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Gao YN, Yang HT, Qiu ZF, Qi F, Lu QH, Zheng JF, Xi ZW, Wang X, Li L, Zhang G, Zhang DY, Lu YD, Qi HP, Qiu H, Gao RL, Zheng YF. Long-term efficacy, safety and biocompatibility of a novel sirolimus eluting iron bioresorbable scaffold in a porcine model. Bioact Mater 2024; 39:135-146. [PMID: 38783928 PMCID: PMC11112549 DOI: 10.1016/j.bioactmat.2024.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 04/19/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024] Open
Abstract
Iron is considered as an attractive alternative material for bioresorbable scaffolds (BRS). The sirolimus eluting iron bioresorbable scaffold (IBS), developed by Biotyx Medical (Shenzhen, China), is the only iron-based BRS with an ultrathin-wall design. The study aims to investigate the long-term efficacy, safety, biocompatibility, and lumen changes during the biodegradation process of the IBS in a porcine model. A total of 90 IBSs and 70 cobalt-chromium everolimus eluting stents (EES) were randomly implanted into nonatherosclerotic coronary artery of healthy mini swine. The multimodality assessments including coronary angiography, optical coherence tomography, micro-computed tomography, magnetic resonance imaging, real-time polymerase chain reaction (PCR), and histopathological evaluations, were performed at different time points. There was no statistical difference in area stenosis between IBS group and EES group at 6 months, 1year, 2 years and 5 years. Although the scaffolded vessels narrowed at 9 months, expansive remodeling with increased mean lumen area was found at 3 and 5 years. The IBS struts remained intact at 6 months, and the corrosion was detectable at 9 months. At 5 years, the iron struts were completely degraded and absorbed in situ, without in-scaffold restenosis or thrombosis, lumen collapse, aneurysm formation, and chronic inflammation. No local or systemic toxicity and abnormal histopathologic manifestation were found in all experiments. Results from real-time PCR indicated that no sign of iron overload was reported in scaffolded segments. Therefore, the IBS shows comparable efficacy, safety, and biocompatibility with EES, and late lumen enlargement is considered as a unique feature in the IBS-implanted vessels.
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Affiliation(s)
- Ya-Nan Gao
- Department of Cardio-Metabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong-Tao Yang
- School of Engineering Medicine, Beihang University, Beijing, China
| | - Zi-Feng Qiu
- Peking University Health Science Center, Beijing, China
| | - Feng Qi
- Department of Cardiology, Fuwai Yunnan Hospital, Chinese Academy of Medical Sciences, Affiliated Cardiovascular Hospital of Kunming Medical University, Kunming, China
| | - Qian-Hong Lu
- Department of Cardiology, Coronary Artery Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian-Feng Zheng
- Department of Cardiology, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Zi-Wei Xi
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Xin Wang
- Beijing Key Laboratory of Pre-clinical Research and Evaluation for Cardiovascular Implant Materials, Animal Experimental Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li Li
- Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Gui Zhang
- R&D Center, Biotyx Medical (Shenzhen) Co. Ltd., Shenzhen, China
| | - De-Yuan Zhang
- R&D Center, Biotyx Medical (Shenzhen) Co. Ltd., Shenzhen, China
| | - Yu-Die Lu
- R&D Center, Biotyx Medical (Shenzhen) Co. Ltd., Shenzhen, China
| | - Hai-Ping Qi
- R&D Center, Biotyx Medical (Shenzhen) Co. Ltd., Shenzhen, China
| | - Hong Qiu
- Department of Cardio-Metabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Run-Lin Gao
- Department of Cardiology, Coronary Artery Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu-Feng Zheng
- School of Materials Science and Engineering, Peking University, Beijing, China
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Muramatsu T, Onuma Y, Serruys PW. Bioresorbable Scaffolds - A Ray of Hope in the Darkness. Circ J 2024; 88:873-875. [PMID: 38631863 DOI: 10.1253/circj.cj-24-0219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Affiliation(s)
- Takashi Muramatsu
- Department of Cardiology, Cardiovascular Center, Fujita Health University Hospital
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Włodarczak A, Rola P, Włodarczak S, Szudrowicz M, Giniewicz K, Łanocha M, Jaroszewska-Pozorska J, Barycki M, Furtan Ł, Kędzierska M, Włodarczak P, Doroszko A, Lesiak M. Two-Year Outcomes for Patients with Non-ST-Elevation Acute Coronary Syndrome Treated with Magmaris and Absorb Bioresorbable Scaffolds in Large-Vessel Lesions. J Pers Med 2024; 14:540. [PMID: 38793122 PMCID: PMC11122016 DOI: 10.3390/jpm14050540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/09/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND The acute coronary syndrome (ACS) continues to be a fundamental indication for revascularization by percutaneous coronary intervention (PCI). Drug-eluting stent (DES) implantation remains a part of contemporary practice but permanent caging of the vascular structure with the metallic stent structure may increase the rate of device-related adverse clinical events. As an alternative to classic metallic DESs, the bioresorbable scaffolds (BRSs) have emerged as a temporary vascular support technology. We evaluated the mid-term outcomes of two generations of bioresorbable scaffolds-Absorb (Abbott-Vascular, Chicago, IL, USA) and Magmaris (Biotronik, Germany)-in patients with non-ST-elevation ACS. METHODS The study cohort consisted of 193 subjects after Magmaris implantation and 160 patients following Absorb implantation in large-vessel lesions. RESULTS At 2 years, a significantly lower rate of a primary outcome (cardiac death, myocardial infarction, stent thrombosis) was observed with Magmaris (5.2% vs. 15%; p = 0.002). In addition, we observed a significantly lower rate of MI in the target vessel (2.6% vs. 9.4%; p = 0.009) and a lower rate of scaffold thrombosis (0% vs. 3.7%; p = 0.008). The TLF rate between the two groups was not significantly different. CONCLUSION Magmaris demonstrated a good safety profile and more favorable clinical outcomes when compared to Absorb in patients with non-ST-elevation ACS.
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Affiliation(s)
- Adrian Włodarczak
- Department of Cardiology, The Copper Health Centre (MCZ), 59-300 Lubin, Poland; (A.W.); (S.W.); (M.S.); (J.J.-P.); (P.W.)
| | - Piotr Rola
- Department of Cardiology, Provincial Specialized Hospital in Legnica, 59-220 Legnica, Poland; (M.B.); (Ł.F.)
- Faculty of Health Sciences and Physical Culture, Witelon Collegium State University, 59-220 Legnica, Poland
| | - Szymon Włodarczak
- Department of Cardiology, The Copper Health Centre (MCZ), 59-300 Lubin, Poland; (A.W.); (S.W.); (M.S.); (J.J.-P.); (P.W.)
| | - Marek Szudrowicz
- Department of Cardiology, The Copper Health Centre (MCZ), 59-300 Lubin, Poland; (A.W.); (S.W.); (M.S.); (J.J.-P.); (P.W.)
| | | | | | - Joanna Jaroszewska-Pozorska
- Department of Cardiology, The Copper Health Centre (MCZ), 59-300 Lubin, Poland; (A.W.); (S.W.); (M.S.); (J.J.-P.); (P.W.)
| | - Mateusz Barycki
- Department of Cardiology, Provincial Specialized Hospital in Legnica, 59-220 Legnica, Poland; (M.B.); (Ł.F.)
| | - Łukasz Furtan
- Department of Cardiology, Provincial Specialized Hospital in Legnica, 59-220 Legnica, Poland; (M.B.); (Ł.F.)
| | | | - Piotr Włodarczak
- Department of Cardiology, The Copper Health Centre (MCZ), 59-300 Lubin, Poland; (A.W.); (S.W.); (M.S.); (J.J.-P.); (P.W.)
| | - Adrian Doroszko
- Department of Cardiology, Center for Heart Diseases, 4th Military Hospital, Faculty of Medicine, Wroclaw University of Science and Technology, 50-981 Wroclaw, Poland;
| | - Maciej Lesiak
- 1st Department of Cardiology, Poznan University of Medical Sciences, 61-491 Poznan, Poland;
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Zuccarelli V, Andreaggi S, Walsh JL, Kotronias RA, Chu M, Vibhishanan J, Banning AP, De Maria GL. Treatment and Care of Patients with ST-Segment Elevation Myocardial Infarction-What Challenges Remain after Three Decades of Primary Percutaneous Coronary Intervention? J Clin Med 2024; 13:2923. [PMID: 38792463 PMCID: PMC11122374 DOI: 10.3390/jcm13102923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 05/11/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024] Open
Abstract
Primary percutaneous coronary intervention (pPCI) has revolutionized the prognosis of ST-segment elevation myocardial infarction (STEMI) and is the gold standard treatment. As a result of its success, the number of pPCI centres has expanded worldwide. Despite decades of advancements, clinical outcomes in STEMI patients have plateaued. Out-of-hospital cardiac arrest and cardiogenic shock remain a major cause of high in-hospital mortality, whilst the growing burden of heart failure in long-term STEMI survivors presents a growing problem. Many elements aiming to optimize STEMI treatment are still subject to debate or lack sufficient evidence. This review provides an overview of the most contentious current issues in pPCI in STEMI patients, with an emphasis on unresolved questions and persistent challenges.
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Affiliation(s)
- Vittorio Zuccarelli
- Oxford Heart Centre, Oxford University Hospitals NHS Trust, Oxford OX3 9DU, UK; (V.Z.); (S.A.); (J.L.W.); (R.A.K.); (M.C.); (J.V.); (A.P.B.)
| | - Stefano Andreaggi
- Oxford Heart Centre, Oxford University Hospitals NHS Trust, Oxford OX3 9DU, UK; (V.Z.); (S.A.); (J.L.W.); (R.A.K.); (M.C.); (J.V.); (A.P.B.)
- Division of Cardiology, Department of Medicine, University of Verona, 37129 Verona, Italy
| | - Jason L. Walsh
- Oxford Heart Centre, Oxford University Hospitals NHS Trust, Oxford OX3 9DU, UK; (V.Z.); (S.A.); (J.L.W.); (R.A.K.); (M.C.); (J.V.); (A.P.B.)
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX1 2JD, UK
| | - Rafail A. Kotronias
- Oxford Heart Centre, Oxford University Hospitals NHS Trust, Oxford OX3 9DU, UK; (V.Z.); (S.A.); (J.L.W.); (R.A.K.); (M.C.); (J.V.); (A.P.B.)
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX1 2JD, UK
| | - Miao Chu
- Oxford Heart Centre, Oxford University Hospitals NHS Trust, Oxford OX3 9DU, UK; (V.Z.); (S.A.); (J.L.W.); (R.A.K.); (M.C.); (J.V.); (A.P.B.)
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX1 2JD, UK
| | - Jonathan Vibhishanan
- Oxford Heart Centre, Oxford University Hospitals NHS Trust, Oxford OX3 9DU, UK; (V.Z.); (S.A.); (J.L.W.); (R.A.K.); (M.C.); (J.V.); (A.P.B.)
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX1 2JD, UK
| | - Adrian P. Banning
- Oxford Heart Centre, Oxford University Hospitals NHS Trust, Oxford OX3 9DU, UK; (V.Z.); (S.A.); (J.L.W.); (R.A.K.); (M.C.); (J.V.); (A.P.B.)
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX1 2JD, UK
- National Institute for Health Research (NIHR), Oxford Biomedical Research Centre, Oxford OX3 9DU, UK
| | - Giovanni Luigi De Maria
- Oxford Heart Centre, Oxford University Hospitals NHS Trust, Oxford OX3 9DU, UK; (V.Z.); (S.A.); (J.L.W.); (R.A.K.); (M.C.); (J.V.); (A.P.B.)
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX1 2JD, UK
- National Institute for Health Research (NIHR), Oxford Biomedical Research Centre, Oxford OX3 9DU, UK
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Wiyono AV, Ardinal AP. Revolutionizing Cardiovascular Frontiers: A Dive Into Cutting-Edge Innovations in Coronary Stent Technology. Cardiol Rev 2024:00045415-990000000-00255. [PMID: 38709038 DOI: 10.1097/crd.0000000000000705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Plain balloon angioplasty was the initial method used to enlarge the intracoronary lumen size. However, it was linked to acute coronary closure due to early vessel recoil. This led to the invention of coronary stents, which offer mechanical support to open and maintain the vascular lumen. Nevertheless, the metallic scaffold introduced other issues, such as thrombosis and restenosis caused by neointimal proliferation. To address these concerns, polymers were employed to cover the scaffold, acting as drug reservoirs and regulators for controlled drug release. The use of polymers prevents direct contact between blood and metallic scaffolds. Drugs within the stent were incorporated to inhibit proliferation and expedite endothelialization in the healing process. Despite these advancements, adverse effects still arise due to the inflammatory reaction caused by the polymer material. Consequently, resorbable polymers and scaffolds were later discovered, but they have limitations and are not universally applicable. Various scaffold designs, thicknesses, materials, polymer components, and drugs have their own advantages and complications. Each stent generation has been designed to address the shortcomings of the preceding generation, yet new challenges continue to emerge. Conflicting data regarding the long-term safety and efficacy of coronary stents, especially in the extended follow-up, further complicates the assessment.
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Affiliation(s)
- Alice Valeria Wiyono
- Faculty of Life Sciences & Medicine, King's College London, School of Cardiovascular and Metabolic Medicine, London, United Kingdom
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Hansen KN, Maehara A, Noori M, Trøan J, Fallesen CO, Hougaard M, Ellert-Gregersen J, Veien KT, Junker A, Hansen HS, Lassen JF, Jensen LO. Optimal lesion preparation before implantation of a Magmaris bioresorbable scaffold in patients with coronary artery stenosis: Rationale, design and methodology of the OPTIMIS study. Contemp Clin Trials Commun 2024; 38:101260. [PMID: 38384894 PMCID: PMC10879808 DOI: 10.1016/j.conctc.2024.101260] [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: 10/11/2023] [Revised: 01/02/2024] [Accepted: 01/15/2024] [Indexed: 02/23/2024] Open
Abstract
Introduction Percutaneous coronary intervention with implantation of a bioresorbable scaffold (BRS) provide the vessel support for a limited period allowing the vessel to restore normal vasomotion after degradation of the BRS, opposed to treatment with drug-eluting stents where the metal persist in the vessel wall. Late lumen loss and reduction in lumen area after implantation have been reported. The purpose of this study was to investigate whether intense pre-dilatation before BRS implantation resulted in less reduction of minimal lumen area at 6- and 12-month follow-up after implantation of a Magmaris BRS (MgBRS). Coronary imaging with optical coherence tomography (OCT) and intravascular ultrasound (IVUS) was assessed to track changes in lumen and vessel dimensions. Methods The prospective Optimal lesion PreparaTion before Implantation of the Magmaris bioresorbable scaffold In patients with coronary artery Stenosis (OPTIMIS) study randomly assigned eighty-two patients with chronic coronary syndrome to two pre-dilatation treatment strategies. Patients were randomized in a 1:1 ratio to pre-dilatation with either a non-compliant scoring balloon or a standard non-compliant balloon prior to implantation of a MgBRS. The treated segment was evaluated with OCT and IVUS at baseline, after 6 and 12 months to assess changes in lumen and vessel dimensions. The hypothesis was that more intense pre-dilatation with a non-compliant scoring balloon before MgBRS implantation can reduce the risk of late lumen reduction compared to standard pre-dilatation. The power calculation used expected MLA after 6 months (6.22 mm2 for the scoring balloon and 5.01 mm2 for the standard non-compliant balloon), power of 80 %, significance level of 0.05 and expected drop-out rate of 15 %, requiring 82 patients to be enrolled. Results Eighty-two patients were included in the study. Enrollment was from December 2020 to September 2023. Conclusion The hypothesis was that more intense pre-dilatation with a non-compliant scoring balloon before MgBRS implantation can reduce the risk of late lumen reduction compared to standard pre-dilatation.
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Affiliation(s)
- Kirstine Nørregaard Hansen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
| | - Akiko Maehara
- Cardiovascular Research Foundation, New York Presbyterian Hospital, New York, USA
| | - Manijeh Noori
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
| | - Jens Trøan
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Mikkel Hougaard
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | | | - Anders Junker
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Henrik Steen Hansen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
| | - Jens Flensted Lassen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
| | - Lisette Okkels Jensen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
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Lungu CN, Creteanu A, Mehedinti MC. Endovascular Drug Delivery. Life (Basel) 2024; 14:451. [PMID: 38672722 PMCID: PMC11051410 DOI: 10.3390/life14040451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/12/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
Drug-eluting stents (DES) and balloons revolutionize atherosclerosis treatment by targeting hyperplastic tissue responses through effective local drug delivery strategies. This review examines approved and emerging endovascular devices, discussing drug release mechanisms and their impacts on arterial drug distribution. It emphasizes the crucial role of drug delivery in modern cardiovascular care and highlights how device technologies influence vascular behavior based on lesion morphology. The future holds promise for lesion-specific treatments, particularly in the superficial femoral artery, with recent CE-marked devices showing encouraging results. Exciting strategies and new patents focus on local drug delivery to prevent restenosis, shaping the future of interventional outcomes. In summary, as we navigate the ever-evolving landscape of cardiovascular intervention, it becomes increasingly evident that the future lies in tailoring treatments to the specific characteristics of each lesion. By leveraging cutting-edge technologies and harnessing the potential of localized drug delivery, we stand poised to usher in a new era of precision medicine in vascular intervention.
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Affiliation(s)
- Claudiu N. Lungu
- Department of Functional and Morphological Science, Faculty of Medicine and Pharmacy, Dunarea de Jos University, 800010 Galati, Romania;
| | - Andreea Creteanu
- Department of Pharmaceutical Technology, University of Medicine and Pharmacy Grigore T Popa, 700115 Iași, Romania
| | - Mihaela C. Mehedinti
- Department of Functional and Morphological Science, Faculty of Medicine and Pharmacy, Dunarea de Jos University, 800010 Galati, Romania;
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Micari A, Dimartino A, Donato R, Vizzari G, Andò G. Late acquired coronary aneurysm and restenosis after bioresorbable vascular scaffold implantation: a case report. Eur Heart J Case Rep 2024; 8:ytae065. [PMID: 38332923 PMCID: PMC10852101 DOI: 10.1093/ehjcr/ytae065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 01/22/2024] [Accepted: 01/26/2024] [Indexed: 02/10/2024]
Abstract
Background Although the technology of bioresorbable vascular scaffold (BVS) aroused the peak of interest a few years ago and currently remains available only as part of experimental research, patients who have had BVS implanted should be still carefully monitored to detect possible long-term complications. Case summary We present the case of a 47-year-old man who had received BVS implantation for ST-segment elevation myocardial infarction. Six years later, computed tomography coronary angiography (CTCA) demonstrated in-segment restenosis in between two newly formed coronary aneurysms at the site of the implanted BVS. The patient received successful optical coherence tomography-guided percutaneous intervention with a new metallic drug-eluting stent implantation. Discussion Our case demonstrates that coronary aneurysms can be well characterized with CTCA and are often incidentally discovered as they cause no symptoms. The incidence of coronary aneurysm at the site of a previously implanted BVS is not defined, and little is known about the pathophysiology and evolution of these lesions. Therefore, the decision to proceed with conservative management or intervention must be tailored to the clinical conditions of the patient, the anatomy, the rapidity of growth, and the possible thrombotic burden.
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Affiliation(s)
- Antonino Micari
- Department of Clinical and Experimental Medicine, University of Messina and AOU Policlinico ‘Gaetano Martino’, Via Consolare Valeria, 98122 Messina, Italy
| | - Angelo Dimartino
- Department of Clinical and Experimental Medicine, University of Messina and AOU Policlinico ‘Gaetano Martino’, Via Consolare Valeria, 98122 Messina, Italy
| | - Rocco Donato
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina and AOU Policlinico ‘Gaetano Martino’, Via Consolare Valeria, 98122 Messina, Italy
| | - Giampiero Vizzari
- Department of Clinical and Experimental Medicine, University of Messina and AOU Policlinico ‘Gaetano Martino’, Via Consolare Valeria, 98122 Messina, Italy
| | - Giuseppe Andò
- Department of Clinical and Experimental Medicine, University of Messina and AOU Policlinico ‘Gaetano Martino’, Via Consolare Valeria, 98122 Messina, Italy
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Menze R, Hesse B, Kusmierczuk M, Chen D, Weitkamp T, Bettink S, Scheller B. Synchrotron microtomography reveals insights into the degradation kinetics of bio-degradable coronary magnesium scaffolds. Bioact Mater 2024; 32:1-11. [PMID: 37771679 PMCID: PMC10522944 DOI: 10.1016/j.bioactmat.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/18/2023] [Accepted: 09/12/2023] [Indexed: 09/30/2023] Open
Abstract
Bioresorbable magnesium scaffolds are a promising future treatment option for coronary artery stenosis, especially for young adults. Due to the degradation of these scaffolds (<1 year), long-term device-related clinical events could be reduced compared to treatments with conventional drug eluting stents. First clinical trials indicate a return of vasomotion after one year, which may be associated with improved long-term clinical outcomes. However, even after decades of development, the degradation process, ideal degradation time and biological response in vivo are still not fully understood. The present study investigates the in vivo degradation of magnesium scaffolds in the coronary arteries of pigs influenced by different strut thicknesses and the presence of antiproliferative drugs. Due to high 3D image contrast of synchrotron-based micro-CT with phase contrast (SR-μCT), a qualitative and quantitative evaluation of the degradation morphology of magnesium scaffolds was obtained. For the segmentation of the μCT images a convolutional network architecture (U-net) was exploited, demonstrating the huge potential of merging high resolution SR-μCT with deep learning (DL) supported data analysis. In total, 30 scaffolds, made of the rare earth alloy Resoloy®, with different strut designs were implanted into the coronary arteries of 10 domestic pigs for 28 days using drug-coated or uncoated angioplasty balloons for post-dilatation. The degradation morphology was analyzed using scanning electron microscopy, energy dispersive x-ray spectroscopy and SR-μCT. The data from these methods were then related to data from angiography, optical coherence tomography and histology. A thinner strut size (95 vs. 130 μm) and the presence of paclitaxel indicated a slower degradation rate at 28 d in vivo, which positively influences the late lumen loss (0.5 and 0.6 mm vs. 1.0 and 1.1 mm) and recoil values (0 and 1.7% vs. 6.1 and 22%).
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Affiliation(s)
- Roman Menze
- MeKo Manufacturing e.K., Im Kirchenfelde 12-14, 31157, Sarstedt, Germany
| | - Bernhard Hesse
- Xploraytion GmbH, Bismarckstr. 10-12, 10625, Berlin, Germany
| | | | - Duote Chen
- Xploraytion GmbH, Bismarckstr. 10-12, 10625, Berlin, Germany
| | - Timm Weitkamp
- Synchrotron SOLEIL, L'Orme des Merisiers, Départementale 128, 91190, Saint-Aubin, France
| | | | - Bruno Scheller
- Universität des Saarlandes, Campus Homburg, 66421, Homburg, Germany
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Koliastasis L, Bennett J, Xaplanteris P, Skalidis I, Guédès A, Demeure F, Vandeloo B, Dugauquier C, Picard F, Warne DW, Pilgrim T, Iglesias JF, de Hemptinne Q. Two-year clinical outcomes of resorbable magnesium scaffold versus conventional drug-eluting stents in ST-segment elevation myocardial infarction: A propensity score matching analysis. Hellenic J Cardiol 2023:S1109-9666(23)00230-0. [PMID: 38134970 DOI: 10.1016/j.hjc.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 12/20/2023] [Indexed: 12/24/2023] Open
Affiliation(s)
- Leonidas Koliastasis
- Department of Cardiology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Johan Bennett
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Panagiotis Xaplanteris
- Department of Cardiology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Ioannis Skalidis
- Department of Cardiology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Antoine Guédès
- CHU UCL Namur, Site de Mont Godinne, Université Catholique de Louvain, Belgium
| | - Fabian Demeure
- CHU UCL Namur, Site de Mont Godinne, Université Catholique de Louvain, Belgium
| | - Bert Vandeloo
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZB), Department of Cardiology, Brussels, Belgium
| | | | - Fabien Picard
- Hôpital Cochin, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - David W Warne
- Research Center for Statistics, Geneva School of Economics and Management, University of Geneva, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Juan F Iglesias
- Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - Quentin de Hemptinne
- Department of Cardiology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium.
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Szydlowska BM, Ding Y, Moore C, Cai Z, Torres-Castanedo CG, Jones E, Hersam MC, Sun C, Ameer GA. A polydiolcitrate-MoS 2 composite for 3D printing Radio-opaque, Bioresorbable Vascular Scaffolds. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.10.27.564364. [PMID: 37961681 PMCID: PMC10634906 DOI: 10.1101/2023.10.27.564364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Implantable polymeric biodegradable devices, such as biodegradable vascular stents or scaffolds, cannot be fully visualized using standard X-ray-based techniques, compromising their performance due to malposition after deployment. To address this challenge, we describe composites of methacrylated poly(1,12 dodecamethylene citrate) (mPDC) and MoS2 nanosheets to fabricate novel X-ray visible radiopaque and photocurable liquid polymer-ceramic composite (mPDC-MoS2). The composite was used as an ink with micro continuous liquid interface production (μCLIP) to fabricate bioresorbable vascular scaffolds (BVS). Prints exhibited excellent crimping and expansion mechanics without strut failures and, importantly, required X-ray visibility in air and muscle tissue. Notably, MoS2 nanosheets displayed physical degradation over time in a PBS environment, indicating the potential for producing bioresorbable devices. mPDC-MoS2 is a promising bioresorbable X-ray-visible composite material suitable for 3D printing medical devices, particularly vascular scaffolds or stents, that require non-invasive X-ray-based monitoring techniques for implantation and evaluation. This innovative composite system holds significant promise for the development of biocompatible and highly visible medical implants, potentially enhancing patient outcomes and reducing medical complications.
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Affiliation(s)
- Beata M. Szydlowska
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Yonghui Ding
- Center for Advanced Regenerative Engineering (CARE), Northwestern University, Evanston, IL 60208, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Connor Moore
- Center for Advanced Regenerative Engineering (CARE), Northwestern University, Evanston, IL 60208, USA
| | - Zizhen Cai
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
| | | | - Evan Jones
- Center for Advanced Regenerative Engineering (CARE), Northwestern University, Evanston, IL 60208, USA
- Department of Mechanical Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Mark C. Hersam
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Chemistry, Northwestern University, Evanston, IL 60208, USA
- Department of Electrical and Computer Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Cheng Sun
- Center for Advanced Regenerative Engineering (CARE), Northwestern University, Evanston, IL 60208, USA
- Department of Mechanical Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Guillermo A. Ameer
- Center for Advanced Regenerative Engineering (CARE), Northwestern University, Evanston, IL 60208, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Simpson Querrey Institute, Northwestern University, Evanston, IL 60208, USA
- Chemistry for Life Processes Institute, Northwestern University, IL, 60208, USA
- International Institute for Nanotechnology, Northwestern University, IL, 60208, USA
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12
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Cortese B, Kalkat H, Bathia G, Basavarajaiah S. The evolution and revolution of drug coated balloons in coronary angioplasty: An up-to-date review of literature data. Catheter Cardiovasc Interv 2023; 102:1069-1077. [PMID: 37870079 DOI: 10.1002/ccd.30891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/30/2023] [Indexed: 10/24/2023]
Abstract
European Society of Cardiology (ESC) guidelines gave class I A indication for use of DCB in in-stent restenosis. However, no indication exists for the usage of DCB in de novo lesions. Although the current generation DES offer excellent results, as we embark more complex lesions such as calcified lesion and chronic total occlusion, restenosis and stent thrombosis are higher and tend to increase within the years. There is increasing desire to leave nothing behind to abolish the risk of restenosis and stent thrombosis and hence the absorbable scaffolds were introduced, but with disappointing results. In addition, they take several years to be absorbed. Drug coated balloons offer an alternative to stents with no permanent implant of metal or polymer. They are already in use in in Europe and Asia and they have been approved for the first time in the United States for clinical trials specifically for restenotic lesions. There is emerging data in de novo lesions which have shown that DCB are noninferior and in some studies maybe even superior to current generation DES especially in small vessels. In this article, we provide a comprehensive review of the literature on this expanding technology focussing on the evidence in both re-stenotic and de novo lesions.
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Affiliation(s)
- Bernardo Cortese
- Fondazione Ricerca e Innovazione Cardiovascolare, Milano, Italy
- DCB Academy, Milano, Italy
- Cardioparc, Lyon, France
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13
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Hwang JJ, Kao HL, Lin MS, Wu CK, Chiang FT, Wang YC. Impact of post-implantation time on bioresorbable vascular scaffold outcomes for type C versus non-type C coronary lesions: A longer-term study. J Formos Med Assoc 2023; 122:1018-1027. [PMID: 37349171 DOI: 10.1016/j.jfma.2023.05.039] [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: 05/08/2023] [Accepted: 05/31/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND We have demonstrated that bioresorbable vascular scaffold (BVS) for ACC/AHA type C lesions was associated with higher risks of long-term target lesion revascularization (TLR) and target lesion failure (TLF). We determined the specific time after which higher risks of BVS for type C lesions are reduced in a longer-term follow-up. METHODS We analyzed data of 457 patients (59 ± 12 years, 87% male) with 714 BVS implanted for 529 lesions and a median follow-up of 56.4 (48.6-62.6) months. Patients with BVS for at least one type C lesion (N = 177) at index intervention and all non-type C lesions (N = 280) were compared for TLF (cardiac death, target vessel myocardial infarction, TLR). We specified the interactions between the non-type C versus type C group and the event-free survival times dichotomized at 24, 30, 32, 33, 36, and 39 months respectively. RESULTS The type C group had more multivessel disease (86% versus 65%, p < 0.001), left anterior descending artery treated (68% versus 53%, p = 0.002), intravascular imaging used (48% vs. 25%, p < 0.001), and BVS (2.3 ± 0.9 vs. 1.1 ± 0.3, p < 0.001) implanted with a longer total length (57 ± 21 vs. 29 ± 8 mm, p < 0.001). The TLR or TLF was higher (both log-rank p < 0.05) in the type C than in the non-type C group. However, the risks of TLR (hazard ratio: 3.6, 95% CI = 1.1-11.6) and TLF (hazard ratio: 3.8, 95% CI = 1.2-12.1) for type C lesions only remained higher until 24 months post-BVS implantation. CONCLUSION BVS provides a longer-term advantage, particularly for type C lesions with the majority requiring long stenting.
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Affiliation(s)
- Juey-Jen Hwang
- No. 7, Chung-Shan South Road, Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan
| | - Hsien-Li Kao
- No. 7, Chung-Shan South Road, Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan
| | - Mao-Shin Lin
- No. 7, Chung-Shan South Road, Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan
| | - Cho-Kai Wu
- No. 7, Chung-Shan South Road, Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan
| | - Fu-Tien Chiang
- No. 7, Chung-Shan South Road, Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan; Division of Cardiology, Department of Internal Medicine, Fu Jen Catholic University and Fu-Jen Catholic University Hospital, New Taipei City, Taiwan
| | - Yi-Chih Wang
- No. 7, Chung-Shan South Road, Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan.
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14
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Saito S, Nef HM, Webster M, Verheye S. DynamX sirolimus-eluting Bioadaptor versus the zotarolimus-eluting Resolute Onyx stent in patients with de novo coronary artery lesions: Design and rationale of the multi-center, international, randomized BIODAPTOR-RCT. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 55:76-82. [PMID: 37479544 DOI: 10.1016/j.carrev.2023.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND Conventional drug-eluting stents achieve good safety and performance outcomes, but the stents permanently cage the vessel, leading to a non-plateauing rate of clinical events. The DynamX Bioadaptor is designed to reduce these long-term events through unique design features that permit restoring vessel function and physiology through the disengagement of uncaging elements after the resorption of a biodegradable polymer over six months. Promising initial results have been obtained in the DynamX mechanistic study, with excellent safety and effectiveness, positive arterial remodeling, improved vasomotion, compliance, and cyclic pulsatility. We now aim to confirm these findings randomizing the DynamX Bioadaptor against the Resolute Onyx stent. METHODS This multi-center, international, randomized single-blinded study is conducted in 34 sites across Europe, Japan, and New Zealand and is divided into the European/New Zealand cohort and the Japanese cohort (which includes an imaging subset). It is designed to randomly assign 444 patients (222 per region) in a 1:1 ratio to either the DynamX Bioadaptor or the Resolute Onyx stent. Furthermore, a pharmacokinetic substudy is conducted in 9 patients enrolled in Japan to assess the pharmacokinetics of sirolimus after implantation of the DynamX Bioadaptor. Study follow-up is scheduled at one, six, and 12 months, and annually thereafter for five years; imaging follow-up includes angiographic, intravascular ultrasound, and optical coherence tomography assessments at 12 months in a subset of patients. The primary endpoint is 12-month target lesion failure. CONCLUSIONS This trial will provide valuable insights into the safety and efficacy of this novel bioadaptor when compared to a contemporary drug-eluting stent. CONDENSED ABSTRACT The DynamX Sirolimus-Eluting Bioadaptor has unique design features aiming to reduce long-term events after percutaneous coronary intervention by permitting the restoration of vessel function through the freeing of uncaging elements. Promising initial results have been obtained in the DynamX mechanistic study. This trial aims to confirm these findings in a randomized setting. The European/ New Zealand and Japanese cohorts were designed to randomly assign 444 subjects in a 1:1 ratio to either the DynamX Bioadaptor or the Resolute Onyx stent. Furthermore, a pharmacokinetic substudy is conducted in 9 patients enrolled in Japan to assess the pharmacokinetics of sirolimus.
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Affiliation(s)
- Shigeru Saito
- Iryohojin Tokushukai Shonan Kamakura General Hospital, Japan.
| | - Holger M Nef
- Department of Cardiology, University of Giessen, Germany.
| | - Mark Webster
- Department of Cardiology, Auckland City Hospital, Auckland, New Zealand.
| | - Stefan Verheye
- Interventional Cardiology, ZNA Cardiovascular Center Middelheim, Antwerp, Belgium
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15
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Sachdeva P, Kaur K, Fatima S, Mahak F, Noman M, Siddenthi SM, Surksha MA, Munir M, Fatima F, Sultana SS, Varrassi G, Khatri M, Kumar S, Elder M, Mohamad T. Advancements in Myocardial Infarction Management: Exploring Novel Approaches and Strategies. Cureus 2023; 15:e45578. [PMID: 37868550 PMCID: PMC10587445 DOI: 10.7759/cureus.45578] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 09/19/2023] [Indexed: 10/24/2023] Open
Abstract
In the landscape of healthcare, the management of myocardial infarction (MI) stands as a pivotal challenge and a critical juncture where advancements are reshaping the trajectory of patient care. Myocardial infarction, commonly known as a heart attack, remains a foremost contributor to global morbidity and mortality. Conventional management strategies have historically focused on rapid restoration of blood flow through revascularization techniques. However, the last decade has witnessed a profound transformation, with a burgeoning emphasis on precision medicine and innovative interventions. This contextual backdrop sets the stage for a deep dive into the realm of novel diagnostic modalities, spanning high-sensitivity biomarkers, advanced imaging techniques, and data-driven algorithms. These innovations facilitate not only early detection but also the stratification of patients, paving the way for individualized treatment plans. By targeting the underlying mechanisms of myocardial damage, these interventions hold the promise of attenuating the impact of MI and promoting cardiac regeneration. It examines the integration of telemedicine, wearable devices, and remote monitoring platforms, bridging the gap between patients and caregivers while enabling timely interventions. Additionally, the psychosocial aspects of MI recovery are explored, highlighting the integration of psychological support and lifestyle interventions to enhance long-term well-being. By exploring novel diagnostics, innovative therapies, and holistic patient-centered strategies, it underscores the collaborative efforts of medical practitioners, researchers, and technological pioneers in reshaping the trajectory of MI care. As we stand at the intersection of medical advancement and compassionate patient management, embracing these novel approaches promises a future where the impact of myocardial infarction can be mitigated, and lives can be extended and enriched.
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Affiliation(s)
- Pranav Sachdeva
- General Medicine, Government Medical College & Hospital, Chandigarh, Chandigarh, IND
| | - Kawanpreet Kaur
- General Medicine, Government Medical College & Hospital, Chandigarh, Chandigarh, IND
| | - Saba Fatima
- Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | - Fnu Mahak
- Medicine, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | | | | | | | - Mishaal Munir
- Medicine, Ghurki Trust and Teaching Hospital, Lahore, PAK
- Internal Medicine, Lahore Medical & Dental College, Lahore, PAK
| | - Fnu Fatima
- Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | | | | | - Mahima Khatri
- Medicine and Surgery, Dow University of Health Sciences, Karachi, Karachi, PAK
| | - Satesh Kumar
- Medicine and Surgery, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, PAK
| | - Mahir Elder
- Interventional Cardiology, Heart and Vascular Institute, Detroit, USA
| | - Tamam Mohamad
- Cardiovascular Surgery, Wayne State University, Detroit, USA
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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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Serruys PW, Revaiah PC, Onuma Y. Bioresorbable Scaffolds: Is There Still Light at the End of the Tunnel? J Am Coll Cardiol 2023; 82:196-199. [PMID: 37438005 DOI: 10.1016/j.jacc.2023.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 05/22/2023] [Indexed: 07/14/2023]
Affiliation(s)
- Patrick W Serruys
- CORRIB Research Centre for Advanced Imaging and Core Laboratory, University of Galway, Galway, Ireland.
| | - Pruthvi C Revaiah
- CORRIB Research Centre for Advanced Imaging and Core Laboratory, University of Galway, Galway, Ireland
| | - Yoshinobu Onuma
- CORRIB Research Centre for Advanced Imaging and Core Laboratory, University of Galway, Galway, Ireland
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Truong BQ, Tran H, Nguyen VX, Nguyen CD, Nguyen KD, Vu VH. Mid-term safe and effective profile of the Magmaris scaffold in percutaneous coronary intervention: a prospective, single-center study. Front Cardiovasc Med 2023; 10:1194933. [PMID: 37304961 PMCID: PMC10250636 DOI: 10.3389/fcvm.2023.1194933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/08/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction Significant advances have been made in the diagnosis and treatment of coronary artery disease over the years. New generations of scaffolds containing novel material and eluting drug have produced one of the most significant advancements in coronary intervention. The newest generation would be Magmaris with a magnesium frame and a sirolimus cover. Methods From July 2018 to August 2020, 58 patients treated with Magmaris at the University Medical Center Ho Chi Minh City were enrolled in this study. Results A total of 60 lesions were stented, 60.3% of which were left anterior descending (LAD) lesions. There was no in-hospital event. Within 1 year after discharge, we noted one myocardial infarction event that required target-lesion revascularization, one stroke event, one non-target-lesion revascularization patient, two target-vessel revascularization patients, and one in-stent thrombosis. Among them, one myocardial infarction occurrence, one non-target-lesion revascularization, and one in-stent thrombosis event were recorded within the first 30 days after discharge. Conclusion In conclusion, the Magmaris scaffold is a safe and effective option for structural procedures performed with imaging device support, particularly intravascular ultrasound.
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Affiliation(s)
- Binh Quang Truong
- Medicine Faculty, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Interventional Cardiology Department, University Medical Center Ho Chi Minh Center, Ho Chi Minh City, Vietnam
| | - Hoa Tran
- Medicine Faculty, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Interventional Cardiology Department, University Medical Center Ho Chi Minh Center, Ho Chi Minh City, Vietnam
| | - Vinh Xuan Nguyen
- Interventional Cardiology Department, University Medical Center Ho Chi Minh Center, Ho Chi Minh City, Vietnam
| | - Chinh Duc Nguyen
- Interventional Cardiology Department, University Medical Center Ho Chi Minh Center, Ho Chi Minh City, Vietnam
| | - Khang Duong Nguyen
- Interventional Cardiology Department, University Medical Center Ho Chi Minh Center, Ho Chi Minh City, Vietnam
| | - Vu Hoang Vu
- Medicine Faculty, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Interventional Cardiology Department, University Medical Center Ho Chi Minh Center, Ho Chi Minh City, Vietnam
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Zhang X, Guo Z, Zhu L, Liu Y, Wang H, Jiang Y, Du B, Hu Y. Challenges and chances coexist: A visualized analysis and bibliometric study of research on bioresorbable vascular scaffolds from 2000 to 2022. Medicine (Baltimore) 2023; 102:e33885. [PMID: 37233419 PMCID: PMC10219738 DOI: 10.1097/md.0000000000033885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 05/09/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Bioresorbable scaffolds (BVS) provide a transient supporting force for blocked vessels and allow them to return to previous physiological characteristics. After verification with twists and turns, it has been acknowledged as an emerging revolution in percutaneous coronary intervention that expresses the current concept of intervention without placement. Through this bibliometric study, we organized the knowledge structure of bioresorbable scaffolds and attempted to predict future research hotspots in this field. METHODS seven thousand sixty-three articles were retrieved from the web of science core collection database from 2000 to 2022. Then, we utilize CiteSpace 6.1.R2, Biblioshiny and VOS viewer 1.6.18 to analyze the data visually. RESULTS First, according to the spatial analysis, the number of annual publications has shown an approximately increasing trend over the past 2 decades. The USA, the People's Republic of China, and GERMANY published the most articles on bioresorbable scaffolds. Second, SERRUYS P ranked first for his most prolific work and highest cited frequency in this domain. Third, the hotspots in this field can be inferred from the keyword distribution; they were the fabrication technique based on tissue engineering; the factors to be optimized for bioresorbable scaffolds, such as mechanical property, degradation, and implantation; and the common adverse effects of bioresorbable scaffolds, such as thrombosis. Most importantly, in terms of burst detection, we could speculate that cutting-edge technology for manufacturing scaffolds represented by 3D printing constitutes the future hotspots in bioresorbable scaffold development. CONCLUSION In the first visualized bibliometric analysis of BVS, we attempt to provide a panoramic view. By enrolling extensive literature, we review the growing trend of BVSs. Since its first introduction, it has been through periods of early prosperity, questioned safety subsequently and the resultantly advanced techniques in recent years. In future, the research should focus on utilizing novel techniques to consummate the manufacturing quality and assure the safety of BVSs.
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Affiliation(s)
- Xiaohan Zhang
- Department of Cardiovascular Diseases, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zezhen Guo
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Lihong Zhu
- Department of Cerebrovascular Disease, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yao Liu
- The Second Clinical College, Shanxi University of Chinese Medicine, Shanxi, China
| | - Huan Wang
- Department of Cardiovascular Diseases, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yuchen Jiang
- Department of Cardiovascular Diseases, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Bai Du
- Department of Cardiovascular Diseases, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yuanhui Hu
- Department of Cardiovascular Diseases, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Hommels TM, Hermanides RS, Fabris E, Kedhi E. Exploring new insights in coronary lesion assessment and treatment in patients with diabetes mellitus: the impact of optical coherence tomography. Cardiovasc Diabetol 2023; 22:123. [PMID: 37226183 DOI: 10.1186/s12933-023-01844-1] [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: 03/21/2023] [Accepted: 04/28/2023] [Indexed: 05/26/2023] Open
Abstract
In this review, we summarise new insights into diagnostic approaches and treatment strategies for coronary artery disease (CAD) in patients with diabetes mellitus (DM). Despite the improvements in therapy, the clinical management of DM patients remains challenging as they develop more extensive CAD at a younger age and consistently have worse clinical outcomes than non-DM patients. Current diagnostic modalities as well as revascularisation treatments mainly focus on ischemic lesions. However, the impact of plaque morphology and composition are emerging as strong predictors of adverse cardiac events even in the absence of identified ischemia. In particular, the presence of vulnerable plaques such as thin-cap fibroatheroma (TCFA) lesions has been identified as a very strong predictor of future adverse events. This emphasises the need for an approach combining both functional and morphological methods in the assessment of lesions. In particular, optical coherence tomography (OCT) has proven to be a valuable asset by truly identifying TCFAs. New treatment strategies should consist of individualised and advanced medical regimens and may evolve towards plaque sealing through percutaneous treatment.
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Affiliation(s)
| | | | - Enrico Fabris
- Cardiovascular Department, University of Trieste, Trieste, Italy
| | - Elvin Kedhi
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Poniatowskiego 15, 40-055, Katowice, Poland.
- Department of Cardiology, Hôpital Erasme, Université libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium.
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Structural and temporal dynamics analysis on drug-eluting stents: History, research hotspots and emerging trends. Bioact Mater 2023; 23:170-186. [DOI: 10.1016/j.bioactmat.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/04/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
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Wang X, Li Y, Fu G, Xu B, Zhou Y, Su X, Liu H, Zhang Z, Yu B, Tao L, Zheng Q, Li L, Xu K, Han Y. Three-year clinical outcomes of the novel sirolimus-eluting bioresorbable scaffold for the treatment of de novo coronary artery disease: A prospective patient-level pooled analysis of NeoVas trials. Catheter Cardiovasc Interv 2023; 101:967-972. [PMID: 36881746 DOI: 10.1002/ccd.30518] [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: 04/09/2022] [Revised: 10/10/2022] [Accepted: 11/20/2022] [Indexed: 03/09/2023]
Abstract
OBJECTIVES We aimed to evaluate the long-term outcomes of the novel NeoVas sirolimus-eluting bioresorbable scaffold (BRS) for the treatment of de novo coronary artery disease. BACKGROUND The long-term safety and efficacy of the novel NeoVas BRS are still needed to be elucidated. METHODS A total of 1103 patients with de novo native coronary lesions for coronary stenting were enrolled. The primary endpoint of target lesion failure (TLF) was defined as a composite of cardiac death (CD), target vessel myocardial infarction (TV-MI), or ischemia-driven-target lesion revascularization (ID-TLR). RESULTS A three-year clinical follow-up period was available for 1,091 (98.9%) patients. The cumulative TLF rate was 7.2% with 0.8% for CD, 2.6% for TV-MI, and 5.1% for ID-TLR. Additionally, 128 (11.8%) patient-oriented composite endpoint and 11 definite/probable stent thromboses (1.0%) were recorded. CONCLUSIONS The extended outcomes of the NeoVas objective performance criterion trial demonstrated a promising 3-year efficacy and safety of the NeoVas BRS in low-risk patients with low complexity in terms of lesions and comorbidities.
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Affiliation(s)
- Xiaozeng Wang
- General Hospital of Northern Theater Command, Shenyang, Liaoning, China
| | - Yang Li
- General Hospital of Northern Theater Command, Shenyang, Liaoning, China
| | - Guosheng Fu
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Bo Xu
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Centre for Coronary Heart Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yujie Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xi Su
- Department of Cardiology, Wuhan Asia Heart Hospital, Affiliated to Wuhan University of Science and Technology, Wuhan, Hubei, China
| | | | - Zheng Zhang
- Department of Cardiology, the First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Bo Yu
- The Key Laboratory of Myocardial Ischemia, Department of Cardiology, 2nd Affiliated Hospital of Harbin Medical University, Chinese Ministry of Education, Harbin, China
| | - Ling Tao
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Qun Zheng
- Department of Cardiology, Halison International Peace Hospital, Hengshui, Shijiazhuang, China
| | - Lang Li
- Department of Cardiology, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Kai Xu
- General Hospital of Northern Theater Command, Shenyang, Liaoning, China
| | - Yaling Han
- General Hospital of Northern Theater Command, Shenyang, Liaoning, China
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Patel S, Patel KB, Patel Z, Konat A, Patel A, Doshi JS, Chokshi P, Patel D, Sharma K, Amdani MM, Shah DB, Dholu U, Patel M. Evolving Coronary Stent Technologies - A Glimpse Into the Future. Cureus 2023; 15:e35651. [PMID: 37009355 PMCID: PMC10065169 DOI: 10.7759/cureus.35651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 03/06/2023] Open
Abstract
One of the most widely accepted forms of treatment for coronary artery disease (CAD) is the implementation of stents into the vessel. This area of research is constantly evolving, ranging from bare-metal stents through drug-eluting stents and, more recently, approaching bioresorbable stents and polymer-free stents. This article reviews the evolution of all these devices and emphasizes how they might be further evolved to provide an optimal coronary stent and overcome unsolved challenges in stent development. We thoroughly evaluated a number of published studies in order to advance coronary stent technologies. Additionally, we looked for various literature that highlighted the inadequacies of the coronary stents that are currently available and how they might be modified to create the optimum coronary stent. Coronary stents have significantly improved clinical outcomes in interventional cardiology, but there are still a number of drawbacks, including an persisted risk of thrombosis due to endothelial injury and in-stent restenosis. Gene eluting stents (GES) and customized coronary stents with self-reporting stent sensors are appealing alternatives to existing stent approaches. Considering the adequacy of these gene eluting stents (GES), customized coronary stents produced by novel 4D printing technologies and integrated self-reporting stent sensors should be assumed for anticipating future advancements to optimal coronary stent devices; however, more interventional evidence is required to determine the future prospects of these stent innovations.
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24
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Lee JM, Joh HS, Choi KH, Hong D, Park TK, Yang JH, Song YB, Choi JH, Choi SH, Jeong JO, Lee JY, Choi YJ, Chae JK, Hur SH, Bae JW, Oh JH, Chun KJ, Kim HJ, Cho BR, Shin D, Lee SH, Hwang D, Lee HJ, Jang HJ, Kim HK, Ha SJ, Shin ES, Doh JH, Hahn JY, Gwon HC. Safety and Efficacy of Everolimus-Eluting Bioresorbable Vascular Scaffold Versus Second-Generation Drug-Eluting Stents in Real-World Practice. J Korean Med Sci 2023; 38:e34. [PMID: 36747363 PMCID: PMC9902667 DOI: 10.3346/jkms.2023.38.e34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 10/27/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The risk of device thrombosis and device-oriented clinical outcomes with bioresorbable vascular scaffold (BVS) was reported to be significantly higher than with contemporary drug-eluting stents (DESs). However, optimal device implantation may improve clinical outcomes in patients receiving BVS. The current study evaluated mid-term safety and efficacy of Absorb BVS with meticulous device optimization under intravascular imaging guidance. METHODS The SMART-REWARD and PERSPECTIVE-PCI registries in Korea prospectively enrolled 390 patients with BVS and 675 patients with DES, respectively. The primary endpoint was target vessel failure (TVF) at 2 years and the secondary major endpoint was patient-oriented composite outcome (POCO) at 2 years. RESULTS Patient-level pooled analysis evaluated 1,003 patients (377 patients with BVS and 626 patients with DES). Mean scaffold diameter per lesion was 3.24 ± 0.30 mm in BVS group. Most BVSs were implanted with pre-dilatation (90.9%), intravascular imaging guidance (74.9%), and post-dilatation (73.1%) at proximal to mid segment (81.9%) in target vessel. Patients treated with BVS showed comparable risks of 2-year TVF (2.9% vs. 3.7%, adjusted hazard ratio [HR], 1.283, 95% confidence interval [CI], 0.487-3.378, P = 0.615) and 2-year POCO (4.5% vs. 5.9%, adjusted HR, 1.413, 95% CI, 0.663-3.012, P = 0.370) than those with DES. The rate of 2-year definite or probable device thrombosis (0.3% vs. 0.5%, P = 0.424) was also similar. The sensitivity analyses consistently showed comparable risk of TVF and POCO between the 2 groups. CONCLUSION With meticulous device optimization under imaging guidance and avoidance of implantation in small vessels, BVS showed comparable risks of 2-year TVF and device thrombosis with DES. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02601404, NCT04265443.
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Affiliation(s)
- Joo Myung Lee
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Sung Joh
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ki Hong Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - David Hong
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Taek Kyu Park
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Bin Song
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin-Ho Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin-Ok Jeong
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Jong-Young Lee
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Jin Choi
- Division of Cardiology, Department of Internal Medicine, Bucheon Sejong Hospital, Bucheon, Korea
| | - Jei-Keon Chae
- Division of Cardiology, Department of Internal Medicine, Jeonbuk National University Hospital and Jeonbuk National University Medical School, Jeonju, Korea
| | - Seung-Ho Hur
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Jang-Whan Bae
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University, Cheongju, Korea
| | - Ju-Hyeon Oh
- Division of Cardiology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Kook-Jin Chun
- Department of Cardiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hyun-Joong Kim
- Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Byung Ryul Cho
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, Korea
| | - Doosup Shin
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Seung Hun Lee
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Doyeon Hwang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Hyun-Jong Lee
- Division of Cardiology, Department of Internal Medicine, Bucheon Sejong Hospital, Bucheon, Korea
| | - Ho-Jun Jang
- Division of Cardiology, Department of Internal Medicine, Bucheon Sejong Hospital, Bucheon, Korea
| | - Hyun Kuk Kim
- Department of Internal Medicine and Cardiovascular Center, Chosun University Hospital, University of Chosun College of Medicine, Gwangju, Korea
| | - Sang Jin Ha
- Division of Cardiology, Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Joon-Hyung Doh
- Department of Cardiology, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Socci MC, Rodríguez G, Oliva E, Fushimi S, Takabatake K, Nagatsuka H, Felice CJ, Rodríguez AP. Polymeric Materials, Advances and Applications in Tissue Engineering: A Review. Bioengineering (Basel) 2023; 10:bioengineering10020218. [PMID: 36829712 PMCID: PMC9952269 DOI: 10.3390/bioengineering10020218] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/28/2023] [Accepted: 01/29/2023] [Indexed: 02/10/2023] Open
Abstract
Tissue Engineering (TE) is an interdisciplinary field that encompasses materials science in combination with biological and engineering sciences. In recent years, an increase in the demand for therapeutic strategies for improving quality of life has necessitated innovative approaches to designing intelligent biomaterials aimed at the regeneration of tissues and organs. Polymeric porous scaffolds play a critical role in TE strategies for providing a favorable environment for tissue restoration and establishing the interaction of the biomaterial with cells and inducing substances. This article reviewed the various polymeric scaffold materials and their production techniques, as well as the basic elements and principles of TE. Several interesting strategies in eight main TE application areas of epithelial, bone, uterine, vascular, nerve, cartilaginous, cardiac, and urinary tissue were included with the aim of learning about current approaches in TE. Different polymer-based medical devices approved for use in clinical trials and a wide variety of polymeric biomaterials are currently available as commercial products. However, there still are obstacles that limit the clinical translation of TE implants for use wide in humans, and much research work is still needed in the field of regenerative medicine.
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Affiliation(s)
- María Cecilia Socci
- Laboratorio de Medios e Interfases (LAMEIN), Departamento de Bioingeniería, FACET-UNT, Tucumán 4000, Argentina
- Instituto Superior de Investigaciones Biológicas (INSIBIO), CONICET, Tucumán 4000, Argentina
- Correspondence: (M.C.S.); (A.P.R.)
| | - Gabriela Rodríguez
- Laboratorio de Medios e Interfases (LAMEIN), Departamento de Bioingeniería, FACET-UNT, Tucumán 4000, Argentina
- Instituto Superior de Investigaciones Biológicas (INSIBIO), CONICET, Tucumán 4000, Argentina
| | - Emilia Oliva
- Laboratorio de Medios e Interfases (LAMEIN), Departamento de Bioingeniería, FACET-UNT, Tucumán 4000, Argentina
- Instituto Superior de Investigaciones Biológicas (INSIBIO), CONICET, Tucumán 4000, Argentina
| | - Shigeko Fushimi
- Department of Oral Pathology and Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8525, Japan
- Department of Oral Pathology and Medicine, Okayama University Dental School, Okayama 700-8525, Japan
| | - Kiyofumi Takabatake
- Department of Oral Pathology and Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8525, Japan
| | - Hitoshi Nagatsuka
- Department of Oral Pathology and Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8525, Japan
| | - Carmelo José Felice
- Laboratorio de Medios e Interfases (LAMEIN), Departamento de Bioingeniería, FACET-UNT, Tucumán 4000, Argentina
- Instituto Superior de Investigaciones Biológicas (INSIBIO), CONICET, Tucumán 4000, Argentina
| | - Andrea Paola Rodríguez
- Laboratorio de Medios e Interfases (LAMEIN), Departamento de Bioingeniería, FACET-UNT, Tucumán 4000, Argentina
- Instituto Superior de Investigaciones Biológicas (INSIBIO), CONICET, Tucumán 4000, Argentina
- Correspondence: (M.C.S.); (A.P.R.)
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26
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Contorni F, Cameli M, Iadanza A, Carrera A, Guerrieri G, Barbati R, Sinicropi G, Bacci E, Baccani B, Fineschi M. Four-year outcomes of a single-center experience with coronary everolimus-eluting bioresorbable scaffolds. Minerva Cardiol Angiol 2023; 71:70-76. [PMID: 34338484 DOI: 10.23736/s2724-5683.21.05703-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Bioresorbable scaffolds (BRS) have been introduced to overcome the limitations of drug-eluting stents and the ABSORB (Everolimus-Eluting BRS, Abbott Vascular, Santa Clara, CA, USA) was the most extensively tested. Nevertheless, major RCTs reported higher rates of target lesion failures and BRS thrombosis at 3 years follow-up, bringing to the withdrawing of the device from the market. It has been suggested that a better lesions selection and an optimized implantation technique could mitigate the displayed adverse results. METHODS Consecutive patients undergoing BRS implantation were included in this observational, single center study. Clinical follow-up was conducted up to 4 years. Endpoint of interest was the target lesion failure (TLF), a composite outcome including cardiac death, target vessel myocardial infarction and target lesion revascularization. RESULTS A total of 62 patients with a mean age of 55±8.5 years were analyzed of which 70.9% presented with an acute coronary syndrome and 59.6% with myocardial infarction. A total of 100 lesions were treated and 51.6% were complex (B2/C). Predilatation was performed in all the case, post-dilatation in 74.1%. All the target vessel reference diameter (RVD) were >2.5 mm (average RVD 3.2±0.24 mm). At 4 years, the rate for TLF was 6.9%. Subgroup's analysis did not show significative differences among groups although consistently higher event rates were found for RVD <2.5 mm (12.6% vs. 6.4%, P=0.5), BRS overlapping (11.8% vs. 5%, P=0.2) and ticagrelor instead of clopidogrel on top of cardioaspirin (9.1% vs. 3%, P=0.2). CONCLUSIONS This small-sized real-world registry displays lower rates of clinical events during long-term follow-up in respect to previous studies. The avoidance of implantation in small vessels, inclusion of acute myocardial infarction and extensive performance of BRS post-dilatation could explain the observed better results. Long-term outcomes of the ongoing ABSORB IV Trial are needed to confirm this data.
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Affiliation(s)
- Francesco Contorni
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy -
| | - Matteo Cameli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Alessandro Iadanza
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Arcangelo Carrera
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Giuseppe Guerrieri
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Riccardo Barbati
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Giuseppe Sinicropi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Elodi Bacci
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Bernardo Baccani
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Massimo Fineschi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
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Seguchi M, Aytekin A, Lenz T, Nicol P, Alvarez-Covarrubias HA, Xhepa E, Klosterman GR, Beele A, Sabic E, Utsch L, Alyaqoob A, Joner M. Challenges of the newer generation of resorbable magnesium scaffolds: Lessons from failure mechanisms of the past generation. J Cardiol 2023; 81:179-188. [PMID: 36122642 DOI: 10.1016/j.jjcc.2022.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/14/2022] [Accepted: 08/01/2022] [Indexed: 11/29/2022]
Abstract
Bioresorbable scaffolds (BRS) were developed to overcome the obstacles of metallic stents, mostly related to sustained presence of metallic foreign body in the coronary vessel. Following earlier success of single-arm BRS studies, randomized controlled trials of Absorb bioresorbable vascular scaffold (Abbott Vascular, Santa Clara, CA, USA) showed poor long-term clinical outcomes, particularly in terms of scaffold thrombosis. BRS made from magnesium alloy provide a promising alternative in terms of radial force, strut thickness and, potentially lower thrombogenicity. A recent clinical study demonstrated that magnesium-based BRS seems to be promising with regards to the risk of scaffold thrombosis. In this review, our aim is to describe the issues that prevented Absorb BVS from achieving favorable outcomes, provide current status of existing BRS technologies and the challenges that newer generation BRSs need to overcome, and the results of clinical studies for commercially available magnesium-based BRS, which remain the only BRS actively studied in clinical practice.
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Affiliation(s)
- Masaru Seguchi
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany.
| | - Alp Aytekin
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - Tobias Lenz
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - Philipp Nicol
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - Hector A Alvarez-Covarrubias
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany; Hospital de Cardiología, Centro Médico Nacional Siglo XXI, IMMS, Ciudad de México, México
| | - Erion Xhepa
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - Grace R Klosterman
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - Alicia Beele
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - Emina Sabic
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - Léa Utsch
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - Aseel Alyaqoob
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - Michael Joner
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany; Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
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28
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Wu Y, Yin J, Li C, Zhang W, Shen L, Ge L, Qian J, Ge J. The standard versus prolonged dual antiplatelet therapy after the XINSORB bioresorbable scaffold implantation (SPARTA) trial: study protocol for a randomized controlled trial. Trials 2023; 24:49. [PMID: 36670441 PMCID: PMC9854195 DOI: 10.1186/s13063-022-07028-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 12/15/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is the standard of care after coronary stenting, including coronary stenting involving bioresorbable scaffolds (BRSs). Current clinical guidelines recommend at least 12 months of DAPT after BRS implantation. However, the correlation between prolonged DAPT and net clinical benefits remains unknown. METHODS The SPARTA trial is designed to be a prospective, randomized, parallel-group, clinical trial. It aims to compare the benefits and risks of DAPT applied for either 12 or 36 months after XINSORB BRS implantation. The primary endpoints are the incidence of the composite endpoint of major adverse cardiac events (MACEs), including all-cause death, any myocardial infarction (MI), and all revascularizations, as well as Bleeding Academic Research Consortium Definition (BARC) type 3 or 5 bleeding events. The secondary endpoints of the study include the device-oriented composite endpoint of target lesion failure (defined as cardiac death, target vessel-related MI, or ischemia-driven target lesion revascularization), target vessel failure (defined as cardiac death, MI, or ischemia-driven target vessel revascularization), scaffold thrombosis, and minor bleeding events. This trial will enroll 2106 subjects treated with the XINSORB BRS only. All subjects will receive DAPT after the index procedure for 12 (± 1) months. Subjects without MACEs or major bleeding will be randomized to receive either 24 additional months of DAPT or aspirin alone. DISCUSSION This trial is designed to investigate the impact of extending the duration of DAPT up to 3 years after XINSORB BRS implantation by investigating the balance of risks and benefits in a broad population of treated patients. TRIAL REGISTRATION ClinicalTrials.gov NCT04501900 . Registered on 6 August 2020.
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Affiliation(s)
- Yizhe Wu
- grid.413087.90000 0004 1755 3939Department of Cardiology, Zhongshan Hospital Fudan University, Shanghai Institute of Cardiovascular Diseases, 180 Fenglin Road, Shanghai, 200032 China ,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Jiasheng Yin
- grid.413087.90000 0004 1755 3939Department of Cardiology, Zhongshan Hospital Fudan University, Shanghai Institute of Cardiovascular Diseases, 180 Fenglin Road, Shanghai, 200032 China ,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Chenguang Li
- grid.413087.90000 0004 1755 3939Department of Cardiology, Zhongshan Hospital Fudan University, Shanghai Institute of Cardiovascular Diseases, 180 Fenglin Road, Shanghai, 200032 China ,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Wei Zhang
- grid.8547.e0000 0001 0125 2443Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
| | - Li Shen
- grid.413087.90000 0004 1755 3939Department of Cardiology, Zhongshan Hospital Fudan University, Shanghai Institute of Cardiovascular Diseases, 180 Fenglin Road, Shanghai, 200032 China ,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Lei Ge
- grid.413087.90000 0004 1755 3939Department of Cardiology, Zhongshan Hospital Fudan University, Shanghai Institute of Cardiovascular Diseases, 180 Fenglin Road, Shanghai, 200032 China ,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Juying Qian
- grid.413087.90000 0004 1755 3939Department of Cardiology, Zhongshan Hospital Fudan University, Shanghai Institute of Cardiovascular Diseases, 180 Fenglin Road, Shanghai, 200032 China ,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Junbo Ge
- grid.413087.90000 0004 1755 3939Department of Cardiology, Zhongshan Hospital Fudan University, Shanghai Institute of Cardiovascular Diseases, 180 Fenglin Road, Shanghai, 200032 China ,National Clinical Research Center for Interventional Medicine, Shanghai, China
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29
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Peng W, Chen Y, Fan H, Chen S, Wang H, Song X. A Novel PLLA/MgF 2 Coating on Mg Alloy by Ultrasonic Atomization Spraying for Controlling Degradation and Improving Biocompatibility. MATERIALS (BASEL, SWITZERLAND) 2023; 16:682. [PMID: 36676415 PMCID: PMC9864383 DOI: 10.3390/ma16020682] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/28/2022] [Accepted: 01/04/2023] [Indexed: 06/17/2023]
Abstract
Problems of rapid degradation and poor biocompatibility (endothelialization and hemocompatibility) limit magnesium (Mg) alloy's further applications in vascular stents. To solve these problems, a novel composite coating was designed on Mg alloy via a two-step method. First, a Mg alloy sample was immersed in hydrofluoric acid. Then, a poly-l-lactic acid (PLLA) coating was made by ultrasonic atomization spraying with 5 and 10 layers (referred to as PLLA(5)-HF-Mg and PLLA(10)-HF-Mg). Characterizations were analyzed from the microstructure, element distribution, and wettability. The degradation behavior was tested with an electrochemical test and immersion test. Endothelialization was investigated using human umbilical vein endothelial cells (HUVECs). Hemocompatibility was examined with a platelet adhesion test. The results showed that the PLLA coating could not only cover the surface, but also could permeate through and cover the holes on the MgF2 layer, mechanically locked with the substrate. Thus, the composite coating had higher corrosion resistance. The PLLA/MgF2 coating, especially on PLLA(10)-HF-Mg, enhanced HUVECs' viability and growth. While incubated with platelets, the PLLA/MgF2 coating, especially on PLLA(10)-HF-Mg, had the lowest platelet adhesion number and activity. Taken together, the novel PLLA/MgF2 coating controls Mg alloy's degradation by spraying different layers of PLLA, resulting in better endothelialization and hemocompatibility, providing a promising candidate for cardiovascular stents.
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Affiliation(s)
- Wenpeng Peng
- Cardiovascular Center, The Fourth Affiliated Hospital of Harbin Medical University, Harbin 150000, China
- Department of Clinical Medicine, Harbin Medical University, Harbin 150000, China
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yizhe Chen
- Hubei Key Laboratory of Advanced Technology for Automotive Components, Wuhan University of Technology, Wuhan 430070, China
| | - Hongde Fan
- Hubei Key Laboratory of Advanced Technology for Automotive Components, Wuhan University of Technology, Wuhan 430070, China
| | - Shanshan Chen
- Institute of Metal Research, Chinese Academy of Sciences, Shenyang 110016, China
| | - Hui Wang
- Hubei Key Laboratory of Advanced Technology for Automotive Components, Wuhan University of Technology, Wuhan 430070, China
| | - Xiang Song
- Cardiovascular Center, The Fourth Affiliated Hospital of Harbin Medical University, Harbin 150000, China
- Department of Clinical Medicine, Harbin Medical University, Harbin 150000, China
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Kereiakes DJ. Bioadapting to Nature With a Novel Coronary Prosthesis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 46:113-114. [PMID: 36243661 DOI: 10.1016/j.carrev.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 01/13/2023]
Affiliation(s)
- Dean J Kereiakes
- The Christ Hospital Heart and Vascular Institute, USA; The Carl and Edyth Lindner Center for Research at The Christ Hospital, USA.
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Verheye S, Morice MC, Zivelonghi C, Mehmedbegovic Z, Neylon A, Bhat V, Colombo A. 24-Month Clinical Follow-Up and Mechanistic Insights From Intravascular Imaging Following Coronary Implantation of the Novel DynamX Bioadaptor Platform. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 46:106-112. [PMID: 36184491 DOI: 10.1016/j.carrev.2022.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/10/2022] [Accepted: 09/21/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND/PURPOSE Conventional stents "cage" the coronary arteries, impairing vascular function and physiology. The DynamX Bioadaptor is a cobalt‑chromium platform with uncaging elements, designed to improve arterial pulsatility, vasomotion, compliance, and positive adaptive remodelling which may attenuate late clinical events associated with the caging of arteries through conventional stents. We present the first 24-month outcomes of this device. METHODS/MATERIALS This European multicenter study enrolled 50 patients with 50 de novo lesions treated with the DynamX Bioadaptor. Clinical follow-up is scheduled until 36 months and imaging follow-up was performed at 9-12 months. RESULTS 24-month endpoints were target lesion failure (2 cardiac deaths), myocardial infarction (1 non-target vessel myocardial infarction), target vessel revascularisation (n = 0), and definite or probable device thrombosis (n = 0). No endpoint events occurred beyond 9 months. Paired intravascular ultrasound analysis of 18 patients from a single center revealed a 0.22 mm2 increase in device cross-sectional area at 9-12 months. Pulsatility analysis showed an increase of in-device lumen area change by 46 % compared to the caged post-procedural configuration, reducing the compliance mismatch between the treated and not-treated vessel segments (segmental compliance). Likewise, vasomotion in response to nitroglycerin improved from 0.03mm2 post-procedure to 0.17mm2 at follow-up. CONCLUSIONS 24-month clinical data demonstrate promising safety and efficacy of the DynamX Bioadaptor. Imaging data confirmed its unique capacity to improve arterial pulsatility, vasomotion, compliance and positive adaptive remodelling after "uncaging" which might have led to the promising clinical outcomes that need to be confirmed in larger studies.
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Affiliation(s)
- Stefan Verheye
- Interventional Cardiology, ZNA Cardiovascular Center Middelheim, Antwerp, Belgium.
| | - Marie-Claude Morice
- Cardiovascular European Research Center (CERC), Massy, France; ICPS Paris Sud, Massy, France.
| | - Carlo Zivelonghi
- Interventional Cardiology, ZNA Cardiovascular Center Middelheim, Antwerp, Belgium
| | | | - Antoinette Neylon
- Cardiovascular European Research Center (CERC), Massy, France; ICPS Paris Sud, Massy, France.
| | | | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy
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Magnesium Bioresorbable Scaffold (BRS) Magmaris vs Biodegradable Polymer DES Ultimaster in NSTE-ACS Population-12-Month Clinical Outcome. J Interv Cardiol 2022; 2022:5223317. [PMID: 36605917 PMCID: PMC9794423 DOI: 10.1155/2022/5223317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/27/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
Background Percutaneous coronary intervention (PCI) in the acute coronary syndrome (ACS) setting is associated with a greater probability of device failure. The currently ongoing development of new scaffold technologies has concentrated an effort on improving the PCI outcomes, including the use of new biodegradable materials. This pilot study evaluates the performance of a magnesium bioresorbable scaffold (Magmaris, Biotronik, Germany) in comparison to the sirolimus-eluting bioresorbable polymer stents (BP-SES) (Ultimaster, Terumo, Japan) in the NSTE-ACS setting. Methods The population of this pilot comprised 362 patients assigned to one of two arms (193-Magmaris vs 169-Ultimaster). The data regarding the primary outcome comprised of death from cardiac causes, myocardial infarction, and stent thrombosis, along with target-lesion failure (TLF) and other clinical events was collected in the 1-yearfollow-up. Results There were no statistically significant differences in clinical outcomes in the short term (30 days) or in the 1-yearfollow-up between both groups. Conclusion At 12 months, there were no statistically significant differences between the Magmaris and Ultimaster for composed endpoints or the TLF.
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Jackson-Smith E, Zioupos S, Banerjee P. Bioresorbable vascular scaffolds versus conventional drug-eluting stents across time: a meta-analysis of randomised controlled trials. Open Heart 2022; 9:openhrt-2022-002107. [PMID: 36288820 PMCID: PMC9615997 DOI: 10.1136/openhrt-2022-002107] [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: 07/30/2022] [Accepted: 09/12/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Bioresorbable vascular scaffolds (BVS) were designed to reduce the rate of late adverse events observed in conventional drug-eluting stents (DES) by dissolving once they have restored lasting patency. OBJECTIVES Compare the safety and efficacy of BVS versus DES in patients receiving percutaneous coronary intervention for coronary artery disease across a complete range of randomised controlled trial (RCT) follow-up intervals. METHODS A systematic review and meta-analysis was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. MEDLINE, EMBASE and Web of Science were searched from inception through 5 January 2022 for RCTs comparing the clinical outcomes of BVS versus DES. The primary safety outcome was stent/scaffold thrombosis (ST), and the primary efficacy outcome was target lesion failure (TLF: composite of cardiac death, target vessel myocardial infarction (TVMI) and ischaemia-driven target lesion revascularisation (ID-TLR)). Secondary outcomes were patient-oriented composite endpoint (combining all-death, all-MI and all-revascularisation), its individual components and those of TLF. Studies were appraised using Cochrane's Risk of Bias tool and meta-analysis was performed using RevMan V.5.4. RESULTS 11 919 patients were randomised to receive either BVS (n=6438) or DES (n=5481) across 17 trials (differing follow-up intervals from 3 months to 5 years). BVS demonstrated increased risk of ST across all timepoints (peaking at 2 years with risk ratio (RR): 3.47; 95% CI 1.80 to 6.70; p=0.0002). Similarly, they showed increased risk of TLF (peaking at 3 years, RR: 1.35; 95% CI 1.07 to 1.70; p=0.01) resulting from high rates of TVMI and ID-TLR. Though improvements were observed after device dissolution (5-year follow-up), these were non-significant. All other outcomes were statistically equivalent. Applicability to all BVS is limited by 91% of the BVS group receiving Abbott's Absorb. CONCLUSION This meta-analysis demonstrates that current BVS are inferior to contemporary DES throughout the first 5 years at minimum.
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Affiliation(s)
| | | | - Prithwish Banerjee
- Warwick Medical School, University of Warwick, Coventry, UK,Centre for Sports, Exercise & Life Sciences (CSELS), Coventry University Faculty of Health and Life Sciences, Coventry, UK,Department of Cardiology, University Hospitals Coventry and Warwickshire, Coventry, UK
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Coronary Stenting: Reflections on a 35-Year Journey. Can J Cardiol 2022; 38:S17-S29. [PMID: 34375695 DOI: 10.1016/j.cjca.2021.07.224] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/12/2021] [Accepted: 07/14/2021] [Indexed: 01/09/2023] Open
Abstract
Stenting was introduced as a therapy for coronary artery disease 35 years ago, and is currently the most commonly performed minimally invasive procedure globally. Percutaneous coronary revascularization, initially with plain old balloon angioplasty and later with stenting, has dramatically affected the outcomes of acute myocardial infarction and acute coronary syndromes. Coronary stenting is probably the most intensively studied therapy in medicine on the basis of the number of randomized clinical trials for a broad range of indications. Continuous improvements in stent materials, design, and coatings concurrent with procedural innovations have truly been awe-inspiring. The story of stenting is replete with high points and some low points, such as the initial experience with stent thrombosis and restenosis, and the more recent disappointment with bioabsorbable scaffolds. History has shown rapid growth of stent use with expansion of indications followed by contraction of some uses in response to clinical trial evidence in support of bypass surgery or medical therapy. In this review we trace the constantly evolving story of the coronary stent from the earliest experience until the present time. Undoubtedly, future iterations of stent design and materials will continue to move the stent story forward.
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Polimeni A, Sorrentino S, Spaccarotella C, Mongiardo A, Sabatino J, De Rosa S, Gori T, Indolfi C. Stent Thrombosis After Percutaneous Coronary Intervention: From Bare-Metal to the Last Generation of Drug-Eluting Stents. Interv Cardiol Clin 2022; 11:465-473. [PMID: 36243491 DOI: 10.1016/j.iccl.2022.07.002] [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] [Indexed: 06/16/2023]
Abstract
Since their introduction in clinical practice in 1986, different types of coronary stents have been developed and become available for the treatment of coronary artery disease. Stent thrombosis (ST) is an uncommon but harmful complication after percutaneous coronary implantation, with a high occurrence of acute myocardial infarction and risk of mortality. Among several procedural and clinical predictors, the type of coronary stent is a strong determinant of ST. This article reviews the available evidence on the most used coronary stent types in the modern era and the related risk of ST.
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Affiliation(s)
- Alberto Polimeni
- Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Graecia" University, Viale Europa, Catanzaro 88100, Italy; Research Center for Cardiovascular Diseases, "Magna Graecia" University, Viale Europa, Catanzaro 88100, Italy
| | - Sabato Sorrentino
- Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Graecia" University, Viale Europa, Catanzaro 88100, Italy; Research Center for Cardiovascular Diseases, "Magna Graecia" University, Viale Europa, Catanzaro 88100, Italy
| | - Carmen Spaccarotella
- Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Graecia" University, Viale Europa, Catanzaro 88100, Italy; Research Center for Cardiovascular Diseases, "Magna Graecia" University, Viale Europa, Catanzaro 88100, Italy
| | - Annalisa Mongiardo
- Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Graecia" University, Viale Europa, Catanzaro 88100, Italy
| | - Jolanda Sabatino
- Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Graecia" University, Viale Europa, Catanzaro 88100, Italy; Research Center for Cardiovascular Diseases, "Magna Graecia" University, Viale Europa, Catanzaro 88100, Italy
| | - Salvatore De Rosa
- Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Graecia" University, Viale Europa, Catanzaro 88100, Italy; Research Center for Cardiovascular Diseases, "Magna Graecia" University, Viale Europa, Catanzaro 88100, Italy
| | - Tommaso Gori
- Kardiologie I, Zentrum für Kardiologie, University Medical Center Mainz, Deutsches Zentrum für Herz und Kreislauf Forschung, Langenbeckstraße 1, Standort Rhein-Main 55131, Germany
| | - Ciro Indolfi
- Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Graecia" University, Viale Europa, Catanzaro 88100, Italy; Research Center for Cardiovascular Diseases, "Magna Graecia" University, Viale Europa, Catanzaro 88100, Italy; Mediterranea Cardiocentro, Via Orazio, 2, Naples 80122, Italy.
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Hill A, Ronan W. A kinetic scission model for molecular weight evolution in bioresorbable polymers. POLYM ENG SCI 2022. [DOI: 10.1002/pen.26131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Aoife Hill
- Biomechanics Research Centre, Biomedical Engineering, School of Engineering University of Galway Galway Ireland
| | - William Ronan
- Biomechanics Research Centre, Biomedical Engineering, School of Engineering University of Galway Galway Ireland
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Wan YD, Wang DY, Deng WQ, Lai SJ, Wang X. Bioresorbable scaffolds vs. drug-eluting stents on short- and mid-term target lesion outcomes in patients after PCI: A systematic review and meta-analysis. Front Cardiovasc Med 2022; 9:949494. [PMID: 36158817 PMCID: PMC9492944 DOI: 10.3389/fcvm.2022.949494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 08/01/2022] [Indexed: 11/26/2022] Open
Abstract
Background While current concerns about bioresorbable scaffolds (BRS) are centered on late or very late scaffold thrombosis, less attention had been paid to short- and mid-term clinical outcomes. This review aimed to compare the short- and mid-term outcomes between BRS and drug-eluting stents (DES). Methods A systematic review of randomized controlled trials (RCTs) that compared BRS vs. DES was conducted by searching PubMed, Cochrane Library, Web of Science, CNKI, WanFang, and VIP databases from inception until 19 April 2022 (language limited to English or Chinese). The primary outcome was target lesion failure (TLF) within 12 months, defined as a composite of target lesion revascularization (TLR), target vessel myocardial infarction (TVMI), and cardiac death. The secondary outcomes were in-stent diameter stenosis (DS%) provided by intraluminal imaging. Results A total of 13 studies were eligible and were included in this review (N = 9,702 patients). The follow-up duration ranged from 6 months to 1 year. A significantly higher rate of TLF [RR, 1.22, 95% CI (1.03, 1.44)] driven by the higher rate of TVMI [RR, 1.39, 95% CI (1.09, 1.76)] was observed in the BRS group than in the DES group. The risk of TLR and cardiac death was similar between the groups. Also, compared with the DES group, the BRS group had a significantly higher in-stent DS% within 1 year [MD = 5.23, 95%CI (3.43, 7.04); I2 = 97%; p < 0.00001]. Conclusion Bioresorbable scaffolds were associated with an increased risk of target lesion failure within 1 year as compared with DES, driven by the increased rates of target vessel myocardial infarction. Also, the in-stent DS% seemed to be higher with BRS. Therefore, BRS was inferior to DES in terms of target lesion outcomes at short- or mid-term follow-up. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=327966, PROSPERO (CRD42022327966).
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Affiliation(s)
- Yan-di Wan
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Da-yang Wang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- Institute of Cardiology, Beijing University of Chinese Medicine, Beijing, China
| | - Wen-qi Deng
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Si-jia Lai
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xian Wang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- Institute of Cardiology, Beijing University of Chinese Medicine, Beijing, China
- *Correspondence: Xian Wang
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Structural and Functional Evaluation of Coronary Arteries Treated With ABSORB Bioresorbable Vascular Scaffold at 5-Year Follow-Up. Am J Cardiol 2022; 182:1-7. [PMID: 36075756 DOI: 10.1016/j.amjcard.2022.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 07/06/2022] [Accepted: 07/11/2022] [Indexed: 11/23/2022]
Abstract
Although complete bioresorbable vascular scaffold (BVS) resorption has been demonstrated at 5-year follow-up, whether corresponding vasomotor function restoration occurs remains unknown. The objective was to simultaneously assess the structural healing response along with vasomotor responses at 5-year follow-up of BVS implantation. We studied consecutive patients treated with ABSORB-BVS at 5-year follow-up (n = 31), who were recruited from a multicenter registry and were contacted to undergo a research protocol-driven repeat coronary angiogram involving intracoronary optical coherence tomography (OCT) and invasive coronary endothelial function testing. Epicardial endothelium-dependent vasomotion was defined as any vasodilatation after intracoronary acetylcholine (ACh), whereas endothelium-independent vasomotion was defined as any vasodilatation after intracoronary nitroglycerine (NTG), using quantitative coronary angiography. The mean implantation time point was 60.5 ± 4.6 months. OCT imaging demonstrated complete scaffold resorption in all patients. New coronary lesions (stenosis >50%) were found in 5 patients (16.1%), 3 of them underwent ad hoc percutaneous revascularization (9.7%). Intracoronary ACh (27 patients) and NTG testing (30 patients) was performed. Quantitative coronary angiography analysis demonstrated vasoconstriction after ACh administration and lack of response to NTG in BVS segments (mean lumen diameter = 2.00 ± 0.61 mm at baseline vs 1.74 ± 0.70 mm post-ACh, p <0.001; 2.05 ± 0.54 mm at baseline vs 2.03 ± 0.50 mm post-NTG, p = 0.69). OCT lumen analysis demonstrated similar vasoconstrictive responses to ACh (mean lumen area = 5.31 ± 2.26 mm2 at baseline vs 5.12 ± 2.55 mm2 post-ACh, p = 0.007) but had a vasodilatory response to NTG (5.96 ± 2.35 mm2 at baseline vs 6.17 ± 2.55 mm2 post-NTG, p<0.001). In conclusion, complete ABSORB-BVS resorption was demonstrated at 5-year follow-up. However, this healing response was associated with endothelium-dependent vasomotor dysfunction within the BVS segment.
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Landolff Q, Lefèvre T, Fajadet J, Sainsous J, Lhermusier T, Elhadad S, Tarragano F, Ranc S, Ghostine S, Cayla G, Marco F, Garot P, Maillard L, Motreff P, Delarche N, De Labriolle A, Pansieri M, Morelle JF, Cazaux P, Moulichon ME, Chopat P, Angoulvant D, Bataille V, Le Breton H, Koning R. Five-year clinical outcomes using the bioresorbable vascular scaffold: Insights from the FRANCE ABSORB registry. Arch Cardiovasc Dis 2022; 115:505-513. [PMID: 36123284 DOI: 10.1016/j.acvd.2022.05.008] [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: 01/18/2022] [Revised: 05/19/2022] [Accepted: 05/23/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Randomized trials comparing the first-generation absorb bioresorbable vascular scaffold (BVS) (Abbott Vascular, Santa Clara, CA, USA) with a drug-eluting stent showed a moderate but significant increase in the rate of 3-year major adverse cardiac events and scaffold thrombosis, followed by a decrease in adverse events after 3 years. AIM The objective of this study was to assess the 5-year outcomes of patients treated with at least one absorb BVS and included in the FRANCE ABSORB registry. METHODS All patients treated in France with an absorb BVS were prospectively included in a large nationwide multicentre registry. The primary efficacy outcome was the occurrence of 5-year major adverse cardiac events. Secondary efficacy outcomes were the rates of 5-year target vessel revascularization and definite/probable scaffold thrombosis. RESULTS Between September 2014 and April 2016, 2,070 patients were included in 86 centres (mean age 55±11 years; 80% men; 49% with acute coronary syndrome). The rates of 1-, 3- and 5-year major adverse cardiac events were 3.9%, 9.4% and 12.1%, respectively (including cardiac death in 2.5% and target vessel revascularization in 10.4%). By multivariable analysis, diabetes, oral anticoagulation, the use of multiple Absorb BVSs and the use of a 2.5mm diameter absorb BVS were associated with 5-year major adverse cardiac events. The rates of 1-, 3- and 5-year definite/probable scaffold thrombosis were 1.5%, 3.1% and 3.6%, respectively. By multivariable analysis, older age, diabetes, anticoagulation at discharge and the use of a 2.5mm diameter absorb BVS were associated with 5-year scaffold thrombosis. CONCLUSIONS Absorb BVS implantation was associated with low rates of 1-year major adverse cardiac events, which increased significantly at 3-year follow-up. There was a clear decrease in the rates of scaffold thrombosis and major adverse cardiac events after 3 years.
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Affiliation(s)
| | - Thierry Lefèvre
- Institut cardiovasculaire Paris Sud, Ramsay-Générale de Santé, hôpital privé Jacques-Cartier, 91300 Massy, France
| | | | | | | | - Simon Elhadad
- Centre hospitalier de Marne-la-Vallée, 77600 Jossigny, France
| | | | - Sylvain Ranc
- Centre hospitalier Saint-Joseph Saint-Luc, 69007 Lyon, France
| | - Saïd Ghostine
- Hôpital Marie-Lannelongue (groupe hospitalier Paris Saint-Joseph), 92350 Le Plessis-Robinson, France
| | | | | | - Philippe Garot
- Hôpital privé Claude-Galien, 91480 Quincy-sous-Sénart, France
| | | | | | | | | | | | | | - Pierre Cazaux
- Centre hospitalier de Bretagne Sud Site de Scorff, 56322 Lorient, France
| | | | - Patrick Chopat
- Centre hospitalier territorial, hôpital Gaston-Bourret, 98800 Nouméa, Nouvelle-Calédonie, France
| | | | - Vincent Bataille
- ADIMEP, université Paul-Sabatier, Toulouse III, 31400 Toulouse, France
| | | | - René Koning
- Clinique Saint-Hilaire, 76000 Rouen, France.
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Pahmeier K, Neusser S, Hamm C, Kastner J, Wöhrle J, Zahn R, Achenbach S, Mehilli J, Gori T, Naber C, Nef H, Neumann T, Richardt G, Schmermund A, Claas C, Riemer T, Biermann-Stallwitz J. Quality of life of patients with coronary heart disease treated with the bioresorbable vascular scaffold (ABSORB™): 2-year results from the GABI-R-registry. BMC Cardiovasc Disord 2022; 22:379. [PMID: 35987601 PMCID: PMC9392935 DOI: 10.1186/s12872-022-02815-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 08/12/2022] [Indexed: 11/24/2022] Open
Abstract
Background Numerous studies have reported clinical endpoints following coronary revascularization using bioresorbable vascular scaffolds (BVS), while information about the impact on health-related quality of life is sparse. In this analysis of the German-Austrian ABSORB RegIstRy, the 2 year results concerning quality of life development in a large cohort of patients treated with BVS were reported. Methods Data were collected at baseline as well as 30 days, 6 and 24 months after coronary revascularization using BVS. The EQ-5D score, EQ visual analogue scale (VAS) and Seattle Angina Questionnaire (SAQ) were determined for each time point. Patients were categorized according to the indication for coronary revascularization [acute coronary syndrome (ACS), stable angina pectoris (SAP), silent myocardial ischemia (SMI), or other]. Binary logistic regression analysis was performed to determine factors that predict above-average scores two years after implantation. Results Data from 1317 patients in 88 centres were included. Reasons for revascularization were: ACS (n = 643), SAP (n = 443), SMI (n = 52), and other (n = 179). Mean EQ-5D was significantly increased after six months, while a value comparable to baseline was found two years after implantation. EQ VAS and four of five dimensions of SAQ were significantly improved over baseline at all follow-up surveys. Particularly strong improvements were seen in SAQ scores angina frequency and quality of life. Binary regressions showed different statistically significant predictors in the respective models. Conclusions Following coronary revascularization with BVS strong decrease in self-reported angina frequency and increase of self-reported quality of life were observed with continuous improvements over two years of follow-up. Trial registration ClinicalTrials.gov Identifier: NCT02066623. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02815-2.
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Comparison of Different Types of Drug-Eluting Stents for De Novo Long Coronary Artery Lesions. JACC: ASIA 2022; 2:446-456. [PMID: 36339368 PMCID: PMC9627890 DOI: 10.1016/j.jacasi.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 11/23/2022]
Abstract
Background Outcomes of percutaneous coronary intervention for diffuse long lesions remain relatively unfavorable. Prior clinical trials investigated the relative efficacy and safety of different types of drug-eluting stents (DES) in long lesions. Objectives This study sought to compare the relative performance of different types of DES for de novo long (≥25 mm) coronary artery lesions. Methods Using a pooled analysis of individual data of 1,450 patients from 3 randomized clinical trials, we compared angiographic and clinical outcomes of 5 different types of DES: 224 patients with cobalt-chromium everolimus-eluting stents (EES), 255 with platinum-chromium EES, 250 with Resolute zotarolimus-eluting stents, 245 with biodegradable polymer biolimus-eluting stents, and 476 with first-generation sirolimus-eluting stents (SES). The primary endpoint was in-segment late lumen loss at 9 months. Results The primary endpoint was not significantly different between 4 second-generation DES and 1 first-generation SES (0.17 ± 0.41 mm in cobalt-chromium EES; 0.11 ± 0.37 in platinum-chromium EES: 0.14 ± 0.38 in Resolute zotarolimus-eluting stents; 0.14 ± 0.38 in biodegradable polymer biolimus-eluting stents; or 0.10 ± 0.37 in SES, respectively, overall P = 0.38). Also, there were no significant between-group differences with respect to death, myocardial infarction, target-vessel revascularization, or stent thrombosis at 12 months. In the multiple treatment propensity-score analysis, the risk of angiographic and clinical outcomes was also similar among several types of DES. Conclusions In this patient-level pooled analysis, several second-generation DES showed similar angiographic and clinical outcomes in patients with de novo long coronary lesions. (Percutaneous Treatment of LONG Native Coronary Lesions With Drug-Eluting Stent-III [LONG-DES-III]; NCT01078038; Percutaneous Treatment of LONG Native Coronary Lesions With Drug-Eluting Stent-IV [LONG-DES-IV]; NCT01186094; and Everolimus-eluting [PROMUS-ELEMENT] vs. Biolimus A9-Eluting [NOBORI] Stents for Long-Coronary Lesions [LONG-DES-V]; NCT01186120)
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Oh S, Jeong MH, Park DS, Kim M, Kim JH, Hyun DY, Cho KH, Kim MC, Sim DS, Hong YJ, Kim JH, Ahn Y. Successful implantation of a novel polymer-free everolimus-eluting stent using nitrogen-doped titanium dioxide film with good patency on follow-up angiography: A case report. Medicine (Baltimore) 2022; 101:e29666. [PMID: 35866823 PMCID: PMC9302256 DOI: 10.1097/md.0000000000029666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Despite technological advances in interventional cardiology during the last decades, many concerns remain regarding the narrowing and occlusion of the in-stent area. Particularly, polymer materials pose several problems, including chronic arterial inflammation, impaired arterial healing, and stent thrombosis. To avoid these complications, we invented the TIGEREVOLUTION stent with a cobalt-chromium alloy-based stent platform deposited with N-TiO2 film, which has demonstrated good biocompatibility. As this stent is not coated with polymer, it is expected to have decreased risk of stent thrombosis. PATIENT CONCERNS A 62-year-old Korean man visited our department because of angina. We commenced coronary angiography (CAG). DIAGNOSIS CAG revealed critical stenosis in the mid-portion of the right coronary artery, with a minimum lumen area of 1.08mm2 on optical coherence tomography (OCT). INTERVENTION Percutaneous coronary intervention was performed with implantation of a novel 3.5 × 26-mm polymer-free everolimus-eluting stent using nitrogen-doped titanium dioxide film (TIGEREVOLUTION® stent). Post-percutaneous coronary intervention OCT showed good stent expansion and apposition, and the patient was discharged successfully and uneventfully. OUTCOMES Eight months later, follow-up coronary angiography demonstrated good stent patency with no definitive evidence of in-stent restenosis, with thin stent strut coverage demonstrated on OCT. LESSONS We report the first case of TIGEREVOLUTION stent implantation with follow-up OCT at 8 months.
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Affiliation(s)
- Seok Oh
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Department of Cardiology, Chonnam National University Medical School, Gwangju, Korea
- *Correspondence: Myung Ho Jeong, Department of Cardiology, Chonnam National University Hospital; Department of Cardiology, Chonnam National University Medical School, 42, Jebong-ro, Dong-gu, Gwangju 61469, Korea (e-mail: )
| | - Dae Sung Park
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
| | - Munki Kim
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
| | - Jung Ha Kim
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
| | - Dae Young Hyun
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Kyung Hoon Cho
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Min Chul Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Department of Cardiology, Chonnam National University Medical School, Gwangju, Korea
| | - Doo Sun Sim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Department of Cardiology, Chonnam National University Medical School, Gwangju, Korea
| | - Young Joon Hong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Department of Cardiology, Chonnam National University Medical School, Gwangju, Korea
| | - Ju Han Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Department of Cardiology, Chonnam National University Medical School, Gwangju, Korea
| | - Youngkeun Ahn
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Department of Cardiology, Chonnam National University Medical School, Gwangju, Korea
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Liu Y, Zheng B, Zhang B, Ndondo-lay R, Nie F, Tang N, Miao Y, Li J, Huo Y. Five-year comparative study of thin-strut rapamycin-eluting bioabsorbable scaffold with metallic drug-eluting stent in porcine coronary artery. Front Cardiovasc Med 2022; 9:938519. [PMID: 35935636 PMCID: PMC9355424 DOI: 10.3389/fcvm.2022.938519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 06/30/2022] [Indexed: 11/21/2022] Open
Abstract
Objectives Using quantitative coronary angiography (QCA), optical coherence tomography (OCT), histomorphometry, and pharmacokinetics, this study tried to evaluate the safety and efficacy of Biomagic rapamycin-eluting bioabsorbable scaffold (BVS) in non-atherosclerotic porcine coronary arteries. Background Biomagic BVS is a new generation of thin-strut bioabsorbable scaffold. We conducted comparative study detailing pathological response, safety and efficacy of Biomagic BVS and the Firebird2 rapamycin-eluting cobalt-based alloy stent (DES) in a porcine coronary artery model. The animals were followed up at 14 days, 1, 3, 6, 12, 18, 24, 30, 36, 42, 48, 54, and 60 months after stent implantation. Methods A total of 143 devices (95 Biomagic and 48 Firebird2) were implanted in 2 or 3 main coronary arteries of 76 nonatherosclerotic swine and examined by QCA, OCT, light microscopy, and pharmacokinetics analyses at various time points. Results Vascular responses to Biomagic and Firebird2 were largely comparable at all time points, with struts being sequestered within the neointima. The degree of inflammation of both devices was mild to moderate, although the Biomagic score was higher at 14 days to 24 months. However, there was no statistical difference between the two groups except 14 days. At each follow-up time point, the percentage of area stenosis in the Biomagic group was greater than that in the Firebird 2 group, but there was no statistical difference between the two groups at 3 and 12 months. The extent of fibrin deposition was similar between Biomagic and Firebird2, which peaked at 1 month and decreased rapidly thereafter. Pharmacokinetic study showed that coronary tissue sirolimus concentration remained above 2 ng/mg of tissue at 28 day. Histomorphometry showed expansile remodeling of Biomagic-implanted arteries starting after 12 months, and lumen area was significantly greater in Biomagic than Firebird2 at 36 and 42 months. These changes correlated with dismantling of Biomagic seen after 12 months. OCT images confirmed that degradation of Biomagic was complete by 36 months. Conclusions Biomagic demonstrates comparable long-term safety to Firebird2 in porcine coronary arteries with mild to moderate inflammation. Although Biomagic was associated with greater percent stenosis relative to Firebird2 within 36 months, expansile remodeling was observed after 12 months in Biomagic with significantly greater lumen area at ≥36 months. Scaffold resorption is considered complete at 36 months.
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Affiliation(s)
- Yaokun Liu
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Bo Zheng
- Department of Cardiology, Peking University First Hospital, Beijing, China
- Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, China
| | - Bin Zhang
- Department of Cardiology, Peking University First Hospital, Beijing, China
- Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, China
| | | | - Fangfang Nie
- Shanghai Biomagic Medical Devices Company Limited, Shanghai, China
| | - Naijie Tang
- Shanghai Biomagic Medical Devices Company Limited, Shanghai, China
| | - Yongsheng Miao
- Shanghai Biomagic Medical Devices Company Limited, Shanghai, China
| | - Jianping Li
- Department of Cardiology, Peking University First Hospital, Beijing, China
- Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, China
- *Correspondence: Jianping Li
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
- Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, China
- Yong Huo
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Al Nooryani A, Aboushokka W, AlBaba B, Kerfes J, Abudaqa L, Bhatia A, Mansoor A, Nageeb R, Aleksandric S, Beleslin B. Long-Term Performance of the Magmaris Drug-Eluting Bioresorbable Metallic Scaffold in All-Comers Patients’ Population. J Clin Med 2022; 11:jcm11133726. [PMID: 35807011 PMCID: PMC9267727 DOI: 10.3390/jcm11133726] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 06/17/2022] [Accepted: 06/21/2022] [Indexed: 01/25/2023] Open
Abstract
Background: The long-term efficacy and safety of bioresorbable vascular scaffolds (BVS) in real world clinical practice including Magmaris need to be elucidated to better understand performance of this new and evolutive technology. The aim of this study was to evaluate long-term performance of Magmaris, drug-eluting bioresorbable metallic scaffold, in all-comers patients’ population. Methods: We included in this prospective registry first 54 patients (54 ± 11 years; male 46) treated with Magmaris, with at least 30 months of follow-up. Diabetes mellitus and acute coronary syndrome were present in 33 (61%) and 30 (56%) of the patients, respectively. Patients were followed for device- and patient-oriented cardiac events during a median follow-up of 47 months (DOCE–cardiac death, target vessel myocardial infarction, and target lesion revascularization; POCE–all cause death, any myocardial infarction, any revascularization). Results: Event-free survivals for DOCE and POCE were 86.8% and 79.2%, respectively. The rate of DOCE was 7/54 (13%), including in total target vessel myocardial infarction in two patients (4%), target lesion revascularization in six patients (11%), and no cardiac deaths. The rate of POCE was 11/54 (21%), including in total any myocardial infarctions in 3 patients (6%), any revascularization in 11 patients (20%), and no deaths. Definite Magmaris thrombosis occurred in two patients (3.7%), and in-scaffold restenosis developed in five patients (9.3%). Variables associated with DOCE were implantation of ≥2 Magmaris BVS (HR: 5.4; 95%CI: 1.21–24.456; p = 0.027) and total length of Magmaris BVS ≥ 40 mm (HR: 6.4; 95%CI: 1.419–28.855; p = 0.016), whereas previous PCI was the only independent predictor of POCE (HR: 7.4; 95%CI: 2.216–24.613; p = 0.001). Conclusions: The results of the long-term clinical outcome following Magmaris implantation in patients with complex clinical and angiographic features were acceptable and promising. Patients with multi-BVS and longer multi-BVS in lesion implantation were associated with worse clinical outcome.
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Affiliation(s)
- Arif Al Nooryani
- Al Qassimi Hospital, Sharjah 3500, United Arab Emirates; (A.A.N.); (W.A.); (B.A.); (J.K.); (L.A.); (A.B.); (A.M.); (R.N.)
| | - Wael Aboushokka
- Al Qassimi Hospital, Sharjah 3500, United Arab Emirates; (A.A.N.); (W.A.); (B.A.); (J.K.); (L.A.); (A.B.); (A.M.); (R.N.)
| | - Bassam AlBaba
- Al Qassimi Hospital, Sharjah 3500, United Arab Emirates; (A.A.N.); (W.A.); (B.A.); (J.K.); (L.A.); (A.B.); (A.M.); (R.N.)
| | - Jalal Kerfes
- Al Qassimi Hospital, Sharjah 3500, United Arab Emirates; (A.A.N.); (W.A.); (B.A.); (J.K.); (L.A.); (A.B.); (A.M.); (R.N.)
| | - Loai Abudaqa
- Al Qassimi Hospital, Sharjah 3500, United Arab Emirates; (A.A.N.); (W.A.); (B.A.); (J.K.); (L.A.); (A.B.); (A.M.); (R.N.)
| | - Amit Bhatia
- Al Qassimi Hospital, Sharjah 3500, United Arab Emirates; (A.A.N.); (W.A.); (B.A.); (J.K.); (L.A.); (A.B.); (A.M.); (R.N.)
| | - Anoop Mansoor
- Al Qassimi Hospital, Sharjah 3500, United Arab Emirates; (A.A.N.); (W.A.); (B.A.); (J.K.); (L.A.); (A.B.); (A.M.); (R.N.)
| | - Ruwaide Nageeb
- Al Qassimi Hospital, Sharjah 3500, United Arab Emirates; (A.A.N.); (W.A.); (B.A.); (J.K.); (L.A.); (A.B.); (A.M.); (R.N.)
| | | | - Branko Beleslin
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
- Correspondence:
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Rola P, Włodarczak A, Łanocha M, Barycki M, Szudrowicz M, Kulczycki JJ, Jaroszewska-Pozorska J, Gosiewska A, Woźnica K, Lesiak M, Doroszko A. Outcomes of the two generations of bioresorbable scaffolds (Magmaris vs. Absorb) in acute coronary syndrome in routine clinical practice. Cardiol J 2022; 30:VM/OJS/J/86514. [PMID: 35621089 PMCID: PMC10713223 DOI: 10.5603/cj.a2022.0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 03/08/2022] [Accepted: 05/10/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Acute coronary syndrome (ACS) as a clinical manifestation of coronary artery disease (CAD) remains a significant cause of mortality and morbidity, as reported worldwide annually. The second generation of drug-eluting stents (DES) is a gold standard in percutaneous interventions in ACS patients however, permanent caging of the vessel with metallic DES has some drawbacks. Bioresorbable vascular scaffolds (BRS) were designed as a temporal vessel-supporting technology allowing for anatomical and functional restoration. Nevertheless, following the initial encouraging reports, numerous concerns about the safety of BRS occurred. METHODS In this study, a 1-year performance of 193 patients with magnesium BRS - Magmaris (Biotronik, Berlin, Germany) was evaluated in comparison to 160 patients with polymer BRS - Absorb (Abbott-Vascular, Chicago, USA) in the non-ST-segment elevation-ACS setting. RESULTS The Magmaris, when compared to Absorb showed a significantly lower rate of primary endpoint (death from cardiac causes, myocardial infarction, stent thrombosis) as well as target lesion failure in 30-day and 1 year follow-up. In the Absorb group, a significantly higher rate of stent thrombosis was observed. CONCLUSIONS Data from the present study suggests encouraging safety a profile and more favorable clinical outcomes of Magnesium BRS in comparison to the polymer Absorb - BRS.
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Affiliation(s)
- Piotr Rola
- Department of Cardiology, The Copper Health Center (MCZ), Lubin, Poland.
- Department of Cardiology, Provincial Specialized Hospital, Legnica, Poland.
| | - Adrian Włodarczak
- Department of Cardiology, The Copper Health Center (MCZ), Lubin, Poland
| | | | - Mateusz Barycki
- Department of Cardiology, Provincial Specialized Hospital, Legnica, Poland
| | - Marek Szudrowicz
- Department of Cardiology, The Copper Health Center (MCZ), Lubin, Poland
| | - Jan J Kulczycki
- Department of Cardiology, The Copper Health Center (MCZ), Lubin, Poland
| | | | - Alicja Gosiewska
- Faculty of Mathematics and Information Science, Warsaw University of Technology, Warsaw, Poland
| | - Katarzyna Woźnica
- Faculty of Mathematics and Information Science, Warsaw University of Technology, Warsaw, Poland
| | - Maciej Lesiak
- 1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Adrian Doroszko
- Department of Internal Medicine, Hypertension and Clinical Oncology, Wroclaw Medical University, Wroclaw, Poland
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Gupta A, Shrivastava A, Vijayvergiya R, Chhikara S, Datta R, Aziz A, Singh Meena D, Nath RK, Kumar JR. Optical Coherence Tomography: An Eye Into the Coronary Artery. Front Cardiovasc Med 2022; 9:854554. [PMID: 35647059 PMCID: PMC9130606 DOI: 10.3389/fcvm.2022.854554] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/24/2022] [Indexed: 01/20/2023] Open
Abstract
Optical coherence tomography (OCT) is slowly but surely gaining a foothold in the hands of interventional cardiologists. Intraluminal and transmural contents of the coronary arteries are no longer elusive to the cardiologist's probing eye. Although the graduation of an interventionalist in imaging techniques right from naked eye angiographies to ultrasound-based coronary sonographies to the modern light-based OCT has been slow, with the increasing regularity of complex coronary cases in practice, such a transition is inevitable. Although intravascular ultrasound (IVUS) due to its robust clinical data has been the preferred imaging modality in recent years, OCT provides a distinct upgrade over it in many imaging and procedural aspects. Better image resolution, accurate estimation of the calcified lesion, and better evaluation of acute and chronic stent failure are the distinct advantages of OCT over IVUS. Despite the obvious imaging advantages of OCT, its clinical impact remains subdued. However, upcoming newer trials and data have been encouraging for expanding the use of OCT to wider indications in clinical utility. During percutaneous coronary intervention (PCI), OCT provides the detailed information (dissection, tissue prolapse, thrombi, and incomplete stent apposition) required for optimal stent deployment, which is the key to successfully reducing the major adverse cardiovascular event (MACE) and stent-related morbidities. The increasing use of OCT in complex bifurcation stenting involving the left main (LM) is being studied. Also, the traditional pitfalls of OCT, such as additional contrast load for image acquisition and stenting involving the ostial and proximal LM, have also been overcome recently. In this review, we discuss the interpretation of OCT images and its clinical impact on the outcome of procedures along with current barriers to its use and newer paradigms in which OCT is starting to become a promising tool for the interventionalist and what can be expected for the immediate future in the imaging world.
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Carrabba N, Pontone G, Andreini D, Buffa V, Cademartiri F, Carbone I, Clemente A, Guaricci AI, Guglielmo M, Indolfi C, La Grutta L, Ligabue G, Liguori C, Mercuro G, Mushtaq S, Neglia D, Palmisano A, Sciagrà R, Seitun S, Vignale D, Francone M, Esposito A. Appropriateness criteria for the use of cardiac computed tomography, SIC-SIRM part 2: acute chest pain evaluation; stent and coronary artery bypass graft patency evaluation; planning of coronary revascularization and transcatheter valve procedures; cardiomyopathies, electrophysiological applications, cardiac masses, cardio-oncology and pericardial diseases evaluation. J Cardiovasc Med (Hagerstown) 2022; 23:290-303. [PMID: 35486680 DOI: 10.2459/jcm.0000000000001303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In the past 20 years, cardiac computed tomography (CCT) has become a pivotal technique for the noninvasive diagnostic workup of coronary and cardiac diseases. Continuous technical and methodological improvements, combined with fast growing scientific evidence, have progressively expanded the clinical role of CCT. Randomized clinical trials documented the value of CCT in increasing the cost-effectiveness of the management of patients with acute chest pain presenting in the emergency department, also during the pandemic. Beyond the evaluation of stents and surgical graft patency, the anatomical and functional coronary imaging have the potential to guide treatment decision-making and planning for complex left main and three-vessel coronary disease. Furthermore, there has been an increasing demand to use CCT for preinterventional planning in minimally invasive procedures, such as transcatheter valve implantation and mitral valve repair. Yet, the use of CCT as a roadmap for tailored electrophysiological procedures has gained increasing importance to assure maximum success. In the meantime, innovations and advanced postprocessing tools have generated new potential applications of CCT from the simple coronary anatomy to the complete assessment of structural, functional and pathophysiological biomarkers of cardiac disease. In this complex and revolutionary scenario, it is urgently needed to provide an updated guide for the appropriate use of CCT in different clinical settings. This manuscript, endorsed by the Italian Society of Cardiology (SIC) and the Italian Society of Medical and Interventional Radiology (SIRM), represents the second of two consensus documents collecting the expert opinion of cardiologists and radiologists about current appropriate use of CCT.
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Affiliation(s)
- Nazario Carrabba
- Department of Cardiothoracovascular Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence
| | | | - Daniele Andreini
- Centro Cardiologico Monzino IRCCS.,Department of Clinical Sciences and Community Health, University of Milan, Milan
| | - Vitaliano Buffa
- Department of Radiology, Azienda Ospedaliera San Camillo Forlanini, Rome
| | | | - Iacopo Carbone
- Department of Radiological, Oncological and Pathological Sciences, 'Sapienza' University of Rome, Rome
| | - Alberto Clemente
- Department of Radiology, CNR (National Council of Research)/Tuscany Region 'Gabriele Monasterio' Foundation (FTGM), Massa
| | - Andrea Igoren Guaricci
- University Cardiology Unit, Cardiothoracic Department, Policlinic University Hospital, Bari
| | | | - Ciro Indolfi
- Department of Medical and Surgical Sciences, Magna Grecia University, Catanzaro
| | - Ludovico La Grutta
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties-ProMISE, University of Palermo
| | - Guido Ligabue
- Department of Medical and Surgical Sciences, Modena and Raggio Emilia University.,Radiology Department, AOU of Modena, Modena
| | - Carlo Liguori
- Radiology Unit, Ospedale del Mare -A.S.L Na1- Centro, Naples
| | - Giuseppe Mercuro
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari
| | | | - Danilo Neglia
- Cardiovascular Department, CNR (National Council of Research)/Tuscany Region 'Gabriele Monasterio' Foundation (FTGM), Pisa
| | - Anna Palmisano
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS Ospedale San Raffaele.,Vita-Salute San Raffaele University, Milan
| | - Roberto Sciagrà
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence
| | - Sara Seitun
- Radiology Department, Ospedale Policlinico San Martino, IRCCS Per L'Oncologia e le Neuroscienze, Genoa, Italy
| | - Davide Vignale
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS Ospedale San Raffaele.,Vita-Salute San Raffaele University, Milan
| | - Marco Francone
- Department of Radiological, Oncological and Pathological Sciences, 'Sapienza' University of Rome, Rome
| | - Antonio Esposito
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS Ospedale San Raffaele.,Vita-Salute San Raffaele University, Milan
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Gallinoro E, Almendarez M, Alvarez-Velasco R, Barbato E, Avanzas P. Bioresorbable stents: Is the game over? Int J Cardiol 2022; 361:20-28. [DOI: 10.1016/j.ijcard.2022.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/08/2022] [Accepted: 05/11/2022] [Indexed: 11/30/2022]
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Bossard M, Madanchi M, Avdijaj D, Attinger-Toller A, Cioffi GM, Seiler T, Tersalvi G, Kobza R, Schüpfer G, Cuculi F. Long-Term Outcomes After Implantation of Magnesium-Based Bioresorbable Scaffolds—Insights From an All-Comer Registry. Front Cardiovasc Med 2022; 9:856930. [PMID: 35498044 PMCID: PMC9046914 DOI: 10.3389/fcvm.2022.856930] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/08/2022] [Indexed: 12/18/2022] Open
Abstract
BackgroundThe magnesium-based sirolimus-eluting bioresorbable scaffold (Mg-BRS) Magmaris™ showed promising clinical outcomes, including low rates of both the target lesion failure (TLF) and scaffold thrombosis (ScT), in selected study patients. However, insights regarding long-term outcomes (>2 years) in all-comer populations remain scarce.MethodsWe analyzed data from a single-center registry, including patients with acute coronary syndrome (ACS) and chronic coronary syndrome (CCS), who had undergone percutaneous coronary intervention (PCI) using the Mg-BRS. The primary outcome comprised the device-oriented composite endpoint (DoCE) representing a hierarchical composite of cardiac death, ScT, target vessel myocardial infarction (TV-MI), and clinically driven target lesion revascularization (TLR) up to 5 years.ResultsIn total, 84 patients [mean age 62 ± 11 years and 63 (75%) men] were treated with the Mg-BRS devices between June 2016 and March 2017. Overall, 101 lesions had successfully been treated with the Mg-BRS devices using 1.2 ± 0.4 devices per lesion. Pre- and postdilatation using dedicated devices had been performed in 101 (100%) and 98 (97%) of all the cases, respectively. After a median follow-up time of 62 (61–64) months, 14 (18%) patients had experienced DoCEs, whereas ScT was encountered in 4 (4.9%) patients [early ScTs (<30 days) in three cases and two fatal cases]. In 4 (29%) of DoCE cases, optical coherence tomography confirmed the Mg-BRS collapse and uncontrolled dismantling.ConclusionIn contradiction to earlier studies, we encountered a relatively high rate of DoCEs in an all-comer cohort treated with the Mg-BRS. We even observed scaffold collapse and uncontrolled dismantling. This implicates that this metal-based BRS requires further investigation and may only be used in highly selected cases.
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Affiliation(s)
- Matthias Bossard
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
- *Correspondence: Matthias Bossard
| | - Mehdi Madanchi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Dardan Avdijaj
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
- Faculty of Medicine, University of Zurich, Luzern, Switzerland
| | | | | | - Thomas Seiler
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Gregorio Tersalvi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Richard Kobza
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Guido Schüpfer
- Department of Anaestesiology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Florim Cuculi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
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Hassan S, Ali MN, Ghafoor B. Evolutionary perspective of drug eluting stents: from thick polymer to polymer free approach. J Cardiothorac Surg 2022; 17:65. [PMID: 35379273 PMCID: PMC8981810 DOI: 10.1186/s13019-022-01812-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 03/20/2022] [Indexed: 11/16/2022] Open
Abstract
Background Introduction of Bare Metal Stents (BMS) was itself a revolutionary step in the history of the medical industry; however, Drug Eluting Stents (DES) maintained its superiority over BMS in every aspect from restenosis rate to late lumen loss. The reason behind the magnanimous position of the DES in the stent market is the degree of improvement with which it evolves. New and better stents come into the market every year, surpassing their predecessors by many folds. Literature review This review paper discusses the journey of DES with supporting clinical trials in detail. In the first generation, there were stainless-steel stents with thicker coatings. Although they had superior results compared to BMS, there was still room for improvement. Afterward came the second-generation stents, which had superior metal platforms with thinner struts and thin coatings. The drugs were also changed from Paclitaxel and Sirolimus to Zotrolimus and Everolimus. These stents performed best; however, there was an issue of permanent coating, which remained intact over the stent surface after complete drug elution and started to cause issues in longer-term studies. Hence, an improved version of DES was introduced to these permanent coatings called the third generation of drug eluting stents, which initially utilized biodegradable polymer and ultimately moved towards polymer free drug coatings. This generation has introduced a unique amalgam of technologies to achieve its polymer free coatings; however, researchers have numerous prospects of growth in this field. This review paper highlights the major coups of stent technology evolution from BMS to DES, from thick polymeric coatings to thin coatings and from durable polymers to polymer free DES. Conclusion In conclusion, though the medical industry promptly accepted BMS as the best treatment option for cardiovascular diseases; however, DES has provided even better results than BMS. In DES, the first and second generation has ruled the technology for many years and are still on the shelves. Still, the issues aroused due to durable polymer shifted the attention towards biodegradable drug eluting stents, the third generation growing rapidly. But the scientific community has not restricted themselves and is investigating bioresorbable stents that completely eliminate the polymer intervention in drug eluting stent technology.
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Affiliation(s)
- Sadia Hassan
- Department of Biomedical Engineering and Sciences (BMES), School of Mechanical and Manufacturing Engineering (SMME), National University of Sciences and Technology (NUST), Islamabad, Pakistan
| | - Murtaza Najabat Ali
- Department of Biomedical Engineering and Sciences (BMES), School of Mechanical and Manufacturing Engineering (SMME), National University of Sciences and Technology (NUST), Islamabad, Pakistan.
| | - Bakhtawar Ghafoor
- Department of Biomedical Engineering and Sciences (BMES), School of Mechanical and Manufacturing Engineering (SMME), National University of Sciences and Technology (NUST), Islamabad, Pakistan
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