: 06/08/2023]
Abstract
This paper studied the mechanical performance of four bioresorbable PLLA stents, i.e., Absorb, Elixir, Igaki-Tamai and RevaMedical, during crimping and expansion using the finite element method. Abaqus CAE was used to create the geometrical models for the four stents. A tri-folded balloon was created using NX software. For the stents, elastic-plastic behaviour was used, with hardening implemented by considering the increase of yield stress with the plastic strain. The tri-folded balloon was treated as linear elastic. To simulate the crimping of stents, a set of 12 rigid plates were generated around the stents with a radially enforced displacement. During crimping, the stents were compressed from a diameter of 3 mm to 1.2 mm, with the maximum stress developed at both inner and outer sides of the U-bends. During expansion, the stent inner diameter increased to 3 mm at the peak pressure and then recoiled to different final diameters after balloon deflation due to different stent designs. The maximum stress was found again at the U-bends of stents. Diameter change, recoiling effect and radial strength/stiffness were also compared for the four stents to assess the effect of design variation on stent performance. The effect of loading rate on stent deformation was also simulated by considering the time-dependent plastic behaviour of polymeric material.
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Affiliation(s)
- T. Y. Qiu
- Wolfson School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University, Loughborough, LE11 3TU UK
| | - M. Song
- Department of Materials, Loughborough University, Loughborough, LE11 3TU UK
| | - L. G. Zhao
- Wolfson School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University, Loughborough, LE11 3TU UK
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Ang HY, Huang YY, Lim ST, Wong P, Joner M, Foin N. Mechanical behavior of polymer-based vs. metallic-based bioresorbable stents. J Thorac Dis 2017; 9:S923-S934. [PMID: 28894598 PMCID: PMC5583085 DOI: 10.21037/jtd.2017.06.30] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 05/18/2017] [Indexed: 11/06/2022]
Abstract
Bioresorbable scaffolds (BRS) were developed to overcome the drawbacks of current metallic drug-eluting stents (DES), such as late in-stent restenosis and caging of the vessel permanently. The concept of the BRS is to provide transient support to the vessel during healing before being degraded and resorbed by the body, freeing the vessel and restoring vasomotion. The mechanical properties of the BRS are influenced by the choice of the material and processing methods. Due to insufficient radial strength of the bioresorbable material, BRS often required large strut profile as compared to conventional metallic DES. Having thick struts will in turn affect the deliverability of the device and may cause flow disturbance, thereby increasing the incidence of acute thrombotic events. Currently, the bioresorbable poly-l-lactic acid (PLLA) polymer and magnesium (Mg) alloys are being investigated as materials in BRS technologies. The bioresorption process, mechanical properties, in vitro observations and clinical outcomes of PLLA-based and Mg-based BRS will be examined in this review.
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Affiliation(s)
- Hui Ying Ang
- National Heart Centre Singapore, Singapore, Singapore
| | - Ying Ying Huang
- School of Materials Science and Engineering, Nanyang Technological University, Singapore, Singapore
| | - Soo Teik Lim
- National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Philip Wong
- National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Michael Joner
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Nicolas Foin
- National Heart Centre Singapore, Singapore, Singapore
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Conformability in everolimus-eluting bioresorbable scaffolds compared with metal platform coronary stents in long lesions. Int J Cardiovasc Imaging 2017; 33:1863-1871. [PMID: 28685314 PMCID: PMC5698382 DOI: 10.1007/s10554-017-1193-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 06/13/2017] [Indexed: 10/27/2022]
Abstract
The aim of this study was to determine if there are significant differences in curvature of the treated vessel after the deployment of a polymeric BRS or MPS in long lesions. The impact of long polymeric bioresorbable scaffolds (BRS) compared with metallic platform stents (MPS) on vessel curvature is unknown. This retrospective study compares 32 patients who received a single everolimus-eluting BRS with 32 patients treated with a single MPS of 28 mm. Quantitative coronary angiography (QCA) was used to evaluate curvature of the treatment and peri-treatment region before and after percutaneous coronary intervention (PCI). Baseline demographic and angiographic characteristics were similar between the BRS and MPS groups. Pretreatment lesion length was 22.19 versus 20.38 mm in the BRS and MPS groups respectively (p = 0.803). After treatment, there was a decrease in median diastolic curvature in the MPS group (from 0.257 to 0.199 cm-1, p = 0.001). A similar trend was observed in the BRS group but did not reach statistical significance (median diastolic curvature from 0.305 to 0.283 cm-1, p = 0.056). Median Percentage relative change in diastolic curvature was lower in the BRS group compared with the MPS group (BRS vs. MPS: 7.48 vs. 29.4%, p = 0.013). By univariate analysis, use of MPS was an independent predictor of change in diastolic curvature (p = 0.022). In the deployment of long coronary scaffolds/stents (28 mm in length), BRS provides better conformability compared with MPS.
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26
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Shen L, Wu Y, Ge L, Zhang Y, Wang Q, Qian J, Qiu Z, Ge J. A head to head comparison of XINSORB bioresorbable sirolimus-eluting scaffold versus metallic sirolimus-eluting stent: 180 days follow-up in a porcine model. Int J Cardiovasc Imaging 2017. [DOI: 10.1007/s10554-017-1148-5] [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: 10/19/2022]
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27
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Haude M, Erbel R, Erne P, Verheye S, Degen H, Vermeersch P, Weissman N, Prati F, Bruining N, Waksman R, Koolen J. Safety and performance of the DRug-Eluting Absorbable Metal Scaffold (DREAMS) in patients with de novo coronary lesions: 3-year results of the prospective, multicentre, first-in-man BIOSOLVE-I trial. EUROINTERVENTION 2017; 12:e160-6. [PMID: 27290675 DOI: 10.4244/eij-d-15-00371] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIMS Bioresorbable scaffolds were designed to overcome the limitations of permanent stents. In the BIOSOLVE-I study we aimed to assess the long-term safety and performance of a drug-eluting absorbable metal scaffold (DREAMS) at three years. METHODS AND RESULTS In this prospective, multicentre first-in-man study, 46 patients with 47 de novo lesions were enrolled. We report the final results at three-year follow-up. Mean age was 65.3±9.7 years, lesions were 2.73±0.48 mm in diameter and 10.99±4.59 mm long. Follow-up at three years was available for 44 patients (one patient died of a non-cardiac cause and one patient withdrew consent). Three target lesion failures (TLF) occurred (6.6%), consisting of two clinically driven target lesion revascularisations at scheduled six-month angiography (4.3%) and one myocardial infarction after drug-eluting balloon treatment in a non-target lesion but target vessel at 12-month angiography (2.2%). No cardiac death or scaffold thrombosis occurred. Seven patients had additional angiographic follow-up at 28±4 months: in-scaffold late lumen loss had improved from 0.51±0.46 mm (median 0.28 mm) at 12 months to 0.32±0.32 mm (median 0.20 mm). CONCLUSIONS The BIOSOLVE-I study showed excellent long-term outcomes at three years with a low TLF rate and no cardiac death or scaffold thrombosis. No TLF event was observed beyond 377 days.
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Affiliation(s)
- Michael Haude
- Medical Clinic I, Städtische Kliniken-Neuss, Lukaskrankenhaus GmbH, Neuss, Germany
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Campos CM, Caixeta A, Franken M, Bartorelli AL, Whitbourn RJ, Wu CJ, Li Paul Kao H, Rosli MA, Carrie D, De Bruyne B, Stone GW, Serruys PW, Abizaid A. Risk and timing of clinical events according to diabetic status of patients treated with everolimus-eluting bioresorbable vascular scaffolds versus everolimus-eluting stent: 2-year results from a propensity score matched comparison of ABSORB EXTEND and SPIRIT trials. Catheter Cardiovasc Interv 2017; 91:387-395. [PMID: 28471086 DOI: 10.1002/ccd.27109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 03/01/2017] [Accepted: 03/25/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVES to compare the occurrence of clinical events in diabetics treated with the Absorb bioresorbable vascular scaffold (Absorb BVS; Abbott Vascular, Santa Clara, CA) versus everolimus-eluting metal stents (EES; XIENCE V; Abbott Vascular, Santa Clara, CA) BACKGROUND: There are limited data dedicated to clinical outcomes of diabetic patients treated with bioresorbable scaffolds (BRS) at 2-year horizon. METHODS The present study included 812 patients in the ABSORB EXTEND study in which a total of 215 diabetic patients were treated with Absorb BVS. In addition, 882 diabetic patients treated with EES in pooled data from the SPIRIT clinical program (SPIRIT II, SPIRIT III and SPIRIT IV trials) were used for comparison by applying propensity score matching using 29 different variables. The primary endpoint was ischemia driven major adverse cardiac events (ID-MACE), including cardiac death, myocardial infarction (MI), and ischemia driven target lesion revascularization (ID-TLR). RESULTS After 2 years, the ID-MACE rate was 6.5% in the Absorb BVS vs. 8.9% in the Xience group (P = 0.40). There was no difference for MACE components or definite/probable device thrombosis (HR: 1.43 [0.24,8.58]; P = 0.69). The occurrence of MACE was not different for both diabetic status (insulin- and non-insulin-requiring diabetes) in all time points up to the 2-year follow-up for the Absorb and Xience groups. CONCLUSION In this largest ever patient-level pooled comparison on the treatment of diabetic patients with BRS out to two years, individuals with diabetes treated with the Absorb BVS had a similar rate of MACE as compared with diabetics treated with the Xience EES. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Carlos M Campos
- Department of Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Adriano Caixeta
- Department of Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Marcelo Franken
- Department of Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Robert J Whitbourn
- Department of Cardiology, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Chiung-Jen Wu
- Department of Cardiology, Chang Gung Memorial Hospital, Niao-Sung Hsiang, Taiwan
| | - Hsien Li Paul Kao
- Department of Cardiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Mohd Ali Rosli
- Department of Cardiology, Institute Jantung Negara, Kuala Lumpur, Malaysia
| | - Didier Carrie
- Department of Cardiology, Hôpital de Rangueil CHU, Toulouse, France
| | | | - Gregg W Stone
- Department of Interventional Cardiology, Columbia University Medical Center, New York.,Cardiovascular Research Foundation, New York
| | - Patrick W Serruys
- International Centre for Circulatory Health, NHLI, Imperial College London, United Kingdom
| | - Alexandre Abizaid
- Department of Interventional Cardiology, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
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Toušek P, Kočka V, Malý M, Kozel M, Petr R, Hajsl M, Jarkovský J, Lisa L, Buděšínský T, Widimský P. Long-term follow-up after bioresorbable vascular scaffold implantation in STEMI patients: PRAGUE-19 study update. EUROINTERVENTION 2017; 12:23-9. [PMID: 27173858 DOI: 10.4244/eijv12i1a5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Early clinical results after implantation of bioresorbable vascular scaffolds (BVS) in ST-elevation myocardial infarction (STEMI) are encouraging, but long-term data are missing. This study evaluates long-term outcome in STEMI patients with implanted BVS. METHODS AND RESULTS The PRAGUE-19 study is an academic study enrolling consecutive STEMI patients with the intention to implant BVS. A total of 580 STEMI patients were screened between December 2012 and March 2015; 117 patients fulfilled entry criteria and BVS was successfully implanted in 114 (97%) of them. The primary combined clinical endpoint (death, reinfarction or target vessel revascularisation) occurred in 11.5% during the mean follow-up period of 730±275 days with overall mortality of 4.4%. Definite scaffold thrombosis occurred in two patients in the early phase after BVS implantation; there was no late thrombosis. Quantitative coronary angiography (10 patients) at three years demonstrated late lumen loss of 0.2±0.33 mm and optical coherence tomography showed minimal lumen area of 5.3±1.37 mm2 and neointimal hyperplasia area of 2.9±0.48 mm2. BVS struts were still visible at three years and 99.4% of them were well apposed and covered. CONCLUSIONS Encouraging clinical and imaging results after BVS implantation in STEMI patients persist during long-term follow-up.
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Affiliation(s)
- Petr Toušek
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
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Long-term in vivo corrosion behavior, biocompatibility and bioresorption mechanism of a bioresorbable nitrided iron scaffold. Acta Biomater 2017; 54:454-468. [PMID: 28315492 DOI: 10.1016/j.actbio.2017.03.020] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 02/11/2017] [Accepted: 03/13/2017] [Indexed: 01/05/2023]
Abstract
Pure iron as a potential bioresorbable material for bioresorbable coronary scaffold has major disadvantages of slow corrosion and bioresorption. However, so far, there are neither quantitative data of long-term in vivo corrosion nor direct experimental evidence for bioresorption of pure iron and its alloys, which are fundamental and vital for developing novel Fe-based alloys overcoming the intrinsic drawbacks of pure iron. This work systemically investigated scaffold performance, long-term in vivo corrosion behavior and biocompatibility of a nitrided iron coronary scaffold and explored its bioresorption mechanism. It was found that the 70μm Fe-based scaffold was superior to a state of the art Co-Cr alloy stent (Xience Prime™) in terms of crossing profile, recoil and radial strength. Mass loss was 76.0±8.5wt% for the nitrided iron scaffold and 44.2±11.4wt% for the pure iron scaffold after 36months implantation in rabbit abdominal aorta (p<0.05). The Fe-based scaffold showed good long-term biocompatibility in both rabbit and porcine model. Its insoluble corrosion products were demonstrated biosafe and could be cleared away by macrophages from in situ to adventitia to be indiscernible by Micro Computed Tomography and probably finally enter the lymphatics and travel to lymph nodes after 53months implantion in porcine coronary artery. The results indicate that the nitrided iron scaffold with further improvements shall be promising for coronary application. STATEMENT OF SIGNIFICANCE Pure iron as a potential bioresorbable material has major disadvantages of slow corrosion and bioresorption. However, so far, there are neither quantitative data of long-term in vivo corrosion nor direct experimental evidence for bioresorption of pure iron and its alloys. Only this work systemically investigated long-term in vivo corrosion behavior and biocompatibility of a nitrided iron coronary scaffold up to 53months after implantation and explored its bioresorption mechanism. These are fundamental and vital for developing novel Fe-based alloys overcoming the intrinsic drawbacks of pure iron. Novel testing and section-preparing methods were also provided in this work to facilitate future research and development of novel Fe-based alloy scaffolds.
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31
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Bioresorbable vascular scaffolds in coronary chronic total occlusions revascularization: safety assessment related to struts coverage and apposition in 6-month OCT follow-up. Heart Vessels 2017; 32:1077-1084. [PMID: 28432385 DOI: 10.1007/s00380-017-0980-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 04/14/2017] [Indexed: 10/19/2022]
Abstract
Beneficial properties of bioresorbable vascular scaffolds (BVS) regarding to vasomotility restoration and no caging of the vessel make them attractive devices in chronic total occlusions (CTO) revascularization. However, more evidence is needed attending to their use in this specific setting. We aim to determine feasibility and safety of BVS use in CTO revascularization attending to struts coverage and apposition, as well as re-stenosis and stent thrombosis (ST) rates. 29 BVS were deployed in 9 CTO lesions revascularization (mean J-CTO score ≥3) with an acute procedural success rate of 100%. Clinical and angiographic follow-up was performed 6 months later, including intracoronary analyses from optical coherence tomography (OCT) images. 44,723 struts were analyzed within the total 636 mm of scaffolded vessel. Mean length scaffolded per lesion was 70.66 ± 31.01 mm with a mean number of 3.22 BVS. 2051 struts (4.59%) were identified as uncovered, being most of them (98.4%) neither malapposed nor disrupted. Mean thickness of struts' coverage was 0.13 ± 0.05 mm. Incomplete strut apposition (ISA) percentage was 0% as no malapposed struts were detected and 134 struts were identified as disrupted, which represents a 0.29% from the total. Mean vessel, scaffold, and lumen diameters were 3.87 ± 0.51, 2.97 ± 0.49, and 2.68 ± 0.50 mm, respectively. Neither in-stent re-stenosis nor ST was detected. During follow-up, none of our patients died, suffered from stroke or needed target lesion revascularization. Clinical and angiographic 6-month follow-up (including OCT analyses) of BVS in CTO revascularization suggests their effectiveness and safety, even in very complex chronic occluded lesions. Nevertheless, more evidence is needed.
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32
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Ang HY, Bulluck H, Wong P, Venkatraman SS, Huang Y, Foin N. Bioresorbable stents: Current and upcoming bioresorbable technologies. Int J Cardiol 2017; 228:931-939. [DOI: 10.1016/j.ijcard.2016.11.258] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 11/09/2016] [Accepted: 11/10/2016] [Indexed: 12/24/2022]
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Chamié D, Garcia-Garcia H, Costa RA, Onuma Y, Abizaid A, Serruys PW. Role of invasive imaging in acute and long-term assessment of bioresorbable scaffold technology. Catheter Cardiovasc Interv 2016; 88:38-53. [PMID: 27797463 DOI: 10.1002/ccd.26815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 10/01/2016] [Indexed: 11/11/2022]
Abstract
Fully bioresorbable scaffolds (BRS) represent a novel approach for the percutaneous treatment of coronary artery stenosis, providing temporary vessel scaffolding with drug-eluting capability during the restenosis-prone phase of the vascular healing. Beyond this initial critical period, when mechanical scaffolding support is no longer necessary, the device is bioresorbed, restoring the normal vascular physiology with the aim to eliminate the long-term safety concerns related to permanent metallic implants. Nonetheless, current BRS technology suffers from limited mechanical properties as compared to available metallic platforms, requiring careful attention to lesion preparation, accurate vessel sizing, and implantation technique. Intravascular imaging has played an important role in providing knowledge on the acute effects after BRS deployment, and it helped refine the current technique of BRS implantation. In addition, extensive work with multiple intravascular imaging modalities have also contributed to the understanding of the unique dynamic vascular changes that are experienced in the treated segment from post-implantation up to complete device bioresorption. In this manuscript, we review the role of invasive imaging modalities-from angiography to sound- and light-based techniques-to guide BRS implantation procedures, to assess its acute results postimplantation, and the changes experienced in the long-term until complete bioresorption has ensued. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Daniel Chamié
- Department of Interventional Cardiology, Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil. .,Cardiovascular Research Center, Sao Paulo, Brazil.
| | - Hector Garcia-Garcia
- Department of Interventional Cardiology, MedStar Heart and Vascular Institute, Washington, DC
| | - Ricardo A Costa
- Department of Interventional Cardiology, Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil.,Cardiovascular Research Center, Sao Paulo, Brazil
| | - Yoshinobu Onuma
- Department of Interventional Cardiology, Erasmus University Medical Center, Thoraxcenter, Rotterdam, The Netherlands.,Cardialysis BV, Rotterdam, The Netherlands
| | - Alexandre Abizaid
- Department of Interventional Cardiology, Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil.,Cardiovascular Research Center, Sao Paulo, Brazil.,Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Patrick W Serruys
- NHLI, Imperial College London, International Centre for Circulatory Health, London, United Kingdom
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Zhang YJ, Wang XZ, Fu G, Jing QM, Wang G, Jin CY, Xie LH, Cai JZ, Xu B, Han YL. Clinical and multimodality imaging results at 6 months of a bioresorbable sirolimus-eluting scaffold for patients with single de novo coronary artery lesions: the NeoVas first-in-man trial. EUROINTERVENTION 2016; 12:1279-1287. [DOI: 10.4244/eijv12i10a209] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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35
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Ming Fam J, van Der Sijde JN, Karanasos A, Felix C, Diletti R, van Mieghem N, de Jaegere P, Zijlstra F, Jan van Geuns R, Regar E. Comparison of acute expansion of bioresorbable vascular scaffolds versus metallic drug-eluting stents in different degrees of calcification: An optical coherence tomography study. Catheter Cardiovasc Interv 2016; 89:798-810. [DOI: 10.1002/ccd.26676] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 07/03/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Jiang Ming Fam
- Thorax Centre; Erasmus University Medical Centre; Rotterdam Netherlands
- National Heart Centre Singapore
| | | | | | - Cordula Felix
- Thorax Centre; Erasmus University Medical Centre; Rotterdam Netherlands
| | - Roberto Diletti
- Thorax Centre; Erasmus University Medical Centre; Rotterdam Netherlands
| | | | - Peter de Jaegere
- Thorax Centre; Erasmus University Medical Centre; Rotterdam Netherlands
| | - Felix Zijlstra
- Thorax Centre; Erasmus University Medical Centre; Rotterdam Netherlands
| | | | - Evelyn Regar
- Thorax Centre; Erasmus University Medical Centre; Rotterdam Netherlands
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Prevalence of parameters of suboptimal scaffold deployment following angiographic guided bioresorbable vascular scaffold implantation in real world practice - an optical coherence tomography analysis. Int J Cardiol 2016; 220:32-42. [PMID: 27372040 DOI: 10.1016/j.ijcard.2016.06.096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 05/19/2016] [Accepted: 06/21/2016] [Indexed: 11/22/2022]
Abstract
AIM To assess the prevalence of suboptimal bioresorbable vascular scaffold (BVS, Abbott Vascular, Santa Clara, California) deployment in real world practice with intracoronary optical coherence tomography (OCT) imaging. METHODS Consecutive patients who underwent percutaneous coronary intervention using BVS and the final optimization assessed with OCT imaging in two tertiary care centers between December 2012 and February 2015 were evaluated for parameters of suboptimal scaffold deployment by OCT. RESULTS Overall, 36 scaffolds were implanted in 27 patients during this period. Mean age of the population was 54.7±8.2years and 19 (70.4%) were type B2/C lesions. The prevalence of parameters of suboptimal scaffold deployment were: underexpansion-22(61.1%), geographic miss-3(8.3%), tissue prolapse-7(25.9%), scaffold pattern irregularity-1(2.8%), longitudinal elongation-7(38.8%). Of the 7 overlaps imaged: excessive overlap was observed in 3 and scaffold gap in one. The median duration of follow up was 679days (range 193-963days). There were four events during this period. None were associated with suboptimal scaffold deployment. CONCLUSION OCT based parameters of suboptimal scaffold deployment are common in real world scenario and were not associated with adverse outcomes on long term follow up. These findings need to be confirmed in larger studies.
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Gonçalves PDA, Rodríguez-Granillo GA, Spitzer E, Suwannasom P, Loewe C, Nieman K, Garcia-Garcia HM. Functional Evaluation of Coronary Disease by CT Angiography. JACC Cardiovasc Imaging 2016; 8:1322-35. [PMID: 26563862 DOI: 10.1016/j.jcmg.2015.09.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 08/30/2015] [Accepted: 09/03/2015] [Indexed: 12/24/2022]
Abstract
In recent years, several technical developments in the field of cardiac computed tomography (CT) have made possible the extraction of functional information from an anatomy-based examination. Several different lines have been explored and will be reviewed in the present paper, namely: 1) myocardial perfusion imaging; 2) transluminal attenuation gradients and corrected coronary opacification indexes; 3) fractional flow reserve computed from CT; and 4) extrapolation from atherosclerotic plaque characteristics. In view of these developments, cardiac CT has the potential to become in the near future a truly 2-in-1 noninvasive evaluation for coronary artery disease.
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Affiliation(s)
| | - Gastón A Rodríguez-Granillo
- Department of Cardiovascular Imaging, Diagnostico Maipu, and Consejo Nacional de Investigaciones Cientificas y Tecnicas (CONICET), Buenos Aires, Argentina
| | | | | | - Christian Loewe
- Section of Cardiovascular and Interventional Radiology, Department of Bioimaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Koen Nieman
- Departments of Cardiology and Radiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Hector M Garcia-Garcia
- Cardialysis B.V., Rotterdam, the Netherlands; Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.
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Bioresorbable Coronary Scaffold Thrombosis: Multicenter Comprehensive Analysis of Clinical Presentation, Mechanisms, and Predictors. J Am Coll Cardiol 2016; 67:921-931. [PMID: 26916481 DOI: 10.1016/j.jacc.2015.12.019] [Citation(s) in RCA: 264] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 11/23/2015] [Accepted: 12/01/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Recent reports suggest an elevated incidence of bioresorbable vascular scaffold (BVS) thrombosis (scaffold thrombosis [ScT]). OBJECTIVES This study investigated occurrence rates, clinical and angiographic characteristics, and possible mechanisms of ScT in all-comer patients undergoing BVS implantation at 2 German and 2 Swiss hospitals. METHODS A total of 1,305 consecutive patients (mean age 64 years, 78% male) who received 1,870 BVS (mean 1.4 ± 0.8 BVS/patient) were enrolled. Clinical/procedural characteristics, mortality, and ScT data at 485 days (range 312 to 652 days) were examined. RESULTS ScT occurred in 42 patients. The incidence of probable and definite ScT was 1.8% at 30 days and 3.0% at 12 months, without differences among centers (p = 0.60). A total of 22 (52%) ScTs presented as ST-segment elevation myocardial infarction and 6 (17%) as sudden cardiac death. In multivariable analysis, ostial lesions (p = 0.049) and impaired left ventricular ejection fraction (p = 0.019) were independently associated with ScT. Nine (21%) of the ScTs occurred in patients who had suspended dual antiplatelet therapy, in 6 cases prematurely. Lower post-procedural minimum lumen and reference vessel diameters were hallmarks of ScT (all p < 0.0001). The risk of ScT appeared to rapidly increase for post-procedural minimum lumen diameters below 2.4 mm (for the 2.5- to 3.0-mm BVS) and 2.8 mm (for the 3.5-mm BVS). When a BVS-specific implantation strategy was implemented, 12-month ScT rates fell from 3.3% to 1.0%, an effect that remained significant when adjusted for multivariable propensity score (p = 0.012; hazard ratio: 0.19; 95% confidence interval: 0.05 to 0.70). CONCLUSIONS The 12-month incidence of ScT reached 3% and could be significantly reduced when an optimized implantation strategy was employed. (retrospective multicentric registry and Mainz Intracoronary Database. The Coronary Slow-flow and Microvascular Diseases Registry [MICAT]; NCT02180178).
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Rizik DG, Hermiller JB, Kereiakes DJ. The ABSORB bioresorbable vascular scaffold: A novel, fully resorbable drug-eluting stent: Current concepts and overview of clinical evidence. Catheter Cardiovasc Interv 2016; 86:664-77. [PMID: 26386235 DOI: 10.1002/ccd.26172] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 07/31/2015] [Accepted: 07/31/2015] [Indexed: 11/09/2022]
Abstract
The advent of fully bioresorbable stent technology and specifically the ABSORB™, a bioresorbable vascular scaffold (BVS) stent, is heralded as breakthrough technology in the current era of percutaneous coronary interventions. This article reviews the current understanding of this technology along with the clinical evidence from trials and registries of ABSORB BVS that included patients with both simple as well as more complex "real-world" coronary lesions. In addition, considering the current limitations of this device-mostly associated with the mechanical properties of the polymeric scaffold structure-a review of guidelines on successful implantation of the ABSORB BVS is presented. Although expert feedback suggests extensive use of this device in routine clinical practice outside the United States despite a paucity of data on long-term safety in this setting, attention to procedural details and implantation technique is obligatory to achieve optimal clinical outcomes.
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Affiliation(s)
- David G Rizik
- Director of Structural & Coronary Interventions, HonorHealth and Scottsdale Healthcare Hospital, Scottsdale, Arizona
| | - James B Hermiller
- Director of Interventional Cardiology and Director of Interventional Cardiology Fellowship, St. Vincent Heart Center of Indiana, Indianapolis, Indiana
| | - Dean J Kereiakes
- Medical Director of The Christ Hospital Heart and Vascular Center, Cincinnati, Ohio.,The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, Ohio
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Diletti R, van der Sijde J, Karanasos A, Fam JM, Felix C, van Mieghem NM, Regar E, Rapoza R, Zijlstra F, van Geuns RJ. Differential thrombotic prolapse burden in either bioresorbable vascular scaffolds or metallic stents implanted during acute myocardial infarction: The snowshoe effect: Insights from the maximal footprint analysis. Int J Cardiol 2016; 220:802-8. [PMID: 27394977 DOI: 10.1016/j.ijcard.2016.06.077] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 05/16/2016] [Accepted: 06/21/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND The hypothesized increased thrombus entrapment during bioresorbable vascular scaffold implantation in acute myocardial infarction, the so-called "snowshoe effect" has never been demonstrated. METHODS Patients enrolled in the BVS STEMI FIRST study matched with STEMI patients implanted with everolimus-eluting metal stents (EES) and undergoing optical coherence tomography (OCT) at the index procedure were compared. Quantitative coronary angiography analysis and optical coherence tomography data for evaluation of thrombotic prolapse were reported. Percentage maximal footprint (%MFP) analysis as an indicator of the snowshoe effect was performed. RESULTS A total of 302 patients were analyzed (151 with BVS and 151 with EES). Of those patients 30 implanted with BVS and 17 implanted with EES were imaged at the index procedure with OCT. Baseline clinical characteristics, TIMI-flow and thrombus burden were similar between groups. Aspiration thrombectomy was similarly performed in the two groups (BVS 83.3% vs 94.1% EES, p=0.405). At the end of the procedure, final TIMI 3 flow was achieved in 93.3% and 82.4% of BVS and EES patients respectively (p=0.296). The %MFP was significantly higher in the BVS treated patients (36.59±5.65% vs 17.61±4.30, p<0.001). The results of the OCT analysis showed a mean prolapse area (0.61±0.26mm(2) vs 0.90±0.31mm(2), p=0.001) and a percentage prolapse area (7.11±2.98mm(2) vs 9.98±2.90mm(2), p=0.002) significantly higher in the EES group. CONCLUSIONS Scaffold structural characteristics such as strut width may play a role in terms of thrombus dislodgment patterns and acute prolapsing material.
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Affiliation(s)
- Roberto Diletti
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.
| | - Jors van der Sijde
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Antonios Karanasos
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Jiang Ming Fam
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands; National Heart Centre Singapore, Singapore
| | - Cordula Felix
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Nicolas M van Mieghem
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Evelyn Regar
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | | | - Felix Zijlstra
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Robert Jan van Geuns
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
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Saad M, Abdin A, Thiele H, Desch S, Ibrahimi P, Wikstroem G, Hoeher M, Henein M. Bioresorbable Vascular Scaffolds in a Real-World Patient Population-Results From a Mid-Term Angiographic Follow-Up. J Interv Cardiol 2016; 29:341-7. [DOI: 10.1111/joic.12297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Mohammed Saad
- Department of Public Health and Clinical Medicine; Umea University; Umea Sweden
- Department of Cardiology; Klinikum Bayreuth; Bayreuth Germany
- Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine); University Heart Center Lübeck; Lübeck Germany
- German Center for Cardiovascular Research (DZHK); Partner Site Hamburg/Kiel/Luebeck; Lübeck Germany
| | - Amr Abdin
- Department of Cardiology; Klinikum Bayreuth; Bayreuth Germany
- Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine); University Heart Center Lübeck; Lübeck Germany
- German Center for Cardiovascular Research (DZHK); Partner Site Hamburg/Kiel/Luebeck; Lübeck Germany
| | - Holger Thiele
- Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine); University Heart Center Lübeck; Lübeck Germany
- German Center for Cardiovascular Research (DZHK); Partner Site Hamburg/Kiel/Luebeck; Lübeck Germany
| | - Steffen Desch
- Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine); University Heart Center Lübeck; Lübeck Germany
- German Center for Cardiovascular Research (DZHK); Partner Site Hamburg/Kiel/Luebeck; Lübeck Germany
| | - Pranvera Ibrahimi
- Department of Public Health and Clinical Medicine; Umea University; Umea Sweden
| | - Gerhard Wikstroem
- Department of Medical Sciences; Cardiology; Uppsala University; Uppsala Sweden
| | - Martin Hoeher
- Department of Cardiology; Klinikum Bayreuth; Bayreuth Germany
| | - Michael Henein
- Department of Public Health and Clinical Medicine; Umea University; Umea Sweden
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Abellas-Sequeiros RA, Ocaranza-Sanchez R, Galvão Braga C, Raposeiras-Roubin S, Lopez-Otero D, Cid-Alvarez B, Souto-Castro P, Trillo-Nouche R, Gonzalez-Juanatey JR. "Assessment of effectiveness and security in high pressure postdilatation of bioresorbable vascular scaffolds during percutaneous coronary intervention. Study in a contemporary, non-selected cohort of Spanish patients". Int J Cardiol 2016; 219:264-70. [PMID: 27343418 DOI: 10.1016/j.ijcard.2016.06.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 06/12/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To determine security and benefits of high pressure postdilatation (HPP) of bioresorbable vascular scaffolds (BVS) in percutaneous coronary intervention (PCI) of complex lesions whatever its indication is. BACKGROUND Acute scaffold disruption has been proposed as the main limitation of BVS when they are overexpanded. However, clinical implications of this disarray are not yet clear and more evidence is needed. METHODS A total of 25 BVS were deployed during PCI of 14 complex lesions after mandatory predilatation. In all cases HPP was performed with NC balloon in a 1:1 relation to the artery. After that, optical coherence tomography (OCT) analyses were performed. RESULTS Mean and maximal postdilatation pressure were 17±3.80 and 20 atmospheres (atm) respectively. Postdilatation balloon/scaffold diameter ratio was 1.01. A total of 39,590 struts were analyzed. Mean, minimal and maximal scaffold diameter were respectively: 3.09±0.34mm, 2.88±0.31mm and 3.31±0.40mm. Mean eccentricity index was 0.13±0.05. ISA percentage was 1.42% with a total of 564 malapposed struts. 89 struts were identified as disrupted, which represents a percentage of disrupted struts of 0.22%. At 30days, none of our patients died, suffered from stroke, stent thrombosis or needed target lesion revascularization (TLR). CONCLUSIONS NC balloon HPP of BVS at more than 17atm (up to 20atm) is safe during PCI and allows to achieve better angiographic and clinical results.
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Affiliation(s)
- Rosa A Abellas-Sequeiros
- Interventional Cardiology Unit, Universitary Clinical Hospital of Santiago de Compostela, 15706, Spain.
| | - Raymundo Ocaranza-Sanchez
- Interventional Cardiology Unit, Universitary Clinical Hospital of Santiago de Compostela, 15706, Spain
| | | | - Sergio Raposeiras-Roubin
- Interventional Cardiology Unit, Universitary Clinical Hospital of Santiago de Compostela, 15706, Spain
| | - Diego Lopez-Otero
- Interventional Cardiology Unit, Universitary Clinical Hospital of Santiago de Compostela, 15706, Spain
| | - Belen Cid-Alvarez
- Interventional Cardiology Unit, Universitary Clinical Hospital of Santiago de Compostela, 15706, Spain
| | - Pablo Souto-Castro
- Interventional Cardiology Unit, Universitary Clinical Hospital of Santiago de Compostela, 15706, Spain
| | - Ramiro Trillo-Nouche
- Interventional Cardiology Unit, Universitary Clinical Hospital of Santiago de Compostela, 15706, Spain
| | - Jose R Gonzalez-Juanatey
- Interventional Cardiology Unit, Universitary Clinical Hospital of Santiago de Compostela, 15706, Spain
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Lesiak M, Łanocha M, Araszkiewicz A, Siniawski A, Grygier M, Pyda M, Olasińska-Wiśniewska A, Iwanczyk S, Skorupski W, Mitkowski P, Lesiak MB, Grajek S. Percutaneous coronary intervention for chronic total occlusion of the coronary artery with the implantation of bioresorbable everolimus-eluting scaffolds. Poznan CTO-Absorb Pilot Registry. EUROINTERVENTION 2016; 12:e144-51. [DOI: 10.4244/eijv12i2a27] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Miyazaki T, Latib A, Ruparelia N, Kawamoto H, Sato K, Figini F, Colombo A. The use of a scoring balloon for optimal lesion preparation prior to bioresorbable scaffold implantation: a comparison with conventional balloon predilatation. EUROINTERVENTION 2016; 11:e1580-8. [DOI: 10.4244/eijv11i14a308] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Optical coherence tomography: A pathway from research to clinical practice. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2016; 17:71-3. [PMID: 26994745 DOI: 10.1016/j.carrev.2016.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Campos CM, Garcia-Garcia HM, Muramatsu T, de Araujo Gonçalves P, Onuma Y, Dudek D, Thuesen L, Webster MW, Kitslaar P, Veldhof S, Reiber JH, Nieman K, Ormiston JA, Serruys PW. Efecto del armazón bioabsorbible liberador de everolimus en la aterosclerosis coronaria. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2015.07.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Haude M, Ince H, Abizaid A, Toelg R, Lemos PA, von Birgelen C, Christiansen EH, Wijns W, Neumann FJ, Kaiser C, Eeckhout E, Lim ST, Escaned J, Garcia-Garcia HM, Waksman R. Safety and performance of the second-generation drug-eluting absorbable metal scaffold in patients with de-novo coronary artery lesions (BIOSOLVE-II): 6 month results of a prospective, multicentre, non-randomised, first-in-man trial. Lancet 2016; 387:31-9. [PMID: 26470647 DOI: 10.1016/s0140-6736(15)00447-x] [Citation(s) in RCA: 208] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Absorbable scaffolds were designed to overcome the limitations of conventional, non-absorbable metal-based drug-eluting stents. So far, only polymeric absorbable scaffolds are commercially available. We aimed to assess the safety and performance of a novel second-generation drug-eluting absorbable metal scaffold (DREAMS 2G) in patients with de-novo coronary artery lesions. METHODS We did this prospective, multicentre, non-randomised, first-in-man trial at 13 percutaneous coronary intervention centres in Belgium, Brazil, Denmark, Germany, Singapore, Spain, Switzerland, and the Netherlands. Eligible patients had stable or unstable angina or documented silent ischaemia, and a maximum of two de-novo lesions with a reference vessel diameter between 2·2 mm and 3·7 mm. Clinical follow-up was scheduled at months 1, 6, 12, 24, and 36. Patients were scheduled for angiographic follow-up at 6 months, and a subgroup of patients was scheduled for intravascular ultrasound, optical coherence tomography, and vasomotion assessment. All patients were recommended to take dual antiplatelet treatment for at least 6 months. The primary endpoint was in-segment late lumen loss at 6 months. We did analysis by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01960504. FINDINGS Between Oct 8, 2013, and May 22, 2015, we enrolled 123 patients with 123 coronary target lesions. At 6 months, mean in-segment late lumen loss was 0·27 mm (SD 0·37), and angiographically discernable vasomotion was documented in 20 (80%) of 25 patients. Intravascular ultrasound assessments showed a preservation of the scaffold area (mean 6·24 mm(2) [SD 1·15] post-procedure vs 6·21 mm(2) [1·22] at 6 months) with a low mean neointimal area (0·08 mm(2) [0·09]), and optical coherence tomography did not detect any intraluminal mass. Target lesion failure occurred in four (3%) patients: one (<1%) patient died from cardiac death, one (<1%) patient had periprocedural myocardial infarction, and two (2%) patients needed clinically driven target lesion revascularisation. No definite or probable scaffold thrombosis was observed. INTERPRETATION Our findings show that implantation of the DREAMS 2G device in de-novo coronary lesions is feasible, with favourable safety and performance outcomes at 6 months. This novel absorbable metal scaffold could be an alternative to absorbable polymeric scaffolds for treatment of obstructive coronary disease. FUNDING Biotronik AG.
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Affiliation(s)
- Michael Haude
- Medical Clinic I, Städtische Kliniken Neuss, Lukaskrankenhaus GmbH, Neuss, Germany.
| | - Hüseyin Ince
- Department of Cardiology, Vivantes Klinikum im Friedrichshain and Am Urban, Berlin, Germany
| | | | - Ralph Toelg
- Herzzentrum Segeberger Kliniken GmbH, Bad Segeberg, Germany
| | | | - Clemens von Birgelen
- Department of Cardiology, Medisch Spectrum Twente, Thoraxcentrum Twente, Enschede, Netherlands
| | | | - William Wijns
- Cardiology Department, Cardiovascular Research Center Aalst, OLV Hospital, Aalst, Belgium
| | - Franz-Josef Neumann
- Klinik für Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Christoph Kaiser
- Department of Cardiology, University Hospital, Basel, Switzerland
| | - Eric Eeckhout
- Department of Cardiology, Lausanne University Hospital, Switzerland
| | - Soo Teik Lim
- Department of Cardiology, National Heart Center Singapore, Singapore
| | - Javier Escaned
- Division of Cardiology, Hospital Clinico San Carlos, Madrid, Spain
| | | | - Ron Waksman
- Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
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Campos CM, Garcia-Garcia HM, Muramatsu T, de Araujo Gonçalves P, Onuma Y, Dudek D, Thuesen L, Webster MWI, Kitslaar P, Veldhof S, Reiber JHC, Nieman K, Ormiston JA, Serruys PW. Impact of the Everolimus-eluting Bioresorbable Scaffold in Coronary Atherosclerosis. ACTA ACUST UNITED AC 2015; 69:109-16. [PMID: 26739828 DOI: 10.1016/j.rec.2015.07.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 07/28/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION AND OBJECTIVES The Absorb bioresorbable vascular scaffold has been shown to decrease total plaque areas in the treated segment. However, it is unknown whether plaque size is modified in scaffolded segments only or whether the modification extends to other coronary segments. METHODS Absorb Cohort A is a single-arm, prospective study, with safety and imaging endpoints, in which 30 patients underwent percutaneous coronary intervention with the first generation Absorb bioresorbable vascular scaffold. Noninvasive multislice computed tomography imaging was performed in 18 patients at 18 months and 5 years of follow-up. The present study was an intrapatient comparison of matched segments (normalized by the segment length) of the scaffolded region with nonintervened segments for lumen volume, vessel volume, plaque volume, plaque burden, and percent change in plaque atheroma volume. RESULTS All 18 scaffolded segments could be analyzed. In the nonintervened segments, 1 of 72 segments had a motion artifact and was excluded. Serial comparison showed that the scaffolded segments showed no significant change in the mean plaque burden, total atheroma volume, total lumen volume, or vessel volume between 18 months and 5 years. Conversely, the untreated segments showed a significant increase in plaque burden (2.7 ± 6.5%; P < .01) and normalized plaque volumes (8.0 ± 22.8mm(3); P < .01). This resulted in a significant difference in plaque burden between scaffolded and nonintervened segments (P = .03). CONCLUSIONS In this small series, the Absorb bioresorbable vascular scaffold showed the potential to provide an additional benefit to pharmacological therapy in locally reducing progression of percent plaque burden. These findings need to be confirmed in larger studies.
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Affiliation(s)
- Carlos M Campos
- Department of Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, The Netherlands; Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil; Department of Interventional Cardiology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Hector M Garcia-Garcia
- Department of Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, The Netherlands.
| | - Takashi Muramatsu
- Department of Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, The Netherlands; Department of Cardiology, Fujita Health University Hospital, Toyoake, Japan
| | - Pedro de Araujo Gonçalves
- Cardiology Department, Hospital de Santa Cruz, CHLO, Lisbon, Portugal; Hospital da Luz, Cardiovascular Center, ESS, Lisbon, Portugal; CEDOC, Chronic Diseases Research Center, FCM-NOVA, Lisbon, Portugal
| | - Yoshinobu Onuma
- Department of Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, The Netherlands
| | | | - Leif Thuesen
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | | | - Pieter Kitslaar
- Medis Medical Imaging Systems, B.V., Leiden, The Netherlands; Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Johan H C Reiber
- Medis Medical Imaging Systems, B.V., Leiden, The Netherlands; Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Koen Nieman
- Department of Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, The Netherlands; Department of Radiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Patrick W Serruys
- International Centre for Circulatory Health, NHLI, Imperial College London, London, United Kingdom
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Campos CM, Suwannasom P, Nakatani S, Onuma Y, Serruys PW, Garcia-Garcia HM. Short- and Long-term Evaluation of Bioresorbable Scaffolds by Optical Coherence Tomography. Interv Cardiol Clin 2015; 4:333-349. [PMID: 28581949 DOI: 10.1016/j.iccl.2015.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The analysis of bioresorbable scaffolds (BRSs) by optical coherence tomography (OCT) requires a dedicated methodology, as the polymeric scaffold has a distinct appearance and undergoes dynamic structural changes with time. The high resolution of OCT allows for the detailed assessment of scaffold implantation, rupture, discontinuity, and strut integration. OCT does not provide reliable information on the extent of scaffold degradation, as it cannot differentiate between polylactide polymer and the provisional matrix of proteoglycan formed by connective tissue. Three-dimensional OCT reconstruction can aid in the evaluation of BRS in special scenarios such as overlapping scaffold segments and bifurcations.
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Affiliation(s)
- Carlos M Campos
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Dr. Molewaterplein 40, Rotterdam 3015 GD, The Netherlands; Department of Interventional Cardiology Heart Institute (InCor), University of São Paulo Medical School, Avenida Doutor Enéas de Carvalho Aguiar, 44 - Terceiro Andar, Sao Paulo 05403-900, Brazil
| | - Pannipa Suwannasom
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Dr. Molewaterplein 40, Rotterdam 3015 GD, The Netherlands
| | - Shimpei Nakatani
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Dr. Molewaterplein 40, Rotterdam 3015 GD, The Netherlands
| | - Yoshinobu Onuma
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Dr. Molewaterplein 40, Rotterdam 3015 GD, The Netherlands
| | - Patrick W Serruys
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Dr. Molewaterplein 40, Rotterdam 3015 GD, The Netherlands; International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, South Kensington Campus, London SW7 2AZ, UK
| | - Hector M Garcia-Garcia
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Dr. Molewaterplein 40, Rotterdam 3015 GD, The Netherlands; Medical Affairs, Cardialysis, Westblaak 98, Entrance B, Rotterdam 3012 KM, The Netherlands.
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