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Song L, Guan C, Yu M, Sun Z, Fu G, He Y, Jia S, Chen J, Qi F, Bai J, Li W, Ge J, Han Y, Gao R. Sirolimus-eluting iron bioresorbable scaffold versus cobalt-chromium everolimus-eluting stents in patients with coronary artery disease: Rationale and design of the IRONMAN-II trial. Am Heart J 2024; 275:53-61. [PMID: 38838969 DOI: 10.1016/j.ahj.2024.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/30/2024] [Accepted: 05/31/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND The previous first-in-human study established the preliminary safety and effectiveness of the novel thin-strut iron bioresorbable scaffold (IBS). The current study aims to directly compare the imaging and physiological efficacy, and clinical outcomes of IBS with contemporary metallic drug-eluting stents (DES). METHODS A total of 518 patients were randomly allocated to treatment with IBS (257 patients) or metallic DES (261 patients) from 36 centers in China. The study is powered to test noninferiority of the IBS compared with the metallic everolimus-eluting stent in terms of the primary endpoint of in-segment late lumen loss at 2 years, and major secondary endpoints including 2-year quantitative flow ratio and cross-sectional mean flow area measured by optical coherence tomography (OCT) (limited to the OCT subgroup, 25 patients in each group). CONCLUSION This will be the first powered randomized trial investigating the safety and efficacy of the novel thin-strut IBS compared to a contemporary metallic DES. The findings will provide valuable evidence for future research of this kind and the application of metallic bioresorbable scaffolds.
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Affiliation(s)
- Lei Song
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Beijing, China; Catheterization Laboratories, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Changdong Guan
- Catheterization Laboratories, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mengyue Yu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Cardiology, Fuwai Yunan hospital, Chinese Academy of Medical Sciences, Kunming, China
| | - Zhongwei Sun
- Catheterization Laboratories, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guosheng Fu
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yong He
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Shaobin Jia
- Department of Cardiology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Jiyan Chen
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Feng Qi
- Department of Cardiology, Fuwai Yunan hospital, Chinese Academy of Medical Sciences, Kunming, China
| | - Jie Bai
- Department of Cardiology, Fuwai Yunan hospital, Chinese Academy of Medical Sciences, Kunming, China
| | - Wei Li
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Beijing, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai, China
| | - Yaling Han
- Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Runlin Gao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Cardiology, Fuwai Yunan hospital, Chinese Academy of Medical Sciences, Kunming, 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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Nakamura M, Suzuki N, Fujii K, Furuya J, Kawasaki T, Kimura T, Sakamoto T, Tanabe K, Kusano H, Stockelman KA, Kozuma K. The Absorb GT1 Bioresorbable Vascular Scaffold System - 5-Year Post-Market Surveillance Study in Japan. Circ J 2024; 88:863-872. [PMID: 38479861 DOI: 10.1253/circj.cj-23-0877] [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] [Indexed: 05/28/2024]
Abstract
BACKGROUND The 1-year clinical outcomes of the Absorb GT1 Japan post-market surveillance (PMS) suggested that an appropriate intracoronary imaging-guided bioresorbable vascular scaffold (BVS) implantation technique may reduce the risk of target lesion failure (TLF) and scaffold thrombosis (ST) associated with the Absorb GT1 BVS. The long-term outcomes through 5 years are now available.Methods and Results: This study enrolled 135 consecutive patients (n=139 lesions) with ischemic heart disease in whom percutaneous coronary intervention (PCI) with the Absorb GT1 BVS was attempted. Adequate lesion preparation, imaging-guided appropriate sizing, and high-pressure post-dilatation using a non-compliant balloon were strongly encouraged. All patients had at least 1 Absorb GT1 successfully implanted at the index procedure. Intracoronary imaging was performed in all patients (optical coherence tomography: 127/139 [91.4%] lesions) and adherence to the implantation technique recommendations was excellent: predilatation, 100% (139/139) lesions; post-dilatation, 98.6% (137/139) lesions; mean (±SD) post-dilatation pressure, 18.8±3.5 atm. At 5 years, the follow-up rate was 87.4% (118/135). No definite/probable ST was reported through 5 years. The cumulative TLF rate was 5.1% (6/118), including 2 cardiac deaths, 1 target vessel-attributable myocardial infarction, and 3 ischemia-driven target lesion revascularizations. CONCLUSIONS Appropriate intracoronary imaging-guided BVS implantation, including the proactive use of pre- and post-balloon dilatation during implantation may be beneficial, reducing the risk of TLF and ST through 5 years.
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Affiliation(s)
- Masato Nakamura
- Division of Minimally Invasive Treatment in Cardiovascular Medicine, Toho University Ohashi Medical Center
| | - Nobuaki Suzuki
- Fourth Department of Internal Medicine, Teikyo University School of Medicine
| | - Kenshi Fujii
- Department of Cardiovascular Medicine, Sakurabashi Watanabe Hospital
| | - Jungo Furuya
- Department of Cardiovascular Medicine, Hanaoka Seishu Memorial Hospital
| | | | - Takumi Kimura
- Department of Cardiovascular Medicine, Iwate Medical University Hospital
| | | | - Kengo Tanabe
- Division of Cardiology, Mitsui Memorial Hospital
| | | | | | - Ken Kozuma
- Department of Cardiovascular Medicine, Teikyo University Hospital
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Saito S, Bennett J, Nef HM, Webster M, Namiki A, Takahashi A, Kakuta T, Yamazaki S, Shibata Y, Scott D, Vrolix M, Menon M, Möllmann H, Werner N, Neylon A, Mehmedbegovic Z, Smits PC, Morice MC, Verheye S. First randomised controlled trial comparing the sirolimus-eluting bioadaptor with the zotarolimus-eluting drug-eluting stent in patients with de novo coronary artery lesions: 12-month clinical and imaging data from the multi-centre, international, BIODAPTOR-RCT. EClinicalMedicine 2023; 65:102304. [PMID: 38106564 PMCID: PMC10725075 DOI: 10.1016/j.eclinm.2023.102304] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/10/2023] [Accepted: 10/13/2023] [Indexed: 12/19/2023] Open
Abstract
Background The DynamX™ bioadaptor is the first coronary implant technology with a unique mechanism of unlocking the bioadaptor frame after polymer resorption over 6 months, uncaging the vessel while maintaining a dynamic support to the vessel. It aims to achieve the acute performance of drug-eluting stents (DES) with the advantages of restoration of vessel function. Methods This international, single blinded, randomised controlled (1:1) trial compared a sirolimus-eluting bioadaptor with a contemporary zotarolimus-eluting stent (DES) in 34 hospitals in Europe, Japan and New Zealand. Patients with de novo coronary lesions and absence of acute myocardial infarction were enrolled from January 2021 to Feburary 2022. The implantation of the bioadaptor followed the standards of DES. An imaging subset of 100 patients had angiographic and intravascular ultrasound assessments, and 20 patients additionally optical coherence tomography. Data collection will continue through 5 years, we herein report 12-month data based on an intention-to-treat population. This trial is registered at ClinicalTrials.gov (NCT04192747). Findings 445 patients were randomised between January 2021 and February 2022. Device, lesion and procedural success rates, and acute gain were similar amongst the groups. The primary endpoint, 12-month target lesion failure, was 1.8% [95% CI: 0.5; 4.6] (n = 4) versus 2.8% [95% CI: 1.0; 6.0] (n = 6), pnon-inferiority < 0.001 for the bioadaptor and the DES, respectively (Δ-1.0% [95% CI: -3.3; 1.4]). One definite or probable device thrombosis occurred in each group. The 12-month imaging endpoints showed superior effectiveness of the bioadaptor such as in-device late lumen loss (0.09 mm [SD 0.34] versus 0.25 mm [SD 0.39], p = 0.04), and restored compliance and cyclic pulsatility (%mid in-device lumen area change of 7.5% versus 2.7%, p < 0.001). Interpretation This is the first randomised controlled trial comparing the novel bioadaptor technology against a contemporary DES. The bioadaptor demonstrated similar acute performance and 12-month clinical outcomes, and superior imaging endpoints including restoration of vessel function. Funding The study was funded by Elixir Medical.
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Affiliation(s)
- Shigeru Saito
- Heart Center, Iryohojin Tokushukai Shonan Kamakura General Hospital, Kamakura City, Japan
| | - Johan Bennett
- Department of Cardiovascular Medicine, UZ Leuven, Leuven, Belgium
| | - Holger M. Nef
- Department of Cardiology and Angiology, University of Giessen, Giessen, Germany
| | - Mark Webster
- Cardiac Investigation Unit, Auckland City Hospital, Auckland, New Zealand
| | - Atsuo Namiki
- Department of Cardiology, Kanto Rosai Hospital, Nakahara-ku, Kawasaki-shi, Japan
| | | | - Tsunekazu Kakuta
- Cardiovascular Medicine, Tsuchiura Kyodo Hospital, Tsuchiura City, Japan
| | - Seiji Yamazaki
- Department of Cardiology, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Yoshisato Shibata
- Department of Cardiology, Miyazaki Medical Association Hospital, Miyazaki City, Japan
| | - Douglas Scott
- Department of Cardiology, Middlemore Hospital, Auckland, New Zealand
| | - Mathias Vrolix
- Department of Cardiology, Ziekenhuis Oost-Limburg, Campus Sint Jan, Genk, Belgium
| | - Madhav Menon
- Department of Cardiology, Waikato Hospital, Hamilton, New Zealand
| | - Helge Möllmann
- Department of Cardiology, St. Johannes Hospital Dortmund, Dortmund, Germany
| | - Nikos Werner
- Department of Cardiology, Krankenhaus der Barmherzigen Brüder Trier, Trier, Germany
| | - Antoinette Neylon
- CERC (Cardiovascular European Research Center) ICPS Ramsay, Massy, France
| | | | - Pieter C. Smits
- CERC (Cardiovascular European Research Center) ICPS Ramsay, Massy, France
| | | | - Stefan Verheye
- Interventional Cardiology, ZNA Cardiovascular Center Middelheim, Antwerp, Belgium
| | - BIOADAPTOR-RCT Collaborators
- Heart Center, Iryohojin Tokushukai Shonan Kamakura General Hospital, Kamakura City, Japan
- Department of Cardiovascular Medicine, UZ Leuven, Leuven, Belgium
- Department of Cardiology and Angiology, University of Giessen, Giessen, Germany
- Cardiac Investigation Unit, Auckland City Hospital, Auckland, New Zealand
- Department of Cardiology, Kanto Rosai Hospital, Nakahara-ku, Kawasaki-shi, Japan
- Department of Cardiology, Takahashi Hospital, Kobe City, Japan
- Cardiovascular Medicine, Tsuchiura Kyodo Hospital, Tsuchiura City, Japan
- Department of Cardiology, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
- Department of Cardiology, Miyazaki Medical Association Hospital, Miyazaki City, Japan
- Department of Cardiology, Middlemore Hospital, Auckland, New Zealand
- Department of Cardiology, Ziekenhuis Oost-Limburg, Campus Sint Jan, Genk, Belgium
- Department of Cardiology, Waikato Hospital, Hamilton, New Zealand
- Department of Cardiology, St. Johannes Hospital Dortmund, Dortmund, Germany
- Department of Cardiology, Krankenhaus der Barmherzigen Brüder Trier, Trier, Germany
- CERC (Cardiovascular European Research Center) ICPS Ramsay, Massy, France
- Interventional Cardiology, ZNA Cardiovascular Center Middelheim, Antwerp, Belgium
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Fan W, Tan J, Li L, Feng B, Shi W, Pei J, Yuan G, Yu B. Efficacy and Safety of Absorb Everolimus-Eluting Bioresorbable Vascular Scaffold in Peripheral Artery Disease: A Single-Arm Meta-Analysis. J Endovasc Ther 2023; 30:651-663. [PMID: 35510722 DOI: 10.1177/15266028221091899] [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: 11/15/2022]
Abstract
PURPOSE This study aimed to evaluate the benefits and risks of patients with peripheral artery disease (PAD) treated with Absorb everolimus-eluting bioresorbable vascular scaffold (BVS) by analyzing all the published studies on the clinical characteristics of patients with PAD. MATERIALS AND METHODS PubMed, Embase, and the Cochrane Library were searched for relevant studies. Efficacy, safety, and basic characteristics were analyzed. RESULTS Four studies were included in meta-analysis, including a total number of 155 patients with PAD. The pooled overall primary patency, freedom from target lesion revascularization (TLR), symptom resolution, and wound healing were 90%, 96%, 94%, and 86%, respectively. The pooled perioperative complication and all-cause mortality were 4% and 9%, respectively. Preoperative total occlusion was detected in 43 of 192 lesions (22%). The mean lesion length was 27.26 mm. In terms of comorbidities, the pooled percentage of hypertension, hyperlipidemia, diabetes mellitus, coronary artery disease, chronic kidney disease history, and smoking were 65%, 74%, 49%, 43%, 20%, and 57%, respectively. CONCLUSION Among these studies, hypertension, hyperlipidemia, and diabetes mellitus were the most common comorbidities in patients with PAD. The Absorb everolimus-eluting BVS was safe and showed the favorable clinical outcomes in both patency and TLR, especially in infrapopliteal disease with heavy calcification. The conclusions of this meta-analysis still needed to be verified by more relevant studies with more careful design, more rigorous execution, and larger sample size.
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Affiliation(s)
- Weijian Fan
- Department of Vascular Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, P.R. China
| | - Jinyun Tan
- Department of Vascular Surgery, Huashan Hospital of Fudan University, Shanghai, P.R. China
- Shanghai Key Laboratory of Vascular Lesions Regulation and Remodeling, Shanghai, P.R. China
| | - Lingyu Li
- National Engineering Research Center of Light Alloy Net Forming and State Key Laboratory of Metal Matrix Composite, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Boxuan Feng
- National Engineering Research Center of Light Alloy Net Forming and State Key Laboratory of Metal Matrix Composite, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Weihao Shi
- Department of Vascular Surgery, Huashan Hospital of Fudan University, Shanghai, P.R. China
| | - Jia Pei
- National Engineering Research Center of Light Alloy Net Forming and State Key Laboratory of Metal Matrix Composite, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Guangyin Yuan
- National Engineering Research Center of Light Alloy Net Forming and State Key Laboratory of Metal Matrix Composite, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Bo Yu
- Department of Vascular Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, P.R. China
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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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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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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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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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10
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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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11
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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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12
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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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Mattesini A, Demola P, Shlofmitz R, Shlofmitz E, Waksman R, Jaffer FA, Di Mario C. Optical Coherence Tomography, Near‐Infrared Spectroscopy, and Near‐Infrared Fluorescence Molecular Imaging. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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14
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Chen HY, Huang WC, Teng HI, Tsai CT, Tsai YL, Chuang MJ, Chen YY, Lu TM. Effects of aggressive predilatation, sizing, and postdilatation strategy for coronary bioresorbable vascular scaffolds implantation. J Chin Med Assoc 2022; 85:543-548. [PMID: 35324547 DOI: 10.1097/jcma.0000000000000716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The results of the recent Amsterdam Investigator-Initiated Absorb Strategy All-Comers trial showed that the predilatation, sizing, and postdilatation (PSP) technique did not lower the long-term rates of scaffold thrombosis and adverse events. We evaluated the impact of aggressive PSP bioresorbable vascular scaffold (BRS) implantation on the short- and long-term clinical outcomes. METHODS From June 2014 to December 2016, 150 patients with BRS implantation were enrolled and received successful percutaneous coronary intervention (PCI), of whom 104 received aggressive PSP technique (high-pressure predilatation and lesion preparation in addition to the traditional PSP technique). Short- and long-term outcomes were compared. RESULTS All patients underwent successful PCI and BRS implantation with final Thrombolysis in Myocardial Infarction grade 3 flow. The baseline and procedure characteristics were similar in both groups. Debulking techniques were used in 13 (8.7%) patients. Intracoronary imaging modalities were used in 73 (48.7%) patients. After BRS implantation, no adverse events were observed within 30 days in both groups. During the mean follow-up period of 2.98 ± 0.77 years, 12 (8.0%) patients experienced major adverse cardiovascular events (MACEs), including one cardiovascular death (0.6%), three nonfatal myocardial infarction (2.0 %), and 11 target-vessel revascularization (7.3 %). Multivariate Cox regression analysis showed that aggressive PSP remained an independent protective factor for MACEs. Moreover, the use of intracoronary imaging and rotablation atherectomy was associated with better clinical outcomes. CONCLUSION Lesion preparation by aggressive PSP in BRS implantation was associated with better long-term clinical outcomes.
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Affiliation(s)
- Hsiang-Yao Chen
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Internal Medicine, Taipei Hospital, Ministry of Health and Welfare, Taiwan, ROC
| | - Wei-Chieh Huang
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Hsin-I Teng
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Internal Medicine, Keelung Hospital, Ministry of Health and Welfare, Taiwan, ROC
| | - Chuan-Tsai Tsai
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yi-Lin Tsai
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Ming-Ju Chuang
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Ying-Ying Chen
- Division of Nephrology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan, ROC
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Tse-Min Lu
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Health Care Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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15
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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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16
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Waksman R, Bhogal S. Scaffold thrombosis: what is to blame? EUROINTERVENTION 2021; 17:e955-e957. [PMID: 34916179 PMCID: PMC9707472 DOI: 10.4244/eijv17i12a159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Ron Waksman
- MedStar Washington Hospital Center, 110 Irving Street NW, Suite 4B-1, Washington, DC 20010, USA. E-mail:
| | - Sukhdeep Bhogal
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
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17
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Rai H, Alfonso F, Maeng M, Bradaric C, Wiebe J, Cuesta J, Christiansen EH, Cassese S, Hoppmann P, Colleran R, Harzer F, Bresha J, Nano N, Schneider S, Laugwitz KL, Joner M, Kastrati A, Byrne RA. Optical coherence tomography tissue coverage and characterization at six months after implantation of bioresorbable scaffolds versus conventional everolimus eluting stents in the ISAR-Absorb MI trial. Int J Cardiovasc Imaging 2021; 37:2815-2826. [PMID: 34420177 PMCID: PMC8494721 DOI: 10.1007/s10554-021-02251-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 04/16/2021] [Indexed: 11/28/2022]
Abstract
Purpose Data regarding vessel healing by optical coherence tomography (OCT) after everolimus-eluting bioresorbable scaffolds (BRS) or everolimus-eluting metallic stent (EES) implantation in acute myocardial infarction (AMI) patients is scarce. We compared OCT findings after BRS or EES implantation in patients with AMI enrolled in a randomized trial. Methods In ISAR-Absorb MI, AMI patients were randomized to BRS or EES implantation, with 6–8 month angiographic follow-up. This analysis includes patients who underwent OCT during surveillance angiography. Tissue characterization was done using grey-scale signal intensity analysis. The association between OCT findings and target lesion failure (TLF) at 2 years was investigated. Results OCT was analyzed in 103 patients (2237 frames, 19,827 struts) at a median of 216 days post-implantation. Of these, 70 were treated with BRS versus 32 with EES. Pre-(92.8 vs. 68.7%, p = 0.002) and post-dilation (51.4 vs. 12.5%, p < 0.001) were more common in BRS as compared to EES. Strut coverage was higher in BRS vs. EES (97.5% vs. 90.9%, p < 0.001). Mean neointimal thickness was comparable in both groups [85.5 (61.9, 124.1) vs. 69.5 (32.7, 127.5) µm, respectively, p = 0.20]. Mature neointimal regions were numerically more common in BRS (43.0% vs. 24.6%; p = 0.35); this difference was statistically significant in ST-elevation myocardial infarction patients (40.9% vs. 21.1%, p = 0.03). At two-years, 8 (7.8%) patients experienced TLF. Mean neointimal area [0.61 (0.21, 1.33) vs. 0.41 (0.11, 0.75) mm2, p = 0.03] and mean neointimal coverage [106.1 (65.2, 214.8) vs. 80.5 (53.5, 122.1) µm, p < 0.01] were higher, with comparable tissue maturity, in lesions with versus without TLF. Conclusions In selected patients who underwent OCT surveillance 6–8 months after coronary intervention for AMI with differing implantation characteristics depending on the device type used, vessel healing was more advanced in BRS compared with EES, particularly in the STEMI subgroup. Supplementary Information The online version contains supplementary material available at 10.1007/s10554-021-02251-x.
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Affiliation(s)
- Himanshu Rai
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,Cardiovascular Research Institute Dublin, Mater Private Network, Dublin, Ireland.,School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | | | - Christian Bradaric
- Medizinische Klinik Und Poliklinik Innere Medizin I, Klinikum Rechts Der Isar, Technische Universität München, Munich, Germany
| | - Jens Wiebe
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Javier Cuesta
- Hospital Universitario de La Princesa Madrid, Madrid, Spain
| | | | - Salvatore Cassese
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Petra Hoppmann
- Medizinische Klinik Und Poliklinik Innere Medizin I, Klinikum Rechts Der Isar, Technische Universität München, Munich, Germany
| | - Roisin Colleran
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,Cardiovascular Research Institute Dublin, Mater Private Network, Dublin, Ireland.,School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Fiona Harzer
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Jola Bresha
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Nejva Nano
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Simon Schneider
- Medizinische Klinik Und Poliklinik Innere Medizin I, Klinikum Rechts Der Isar, Technische Universität München, Munich, Germany
| | - Karl-Ludwig Laugwitz
- Medizinische Klinik Und Poliklinik Innere Medizin I, Klinikum Rechts Der Isar, Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Michael Joner
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Robert A Byrne
- Cardiovascular Research Institute Dublin, Mater Private Network, Dublin, Ireland. .,School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
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Ioseliani DG, Asadov DA, Fomenko VV, Azarov AV, Semitko SP. Five-year outcomes of implantation of Absorb biodegradable stents using the bifurcation stenting technique: a case report. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2021. [DOI: 10.15829/1728-8800-2021-2864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The presented case report describes a five-year outcomes of bifurcation stenting of the left anterior descending artery and large diagonal branch with Absorb bioabsorbable vascular stent (BVS) according to selective coronary angiography and optical coherence tomography. The example demonstrates not only the successful implantation of biodegradable stents into the bifurcation area, but also the complete restoration of the arterial wall with the formation of neocarina. Optical coherence tomography made it possible to study in detail all stages of vascular wall alterations from the inside. This case report prompts a fresh look at the biodegradable BVS Absorb stents and does not rule out the potential of returning these stents to clinical practice in the future. Currently, the production and use of Absorb BVSs has been suspended, but they have filled a certain niche in the endovascular treatment of patients with coronary artery disease.
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Affiliation(s)
| | - D. A. Asadov
- I.M. Sechenov First Moscow State Medical University
| | | | - A. V. Azarov
- I.M. Sechenov First Moscow State Medical University
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Kaul S. Understanding the Merits and Drawbacks of Noninferiority Trials in Cardiovascular Medicine. Can J Cardiol 2021; 37:1378-1393. [PMID: 34118378 DOI: 10.1016/j.cjca.2021.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/03/2021] [Accepted: 05/15/2021] [Indexed: 11/20/2022] Open
Abstract
A noninferiority trial is designed to show that the new treatment is not unacceptably worse than the standard treatment by more than a predefined noninferiority margin. These trials are typically performed when standard placebo-controlled trials are considered to be unethical or impractical and the new treatment offers advantages over the existing standard treatment in terms of safety, convenience, or cost. Given that noninferiority trials are being performed with increasing frequency in cardiovascular applications, it is important to understand their complex trial design and analysis. This narrative review aims to provide readers with a detailed perspective on the goals, characteristics, design, and analysis of noninferiority trials. Trials designed to show noninferiority require an appropriate reference population, a proven standard treatment and dose, an appropriate margin of noninferiority that is statistically justifiable (based on historical placebo-controlled trials evaluating standard treatment effect) and clinically reasonable (choosing the fraction of the effect of the standard drug that should be "preserved" by the new drug), a high level of adherence to treatment, and adequate statistical power to reliably conclude that a treatment is truly noninferior and therefore effective. The merits and pitfalls of noninferiority trials, with representative contemporary cardiovascular clinical trials in interventional cardiology, cardiac surgery, and atrial fibrillation management as exemplars, are described. The key issues that challenge the design, conduct, analysis, interpretation, and implementation of these trials are discussed, and a variety of ways to identify and mitigate key errors are recommended to allow for optimal evaluation of noninferiority trials conducted in cardiovascular medicine.
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Affiliation(s)
- Sanjay Kaul
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA.
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Song L, Xu B, Chen Y, Zhou Y, Jia S, Zhong Z, Su X, Ma Y, Zhang Q, Liu J, Wang Y, Guan C, Zheng M, Qiao S, Gao R. Thinner Strut Sirolimus-Eluting BRS Versus EES in Patients With Coronary Artery Disease: FUTURE-II Trial. JACC Cardiovasc Interv 2021; 14:1450-1462. [PMID: 34238555 DOI: 10.1016/j.jcin.2021.04.048] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/28/2021] [Accepted: 04/28/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of the present study was to evaluate the safety and efficacy of thinner strut Firesorb (100/125 μm) sirolimus-eluting bioresorbable scaffolds (BRS) versus cobalt-chromium everolimus-eluting stents (CoCr-EES) in patients with coronary artery disease. BACKGROUND First-generation thicker strut BRS were associated with unexpected device-related adverse outcomes at long-term follow-up. METHODS Eligible patients with 1 or 2 de novo noncomplex coronary lesions were randomized to the Firesorb BRS group or CoCr-EES group in a 1:1 ratio. The primary endpoint was 1-year angiographic in-segment late loss (LL), powered for noninferiority testing. The key secondary endpoint was the 1-year proportion of covered struts assessed on optical coherence tomography, powered for noninferiority and subsequent superiority testing. RESULTS A total of 433 participants from 28 Chinese centers were randomized to the Firesorb BRS group (n = 215) or CoCr-EES group (n = 218). Patient-level 1-year in-segment LL was 0.17 ± 0.27 mm in the Firesorb BRS group and 0.18 ± 0.37 mm in the CoCr-EES group (difference -0.01 mm; 95% confidence interval [CI]: -0.07 to 0.06; pnoninferiority < 0.0001) in the intention-to-treat population and was 0.17 ± 0.27 mm in the Firesorb BRS group and 0.19 ± 0.37 mm in the CoCr-EES group (difference -0.005 mm; 95% CI: -0.07 to 0.06; pnoninferiority < 0.0001) in the per-protocol set. The proportion of covered struts was 99.3% in the Firesorb BRS group and 98.8% in the CoCr-EES group (difference 0.8%; 95% CI: -0.5% to 2.1%; pnoninferiority < 0.0001; psuperiority = 0.21). One-year clinical outcomes were similar between groups. CONCLUSIONS The thinner strut Firesorb BRS was noninferior to the CoCr-EES for the primary endpoint of 1-year angiographic in-segment LL and the key secondary endpoint of 1-year proportion of covered struts by optical coherence tomography. (A Trial of Firesorb in Patients With Coronary Artery Disease: FUTURE-II [FUTURE-II]; NCT02890160).
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Affiliation(s)
- Lei Song
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Bo Xu
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China; Catheterization Laboratories, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Yundai Chen
- Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yujie Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shaobin Jia
- Department of Cardiology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Zhixiong Zhong
- Department of Cardiology, Meizhou People's Hospital, Meizhou, China
| | - Xi Su
- Department of Cardiology, Wuhan Asian Heart Hospital, Wuhan, China
| | - Yitong Ma
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Qi Zhang
- Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jian Liu
- Department of Cardiology, Peking University People's Hospital, Beijing, China
| | - Yang Wang
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Beijing, China
| | - Changdong Guan
- Catheterization Laboratories, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ming Zheng
- Shanghai MicroPort Medical (Group), Shanghai, China
| | - Shubin Qiao
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Runlin Gao
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Beijing, China.
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21
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Nishi T, Okada K, Kitahara H, Kameda R, Ikutomi M, Imura S, Hollak MB, Yock PG, Popma JJ, Kusano H, Cheong WF, Sudhir K, Fitzgerald PJ, Ellis SG, Kereiakes DJ, Stone GW, Honda Y, Kimura T. Intravascular ultrasound predictors of long-term outcomes following ABSORB bioresorbable scaffold implantation: A pooled analysis of the ABSORB III and ABSORB Japan trials. J Cardiol 2021; 78:224-229. [PMID: 33893022 DOI: 10.1016/j.jjcc.2021.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/11/2021] [Accepted: 02/23/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The long-term prognostic impact of IVUS findings following Absorb BVS implantation remains uncertain. This study aimed to identify the IVUS predictors of long-term clinical outcomes following ABSORB bioresorbable vascular scaffold (BVS) implantation from the pooled IVUS substudy cohorts of the ABSORB III and Japan trials. METHODS A total of 298 lesions in 286 patients were enrolled with 2:1 randomization to ABSORB BVS vs. cobalt-chromium everolimus-eluting stents. This sub-analysis included 168 lesions of 160 patients in the Absorb arm whose post-procedural quantitative IVUS were available. The primary endpoint of this analysis was device-oriented composite endpoint (DOCE) of target lesion failure, including cardiac death, target vessel-related myocardial infarction, or ischemia-driven target lesion revascularization. The median follow-up duration was 4.9 [3.1-5.0] years. RESULTS During follow-up, DOCE occurred in 10.1% of lesions treated with Absorb BVS. Among several post-procedural IVUS indices associated with DOCE, non-uniform device expansion (defined as uniformity index = minimum / maximum device area) (hazard ratio 0.47 per 0.1 increase [95%CI 0.28 to 0.77]; p = 0.003) and residual reference plaque burden (hazard ratio 4.01 per 10% increase [95%CI 1.50 to 10.77]; p = 0.006) were identified as independent predictors of DOCE by Cox multivariable analysis. CONCLUSIONS Nonuniform device expansion and substantial untreated residual plaque in reference segments were associated with long-term adverse events following BVS implantation. Baseline imaging to identify the appropriate device landing zone and procedural imaging to achieve uniform device expansion if possible (e.g. through post-dilatation) may improve clinical outcomes of BVS implantation. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01751906 (ABSORB III); NCT01844284 (ABSORB Japan).
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Affiliation(s)
- Takeshi Nishi
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, United States
| | - Kozo Okada
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, United States
| | - Hideki Kitahara
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, United States
| | - Ryo Kameda
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, United States
| | - Masayasu Ikutomi
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, United States
| | - Shinji Imura
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, United States
| | - M Brooke Hollak
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, United States
| | - Paul G Yock
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, United States
| | - Jeffrey J Popma
- Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Hajime Kusano
- Clinical Science and Medical Affairs, Abbott Vascular, Santa Clara, CA, United States
| | - Wai-Fung Cheong
- Clinical Science and Medical Affairs, Abbott Vascular, Santa Clara, CA, United States
| | - Krishnankutty Sudhir
- Clinical Science and Medical Affairs, Abbott Vascular, Santa Clara, CA, United States
| | - Peter J Fitzgerald
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, United States
| | - Stephen G Ellis
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Dean J Kereiakes
- The Christ Hospital Heart and Vascular Center/The Lindner Research Center, Cincinnati, OH, United States
| | - Gregg W Stone
- Cardiovascular Research Foundation, New York, NY, United States; Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Yasuhiro Honda
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, United States.
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Hospital, Kyoto, Japan
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22
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Ng AKY, Ng PY, Siu CW, Jim MH. Factors associated with long-term major adverse cardiac events of coronary bioresorbable vascular scaffold. Cardiovasc Interv Ther 2021; 36:462-469. [PMID: 33387354 DOI: 10.1007/s12928-020-00723-w] [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: 06/22/2020] [Accepted: 10/14/2020] [Indexed: 11/25/2022]
Abstract
The long-term clinical outcomes after implantation of bioresorbable vascular scaffolds (BVS) in a real-world cohort were not well described. To identify factors associated with major adverse cardiovascular events (MACE) on long-term follow-up after implantation of BVS in patients undergoing elective percutaneous coronary intervention (PCI). This was an observational study based on a hospital registry of percutaneous coronary intervention. Participants were consecutive patients who underwent PCI and implanted with at least one everolimus-eluting BVS (Absorb®) in a single center between 2014 and 2017. Among the 170 cases analyzed (mean age 60.4 ± 10.7), a total of 203 Absorb BVS were implanted. MACE developed in 33 (19.4%) patients over a median follow-up period of 61 months, including 9 (5.3%) deaths, 13 (7.6%) non-fatal myocardial infarction and 19 (11.2%) ischemia driven target vessel revascularization. Definite or probable stent thrombosis developed in 4 (2.4%) patients. In crude analysis, history of smoking and initial presentation of non-ST elevation-acute coronary syndrome (NSTE-ACS) were predictors of long-term MACE. In adjusted analysis, presentation with NSTE-ACS was an independent predictor of long-term MACE [adjusted odds ratio (OR) 4.52; 95% confidence interval (95% CI) 1.50 to 13.6, P = 0.007]. Among patients receiving implantation of ABSORB BVS, presentation with NSTE-ACS was an independent predictor of MACE after a median follow-up period of 61 months. Future research is needed to confirm these findings and to determine the long-term safety of BVS in patients with NSTE-ACS.
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Affiliation(s)
- Andrew Kei-Yan Ng
- Cardiac Medical Unit, Grantham Hospital, 125 Wong Chuk Hang Road, Hong Kong Sar, China
| | - Pauline Yeung Ng
- Department of Adult Intensive Care, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China
- Division of Respiratory and Critical Care Medicine, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Chung-Wah Siu
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong SAR, Hong Kong SAR, China
| | - Man-Hong Jim
- Cardiac Medical Unit, Grantham Hospital, 125 Wong Chuk Hang Road, Hong Kong Sar, China.
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23
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Duijvelshoff R, Cabrera MS, Sanders B, Dekker S, Smits AIPM, Baaijens FPT, Bouten CVC. Transcatheter-Delivered Expandable Bioresorbable Polymeric Graft With Stenting Capacity Induces Vascular Regeneration. ACTA ACUST UNITED AC 2020; 5:1095-1110. [PMID: 33294741 PMCID: PMC7691284 DOI: 10.1016/j.jacbts.2020.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/14/2020] [Accepted: 09/14/2020] [Indexed: 01/22/2023]
Abstract
We designed a transcatheter balloon-expandable resorbable vascular graft with support capacity. After 2 months in vivo, grafts show native-like tissue reconstruction with endoluminal elastin. The concept convenes regenerative grafting, minimally invasive delivery, and clinical stenting.
As the next step in the translation of vascular tissue engineering, this study uniquely combines transcatheter delivery and in situ tissue regeneration using a novel bioresorbable electrospun polymer graft that can be implanted minimally invasively. Once delivered inside a small-diameter vessel, the electrospun microstructure supports the vessel wall, facilitates cellular infiltration, and guides organized tissue formation.
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Key Words
- BVS, bioresorbable vascular scaffold(s)
- ECM, extracellular matrix
- GPC, gel permeation chromatography
- Mw, weight-average molecular weight
- PBS, phosphate-buffered saline
- SEM, scanning electron microscopy
- SMA, smooth muscle actin
- SMC, smooth muscle cell
- T-TEVG, transcatheter tissue-engineered vascular graft
- TE, tissue engineering
- elastin
- regeneration
- tissue engineering
- transcatheter delivery
- vascular graft
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Affiliation(s)
- Renee Duijvelshoff
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.,Institute for Complex Molecular Systems, Eindhoven, the Netherlands
| | | | | | - Sylvia Dekker
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Anthal I P M Smits
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.,Institute for Complex Molecular Systems, Eindhoven, the Netherlands
| | - Frank P T Baaijens
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.,Institute for Complex Molecular Systems, Eindhoven, the Netherlands
| | - Carlijn V C Bouten
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.,Institute for Complex Molecular Systems, Eindhoven, the Netherlands
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Kimura T, Yamamoto K. "Uncaging" the artery with a novel metallic coronary device. EUROINTERVENTION 2020; 16:e957-e959. [DOI: 10.4244/eijv16i12a175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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25
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Eltahlawi MA, Abdel-Aziz AAF, Sherif AS, Shokry KAA, Shehata IE. Long-term follow-up of therapeutic efficacy of everolimus-eluting bioresorbable vascular scaffold in comparison to everolimus-eluting stent in treatment of chronic total occlusion guided by intracoronary imaging. Egypt Heart J 2020; 72:72. [PMID: 33085004 PMCID: PMC7578208 DOI: 10.1186/s43044-020-00104-x] [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: 07/05/2020] [Accepted: 10/05/2020] [Indexed: 11/10/2022] Open
Abstract
Background We hypothesized that 1st generation everolimus-eluting bioresorbable vascular scaffold (BVS) stent associated with less complication and less restenosis rate than everolimus-eluting stent (EES) in chronic total occlusion (CTO) recanalization guided by intracoronary imaging. Therefore, we aimed to assess the safety and performance of BVS stent in CTO revascularization in comparison to EES guided by intracoronary imaging. Our prospective comparative cross-sectional study was conducted on 60 CTO patients divided into two groups according to type of stent revascularization: group I (EES group): 40 (66.7%) patients and group II (BVS group): 20 (33.3%) patients. All patients were subjected to history taking, electrocardiogram (ECG), echocardiography, laboratory investigation, stress thallium study to assess viability before revascularization. Revascularization of viable CTO lesion guided by intracoronary imaging using optical coherence tomography (OCT). Then, long-term follow-up over 1 year clinically and by multi-slice CT coronary angiography (MSCT). Our clinical and angiographic endpoints were to detect any clinical or angiographic complications during the follow-up period. Results At 6 months angiographic follow-up, BVS group had not inferior angiographic parameters but without statistically significant difference (p = 0.566). At 12 months follow-up, there was no difference at end points between the two groups (p = 0.476). No differences were found at angiographic or clinical follow-up between BVS and EES. Conclusion This study shows that 1st generation everolimus-eluting BVS is non-inferior to EES for CTO revascularization. Further studies are needed to clearly state which new smaller footprint BVS, faster reabsorption, magnesium-based less thrombogenicity, and advanced mechanical properties is under development. We cannot dismiss the efficacy and safety of new BVS technology. Trial registration ZU-IRB#2498/3-12-2016 Registered 3 December 2016, email: IRB_123@medicine.zu.edu.eg
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Lhermusier T, Carrie D, Cayla G, Fajadet J, Sainsous J, Elhadad S, Tarragano F, Chevalier B, Ranc S, Curinier C, Le Breton H, Koning R. Three-year clinical outcomes with the ABSORB bioresorbable vascular scaffold in real life: Insights from the France ABSORB registry. Catheter Cardiovasc Interv 2020; 98:511-519. [PMID: 33211387 DOI: 10.1002/ccd.29369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 08/26/2020] [Accepted: 10/26/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVES The aim of this study was to determine the 3-year outcomes of patients treated with Absorb bioresorbable vascular scaffold (BVS) implantation. BACKGROUND Randomized trials and observational registries performed in patients undergoing percutaneous coronary intervention have demonstrated higher 1-year and midterm rates of device thrombosis and adverse events with BVS compared to contemporary drug eluting stent. Data on long-term follow-up of patients treated with BVS are scarce. METHODS All patients treated with BVS were included in a large nationwide prospective multicenter registry (FRANCE ABSORB). The primary endpoint was a composite of cardiovascular death, myocardial infarction, and target lesion revascularization at 3 years. Secondary endpoints were 3-year scaffold thrombosis and target vessel revascularization (TVR). RESULTS Between September 2014 and April 2016, 2070 patients were included (mean age 55 ± 11 years; 80% men). The indication was acute coronary syndrome (ACS) in 49% of patients. At 3 years, the primary endpoint occurred in 184 patients (8.9%) and 3-year mortality in 43 patients (2.1%). Scaffold thrombosis and TVR rates through 3 years were, respectively, 3 and 7.6%. In a multivariable analysis, independent predictors of primary endpoint occurrence were diabetes, oral anticoagulation, active smoking, absence of initial angiographic success and the association of a total BVS length ≥30 mm with the use of 2.5 mm diameter BVS. CONCLUSIONS Although 3-year mortality was low in this ACS population, device-related events were significant beyond 1 year. Total BVS length and 2.5 mm BVS were associated with higher rates of MACE at long-term follow-up.
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Affiliation(s)
- Thibault Lhermusier
- Service de Cardiologie, Hôpital Rangueil, Centre Hospitalo Universitaire de Toulouse, Toulouse, France
| | - Didier Carrie
- Service de Cardiologie, Hôpital Rangueil, Centre Hospitalo Universitaire de Toulouse, Toulouse, France
| | | | - Jean Fajadet
- Département de Cardiologie, Clinique Pasteur, Toulouse, France
| | - Joel Sainsous
- Service de Cardiologie, Clinique Rhône-Durance, Avignon, France
| | - Simon Elhadad
- Service de Cardiologie, Centre hospitalier de Marne-la-Vallée, Jossigny, France
| | | | - Bernard Chevalier
- Hôpital Privé Jacques-Cartier, Institut Cardiovasculaire Paris-Sud, Ramsay-générale de Santé, Massy, France
| | - Sylvain Ranc
- Service de Cardiologie, Centre hospitalier Saint-Joseph et Saint-Luc, Lyon, France
| | - Corentin Curinier
- Service de Cardiologie, Centre hospitalier de Perpignan, Perpignan, France
| | | | - Rene Koning
- Département de Cardiologie, Clinique Saint-Hilaire, Rouen, France
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Buono A, Ielasi A, Colombo A. Latest generation stents: is it time to revive the bioresorbable scaffold? Minerva Cardioangiol 2020; 68:415-435. [DOI: 10.23736/s0026-4725.20.05188-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Varcoe RL, Menting TP, Thomas SD, Lennox AF. Long‐term
results of a prospective,
single‐arm
evaluation of
everolimus‐eluting
bioresorbable vascular scaffolds in infrapopliteal arteries. Catheter Cardiovasc Interv 2020; 97:142-149. [DOI: 10.1002/ccd.29327] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 09/21/2020] [Accepted: 10/02/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Ramon L. Varcoe
- Department of Surgery Prince of Wales Hospital Sydney New South Wales Australia
- Faculty of Medicine University of New South Wales Sydney New South Wales Australia
- The Vascular Institute Prince of Wales Hospital Sydney New South Wales Australia
| | - Theo P. Menting
- Department of Surgery Prince of Wales Hospital Sydney New South Wales Australia
| | - Shannon D. Thomas
- Department of Surgery Prince of Wales Hospital Sydney New South Wales Australia
- Faculty of Medicine University of New South Wales Sydney New South Wales Australia
- The Vascular Institute Prince of Wales Hospital Sydney New South Wales Australia
| | - Andrew F. Lennox
- Department of Surgery Prince of Wales Hospital Sydney New South Wales Australia
- The Vascular Institute Prince of Wales Hospital Sydney New South Wales Australia
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Randomized Comparison Between Everolimus-Eluting Bioresorbable Scaffold and Metallic Stent: Multimodality Imaging Through 3 Years. JACC Cardiovasc Interv 2020; 13:116-127. [PMID: 31918929 DOI: 10.1016/j.jcin.2019.09.047] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 09/09/2019] [Accepted: 09/23/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the vascular responses and fates of the scaffold after bioresorbable vascular scaffold (BVS) implantation using multimodality imaging. BACKGROUND Serial comprehensive image assessments after BVS implantation in the context of a randomized trial have not yet been reported. METHODS In the ABSORB Japan trial, 400 patients were randomized to a BVS (n = 266) or a cobalt-chromium everolimus-eluting stent (n = 134). Through 3 years, patients underwent serial angiography and intravascular ultrasound or optical coherence tomography (OCT). RESULTS Luminal dimension at 3 years was consistently smaller with the BVS than with the cobalt-chromium everolimus-eluting stent (mean angiographic minimal luminal diameter 2.04 ± 0.63 mm vs. 2.40 ± 0.56 mm, mean difference -0.37 mm [95% confidence interval: -0.50 to -0.24 mm]; p < 0.001), mainly because of smaller device area (6.13 ± 2.03 mm2 vs. 7.15 ± 2.16 mm2, mean difference -1.04 mm2 [95% confidence interval: -1.66 to -0.42 mm2]; p < 0.001), and larger neointimal area (2.10 ± 0.61 mm2 vs. 1.86 ± 0.64 mm2, mean difference 0.24 mm2 [95% confidence interval: 0.06 to 0.43 mm2]; p = 0.01) by OCT. BVS-treated vessels did not show previously reported favorable vessel responses, such as positive vessel remodeling, late luminal enlargement, and restoration of vasomotion, although the OCT-based healing score was on average zero (interquartile range: 0.00 to 0.00). At 3 years, intraluminal scaffold dismantling (ISD) was observed in 14% of BVS. On serial OCT, ISD was observed in 6 lesions at 2 years, where the struts had been fully apposed at post-procedure, while ISD was observed in 12 lesions at 3 years, where 8 lesions were free from ISD on 2-year OCT. In 5 cases of very late scaffold thrombosis, strut discontinuities were detected in all 4 cases with available OCT immediately before reintervention. CONCLUSIONS In this multimodality serial imaging study, luminal dimension at 3 years was smaller with the BVS than with the cobalt-chromium everolimus-eluting stent. ISD, suspected to be one of the mechanisms of very late BVS thrombosis, was observed in a substantial proportion of cases at 3 years, which developed between post-procedure and 2 years and even beyond 2 years. (AVJ-301 Clinical Trial: A Clinical Evaluation of AVJ-301 [Absorb™ BVS] in Japanese Population [ABSORB JAPAN]; NCT01844284).
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Okada K, Honda Y, Kitahara H, Ikutomi M, Kameda R, Brooke Hollak M, Yock PG, Popma JJ, Kusano H, Cheong WF, Sudhir K, Fitzgerald PJ, Kimura T. Scaffold underexpansion and late lumen loss after bioresorbable scaffold implantation: Insights from ABSORB JAPAN trial. IJC HEART & VASCULATURE 2020; 31:100623. [PMID: 32944608 PMCID: PMC7481138 DOI: 10.1016/j.ijcha.2020.100623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/26/2020] [Accepted: 08/09/2020] [Indexed: 11/30/2022]
Abstract
Background Device underexpansion is associated with late adverse outcomes after bioresorbable vascular scaffold (BVS) implantation. This study, representing official IVUS results of the ABSORB Japan trial, aimed to characterize IVUS findings, focusing specifically on acute device expansion, and to investigate its impact on late lumen loss (LLL) with Absorb-BVS compared with cobalt-chromium everolimus-eluting stents (CoCr-EES). Methods ABSORB Japan enrolled 148 patients (2:1 randomization) in the IVUS cohort. Serial IVUS was prescheduled at post-procedure and 3 years. Acute device expansion was evaluated with respect to the degree and uniformity of the implanted device. Results Overall, Absorb-BVS showed smaller and more nonuniform device expansion at post-procedure, compared with CoCr-EES, which was particularly prominent in small-vessel lesions. In serial analysis, Absorb-BVS showed unique associations of smaller device expansion (r = 0.40, p = 0.001) and more nonuniformity (r = 0.29, p = 0.007) at post-procedure with greater LLL at 3 years, primarily attributable to greater negative remodeling (r = 0.39, p = 0.006). In contrast, acute device expansion showed no relation with subsequent lumen change in CoCr-EES. In Absorb-BVS, ischemic-driven target lesion or vessel revascularization (ID-TLR or ID-TVR) at 3 years occurred more frequently in small- versus large-vessel lesions (12.5% vs. 0%, p = 0.04 for ID-TLR and 15.6% vs. 2.3%, p = 0.08 for ID-TVR). Conversely, Absorb BVS had no target lesion nor vessel failure, even in small-vessel lesions, when adequate device expansion was achieved at post-procedure. Conclusions Unlike CoCr-EES, underexpansion was associated with greater negative remodeling and LLL in Absorb-BVS. This may in part account for the poorer outcomes of Absorb-BVS than CoCr-EES when under-expanded.
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Key Words
- Absorb BVS
- BVS, bioresorbable vascular scaffolds
- CV, coefficient of variation
- CoCr-EES, cobalt-chromium everolimus-eluting stents
- DS, diameter stenosis
- ID-TLR, ischemic-driven target lesion revascularization
- ID-TVR, ischemic-driven target vessel revascularization
- ISA, incomplete strut apposition
- IVUS, intravascular ultrasound
- LISA, late-acquired incomplete strut apposition
- LLL, late lumen loss
- Late acquired ISA
- Late lumen loss
- MI, myocardial infarction
- MLD, minimum lumen diameter
- QCA, quantitative coronary angiography
- RLD, reference lumen diameter
- RVD, reference vessel diameter
- ST, stent thrombosis
- ScT, scaffold thrombosis
- Scaffold underexpansion
- TLF, target lesion failure
- TVF, target vessel failure
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Affiliation(s)
- Kozo Okada
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, CA, United States
| | - Yasuhiro Honda
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, CA, United States
- Corresponding author at: Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Room H3554, Stanford, CA 94305-5637, United States.
| | - Hideki Kitahara
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, CA, United States
| | - Masayasu Ikutomi
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, CA, United States
| | - Ryo Kameda
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, CA, United States
| | - M. Brooke Hollak
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, CA, United States
| | - Paul G. Yock
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, CA, United States
| | | | - Hajime Kusano
- Clinical Science and Medical Affairs, Abbott Vascular, Santa Clara, CA, United States
| | - Wai-Fung Cheong
- Clinical Science and Medical Affairs, Abbott Vascular, Santa Clara, CA, United States
| | - Krishnankutty Sudhir
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, CA, United States
- Clinical Science and Medical Affairs, Abbott Vascular, Santa Clara, CA, United States
| | - Peter J. Fitzgerald
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, CA, United States
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Ito N, Takahara M, Soga Y, Hiramori S, Hirose K, Tomoi Y, Ando K. Lumen Loss at 1 Year After Bare Nitinol Stent Implantation in the Superficial Femoral Artery. J Endovasc Ther 2020; 28:132-138. [PMID: 32813594 DOI: 10.1177/1526602820950261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To investigate lumen loss (LL) at 1 year after bare nitinol stent (BNS) implantation for de novo superficial femoral artery (SFA) lesions. MATERIALS AND METHODS The subjects were 701 consecutive patients (mean age 74±9 years; 492 men) with 817 de novo SFA lesions treated with BNS implantation between January 2004 and September 2015. The mean lesion length was 141±88 mm and the mean vessel diameter was 5.4±0.9 mm. The endpoint was LL at 1 year after BNS implantation. Secondary outcomes were restenosis and target lesion revascularization (TLR) estimated using the Kaplan-Meier method; estimates are reported with the 95% confidence interval (CI). LL was defined as the minimum lumen diameter immediately after BNS implantation minus that at 1 year measured by angiographic quantitative vessel analysis. The distribution of LL in the overall population was estimated using an accelerated failure time model. RESULTS Mean LL at 1 year was estimated to be 1.74±1.28 mm (95% CI 1.63 to 1.84). Current smoking was positively associated with LL (p=0.015), whereas lack of cilostazol use was correlated with an increase in LL (p=0.001). Reference vessel diameter and lesion length did not have any significant association with LL at 1 year. The 1-year cumulative estimate of restenosis was 25% (95% CI 22% to 28%); the corresponding value for TLR was 18% (95% CI 15% to 21%). CONCLUSION Mean LL progressed by at least 1.6 mm up to 1 year after BNS implantation. The risk factors for increased LL were current smoker and lack of cilostazol use.
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Affiliation(s)
- Nobuhiro Ito
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Mitsuyoshi Takahara
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yoshimitsu Soga
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Seiichi Hiramori
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kaoru Hirose
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Yusuke Tomoi
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
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Kawashima H, Zocca P, Buiten RA, Smits PC, Onuma Y, Wykrzykowska JJ, de Winter RJ, von Birgelen C, Serruys PW. The 2010s in clinical drug-eluting stent and bioresorbable scaffold research: a Dutch perspective. Neth Heart J 2020; 28:78-87. [PMID: 32780336 PMCID: PMC7419418 DOI: 10.1007/s12471-020-01442-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Dutch researchers were among the first to perform clinical studies in bare metal coronary stents, the use of which was initially limited by a high incidence of in-stent restenosis. This problem was greatly solved by the introduction of drug-eluting stents (DES). Nevertheless, enthusiasm about first-generation DES was subdued by discussions about a higher risk of very-late stent thrombosis and mortality, which stimulated the development, refinement, and rapid adoption of new DES with more biocompatible durable polymer coatings, biodegradable polymer coatings, or no coating at all. In terms of clinical DES research, the 2010s were characterised by numerous large-scale randomised trials in all-comers and patients with minimal exclusion criteria. Bioresorbable scaffolds (BRS) were developed and investigated. The Igaki-Tamai scaffold without drug elution was clinically tested in the Netherlands in 1999, followed by an everolimus-eluting BRS (Absorb) which showed favourable imaging and clinical results. Afterwards, multiple clinical trials comparing Absorb and its metallic counterpart were performed, revealing an increased rate of scaffold thrombosis during follow-up. Based on these studies, the commercialisation of the device was subsequently halted. Novel technologies are being developed to overcome shortcomings of first-generation BRS. In this narrative review, we look back on numerous devices and on the DES and BRS trials reported by Dutch researchers.
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Affiliation(s)
- H Kawashima
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - P Zocca
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - R A Buiten
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands.,Health Technology and Services Research, Faculty of Behavioural Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - P C Smits
- Department of Cardiology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Y Onuma
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - J J Wykrzykowska
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - R J de Winter
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - C von Birgelen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands.,Health Technology and Services Research, Faculty of Behavioural Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - P W Serruys
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland. .,Imperial College London, London, UK.
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33
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Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, Byrne RA, Collet JP, Falk V, Head SJ, Jüni P, Kastrati A, Koller A, Kristensen SD, Niebauer J, Richter DJ, Seferovic PM, Sibbing D, Stefanini GG, Windecker S, Yadav R, Zembala MO. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J 2020; 40:87-165. [PMID: 30165437 DOI: 10.1093/eurheartj/ehy394] [Citation(s) in RCA: 3843] [Impact Index Per Article: 960.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Stone GW, Kimura T, Gao R, Kereiakes DJ, Ellis SG, Onuma Y, Chevalier B, Simonton C, Dressler O, Crowley A, Ali ZA, Serruys PW. Time-Varying Outcomes With the Absorb Bioresorbable Vascular Scaffold During 5-Year Follow-up: A Systematic Meta-analysis and Individual Patient Data Pooled Study. JAMA Cardiol 2020; 4:1261-1269. [PMID: 31561250 DOI: 10.1001/jamacardio.2019.4101] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Importance Bioresorbable scaffolds were designed to provide clinical benefits after their complete bioresorption. Prior studies demonstrated early risks with the Absorb polymeric bioresorbable vascular scaffold (BVS). Whether this risk profile changes over time during the course of its bioresorption is unknown. Objective To examine outcomes of the first-generation BVS before and after 3 years, the point of its complete bioresorption in animals. Data Sources We searched MEDLINE and the Cochrane database, conference proceedings, and public websites for relevant studies. Study Selection Eligible studies were randomized clinical trials of BVS vs metallic drug-eluting stents in patients with coronary artery disease with at least 5-year follow-up. Four trials of BVS vs everolimus-eluting stents (EES) with 3384 patients met criteria. Data Extraction and Synthesis Individual patient data from the 4 trials were pooled, and summary-level meta-analysis was performed. Main Outcomes and Measures The major effectiveness and safety measures were target lesion failure (TLF; cardiac death, target vessel-related myocardial infarction, or ischemia-driven target lesion revascularization) and device thrombosis. Outcomes were examined through 5-year follow-up and between 0 to 3 and 3 to 5 years. Results Mean age for the 3384 patients was 62.8 years; 2452 patients were men (72.5%), and diabetes was present in 1020 patients (30.2%). Through 5-year follow-up, treatment with BVS compared with EES was associated with higher rates of TLF (14.9% vs 11.6%; HR, 1.26; 95% CI, 1.03-1.54; P = .03) and device thrombosis (2.5% vs 0.8%; HR, 2.87; 95% CI, 1.46-5.65; P = .002). Target lesion failure occurred in 11.6% of BVS-treated patients vs 7.9% of EES-treated patients between 0 to 3 years (HR, 1.42; 95% CI, 1.12-1.80), and 4.3% of BVS-treated patients vs 4.5% of EES-treated patients between 3 to 5 years (HR, 0.92; 95% CI, 0.64-1.31) (P for interaction = .046). Device thrombosis occurred in 2.4% of BVS-treated patients vs 0.6% of EES-treated patients between 0 to 3 years (HR, 3.86; 95% CI, 1.75-8.50) and 0.1% of BVS-treated patients vs 0.3% of EES-treated patients between 3 to 5 years (HR, 0.44; 95% CI, 0.07-2.70) (P for interaction = .03). These results were consistent by spline analysis and after multiple imputation and multivariable analysis. Conclusions and Relevance The period of excess risk for the first-generation Absorb BVS ends at 3 years. These data provide mechanistic insights into the timing of adverse events after BVS and identify the hurdles to be overcome for bioresorbable technology to be accepted as a valid alternative for patients with coronary artery disease. Trial Registration ClinicalTrials.gov identifiers: NCT01751906, NCT01844284, NCT01923740, and NCT01425281.
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Affiliation(s)
- Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.,The Cardiovascular Research Foundation, New York, New York
| | | | - Runlin Gao
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Dean J Kereiakes
- The Christ Hospital, Heart and Vascular Center, Lindner Research Center, Cincinnati, Ohio
| | | | | | | | | | | | - Aaron Crowley
- Columbia University Medical Center, New York, New York
| | - Ziad A Ali
- Columbia University Medical Center, New York, New York.,the Cardiovascular Research Foundation, New York, New York
| | - Patrick W Serruys
- International Centre for Cardiovascular Health, Imperial College, London, England
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35
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Zhou C, Feng X, Shi Z, Song C, Cui X, Zhang J, Li T, Toft ES, Ge J, Wang L, Zhang H. Research on elastic recoil and restoration of vessel pulsatility of Zn-Cu biodegradable coronary stents. ACTA ACUST UNITED AC 2020; 65:219-227. [PMID: 31527289 DOI: 10.1515/bmt-2019-0025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 06/24/2019] [Indexed: 11/15/2022]
Abstract
Coronary stents made of zinc (Zn)-0.8 copper (Cu) (in wt%) alloy were developed as biodegradable metal stents (Zn-Cu stents) in this study. The mechanical properties of the Zn-Cu stents and the possible gain effects were characterized by in vitro and in vivo experiments compared with 316L stainless steel stents (316L stents). Young's modulus of the as-extruded Zn-0.8Cu alloy and properties of the stents, including their intrinsic elastic recoil, stent trackability were evaluated compared with 316L stents. In vivo study was also conducted to evaluate restoration of pulsatility of vessel segment implanted stents. Both Zn-Cu stents and 316L stents have good acute lumen gain. By comparison, the advantages of Zn-Cu stents are as follows: (I) Zn-Cu stents have less intrinsic elastic recoil than 316L stents; (II) stent trackability indicates that Zn-Cu stents have a smaller push force when passing through curved blood vessels, which may cause less mechanical stimulation to blood vessels; (III) in vivo study suggests that Zn-Cu stents implantation better facilitates the recovery of vascular pulsatility.
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Affiliation(s)
- Chao Zhou
- School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing 100083, P.R. China
| | - Xiangyi Feng
- National United Engineering Laboratory for Biomedical Material Modification, Branden Industrial Park, Qihe Economic and Development Zone, Dezhou City, Shandong 251100, P.R. China
| | - Zhangzhi Shi
- School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing 100083, P.R. China
| | - Caixia Song
- National United Engineering Laboratory for Biomedical Material Modification, Branden Industrial Park, Qihe Economic and Development Zone, Dezhou City, Shandong 251100, P.R. China
| | - Xiaoshan Cui
- National United Engineering Laboratory for Biomedical Material Modification, Branden Industrial Park, Qihe Economic and Development Zone, Dezhou City, Shandong 251100, P.R. China
| | - Junwei Zhang
- National United Engineering Laboratory for Biomedical Material Modification, Branden Industrial Park, Qihe Economic and Development Zone, Dezhou City, Shandong 251100, P.R. China
| | - Ting Li
- School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing 100083, P.R. China
| | - Egon Steen Toft
- Vice President for Medical and Health Sciences, Medical and Health Sciences Office, College of Medicine, Qatar University, Doha, Qatar
| | - Junbo Ge
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, P.R. China
| | - Luning Wang
- School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing 100083, P.R. China
| | - Haijun Zhang
- Department of Interventional and Vascular Surgery, The Tenth People's Hospital of Shanghai, Tongji University, Shanghai 200072, P.R. China.,Branden Industrial Park, Qihe Economic and Development Zone, Dezhou City, Shandong 251100, P.R. China.,Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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36
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Kim Y, Bae S, Jeong MH, Ahn Y, Kim CJ, Cho MC, Baumbach A, Gogas BD, King SB. One-year efficacy and safety of everolimus-eluting bioresorbable scaffolds in the setting of acute myocardial infarction. PLoS One 2020; 15:e0235673. [PMID: 32645029 PMCID: PMC7347113 DOI: 10.1371/journal.pone.0235673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 06/19/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVES This study sought to compare clinical outcomes between bioresorbable scaffolds (BRS) and durable polymer everolimus-eluting metallic stents (DP-EES) in patients with acute myocardial infarction (AMI) undergoing successful percutaneous coronary intervention (PCI). METHODS From March 2016 to October 2017, 952 patients with AMI without cardiogenic shock undergoing successful PCI with BRS (n = 136) or DP-EES (n = 816) were enrolled from a multicenter, observational Korea Acute Myocardial Infarction Registry. RESULTS In the crude population, there was no significant difference in the 1-year rate of device-oriented composite endpoint (DOCE) and device thrombosis between the BRS and DP-EES groups (2.2% vs. 4.8%, hazard ratio [HR] 0.43, 95% confidence interval [CI] 0.13-1.41, p = 0.163; 0.7% vs. 0.5%, HR 1.49, 95% CI 0.16-13.4, p = 0.719, respectively). BRS implantation was opted in younger patients (53.7 vs. 62.6 years, p < 0.001) with low-risk profiles, and intravascular image-guided PCI was more preferred in the BRS group (60.3% vs. 27.2%, p < 0.001). CONCLUSIONS At 1-year follow-up, no differences in the rate of DOCE and device thrombosis were observed between patients with AMI treated with BRS and those treated with DP-EES. Our data suggest that imaging-guided BRS implantation in young patients with low risk profiles could be a reasonable strategy in the setting of AMI.
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Affiliation(s)
- Yongcheol Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, Korea
- Division of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - SungA Bae
- Division of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Seoul, Korea
| | - Myung Ho Jeong
- Division of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- * E-mail:
| | - Youngkeun Ahn
- Division of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Chong Jin Kim
- Department of Cardiology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Myeong Chan Cho
- Department of Cardiology, Chungbuk National University Hospital, Cheongju, Korea
| | - Andreas Baumbach
- Barts Heart Centre, London and Queen Mary University of London, London, United Kingdom
| | - Bill D. Gogas
- The Spencer B. King III Catheterization Laboratory, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Spencer B. King
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
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37
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Kawashima H, Ono M, Kogame N, Takahashi K, Chang CC, Hara H, Gao C, Wang R, Tomaniak M, Modolo R, Wykrzykowska JJ, De Winter RJ, Sharif F, Serruys PW, Onuma Y. Drug-eluting bioresorbable scaffolds in cardiovascular disease, peripheral artery and gastrointestinal fields: a clinical update. Expert Opin Drug Deliv 2020; 17:931-945. [DOI: 10.1080/17425247.2020.1764932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Hideyuki Kawashima
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Masafumi Ono
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Norihiro Kogame
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Kuniaki Takahashi
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Chun-Chin Chang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hironori Hara
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Chao Gao
- Department of Cardiology, Radboudumc, Nijmegen, The Netherlands
| | - Rutao Wang
- Department of Cardiology, Radboudumc, Nijmegen, The Netherlands
| | - Mariusz Tomaniak
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Rodrigo Modolo
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Internal Medicine, Cardiology Division, University of Campinas (UNICAMP), Campinas, Brazil
| | - Joanna J. Wykrzykowska
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Robbert J. De Winter
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Faisal Sharif
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Patrick W. Serruys
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
- NHLI, Imperial College London, London, UK
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
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38
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Kozuma K, Tanabe K, Hamazaki Y, Okamura T, Ando J, Ikari Y, Nakagawa Y, Kusano H, Ediebah D, Kimura T. Long-Term Outcomes of Absorb Bioresorbable Vascular Scaffold vs. Everolimus-Eluting Metallic Stent ― A Randomized Comparison Through 5 Years in Japan ―. Circ J 2020; 84:733-741. [DOI: 10.1253/circj.cj-19-1184] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Ken Kozuma
- Department of Cardiology, Teikyo University
| | - Kengo Tanabe
- Department of Cardiology, Mitsui Memorial Hospital
| | | | - Takayuki Okamura
- Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine
| | - Jiro Ando
- Department of Cardiovascular Medicine, The University of Tokyo Hospital
| | - Yuji Ikari
- Department of Cardiology, Tokai University Hospital
| | - Yoshihisa Nakagawa
- Department of Cardiovascular Medicine, Shiga University of Medical Science
| | | | | | - Takeshi Kimura
- Department of Cardiovascular Medicine/Graduate School of Medicine, Kyoto University
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39
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Brugaletta S, Gori T, Tousek P, Gomez-Lara J, Pinar E, Ortega-Paz L, Schulz E, Kocka V, Münzel T, Cequier À, Buono A, Serruys PW, Sabaté M. Bioresorbable vascular scaffolds versus everolimus-eluting metallic stents in patients with ST-segment elevation myocardial infarction: 5-year results of the BVS-EXAMINATION study. EUROINTERVENTION 2020; 15:1436-1443. [PMID: 31845896 DOI: 10.4244/eij-d-19-00773] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this study was to compare five-year clinical outcomes between an everolimus-eluting bioresorbable scaffold (BRS) and an everolimus-eluting metallic stent (EES) in STEMI patients. METHODS AND RESULTS This observational and retrospective study included 235 consecutive STEMI patients treated with BRS, compared with 235 STEMI patients treated with EES from the EXAMINATION trial, by applying propensity score matching. The primary endpoint was a device-oriented endpoint (DOCE), including cardiac death, target vessel myocardial infarction and target lesion revascularisation at five-year follow-up. Device thrombosis, according to the ARC criteria, was also evaluated. Optical coherence tomography (OCT) analysis was also performed at five years in event-free BRS patients. The cumulative incidence of five-year DOCE was higher in the BRS group as compared to the EES group (13.2% vs 7.6%, HR 1.87, 95% CI: 0.94-3.44, p=0.071), mainly driven by a higher rate of TLR (7.6% vs 1.7%, HR 1.15, 95% CI: 0.44-2.30, p=0.004). The five-year definite BRS thrombosis rate was also higher as compared to EES (4.2% vs 1.2%, HR 3.49, 95% CI: 0.95-12.82, p=0.054). OCT analysis showed a high incidence of neoatherosclerosis in the BRS group. CONCLUSIONS The five-year event risk was higher with BRS versus EES in STEMI. This suggests that the probability of obtaining favourable results at very long-term follow-up is low. Whether better results will be obtained with new-generation BVS remains to be determined.
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Affiliation(s)
- Salvatore Brugaletta
- Cardiovascular Institute, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
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Clinical expert consensus document on quantitative coronary angiography from the Japanese Association of Cardiovascular Intervention and Therapeutics. Cardiovasc Interv Ther 2020; 35:105-116. [PMID: 32125622 PMCID: PMC7105443 DOI: 10.1007/s12928-020-00653-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 02/19/2020] [Indexed: 01/15/2023]
Abstract
Quantitative coronary angiography (QCA) remains to play an important role in clinical trials and post-marketing surveillance related to the safety and efficacy of new PCI devices. In this document, the current standard methodology of QCA is summarized. In addition, its history, recent development and future perspectives are also reviewed.
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A paradox in sex-specific clinical outcomes after bioresorbable scaffold implantation: 2-year results from the AIDA trial. Int J Cardiol 2020; 300:93-98. [PMID: 31511193 DOI: 10.1016/j.ijcard.2019.08.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/09/2019] [Accepted: 08/20/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Females are underrepresented in clinical trials evaluating new stent technologies whilst results may differ between the sexes. Females are known to have smaller, more tortuous coronary arteries and have generally more comorbidities. On the other hand, they may have smaller plaque burden. This subgroup-analysis sought to assess sex-specific outcomes after Absorb bioresorbable vascular scaffold (BVS) or XIENCE everolimus-eluting stent (EES) implantation. METHODS The AIDA trial was an investigator-initiated, non-inferiority, all-comers trial, in which 1845 patients were randomly assigned to either Absorb BVS or XIENCE EES. Baseline clinical, angiography and procedural variables, as well as 2-year clinical outcomes were analyzed by sex and device modality. RESULTS Of the 1845 randomized patients, 475 (25.7%) were females. The 2-year rates of target vessel failure (TVF) with Absorb BVS versus XIENCE EES in females were 6.4% versus 10.6% (HR 0.59; 95% CI: 0.31-1.11; p = 0.10) and in males 12.7% versus 9.7% (HR 1.34; 95% CI: 0.98-1.85; p = 0.07). Males treated with Absorb BVS were at higher risk for TVF compared to females treated with Absorb BVS (HR 2.06; 95% CI 1.21-3.53; p = 0.007). Definite/probable device thrombosis occurred in females with Absorb BVS versus XIENCE EES in 1.6% versus 1.4% (HR 1.15; 95% CI: 0.26-5.12; p = 0.86) and in males 3.9% versus 0.7% (HR 5.55; 95% CI: 2.11-14.35; p < 0.001). A statistical significant interaction between sex and device was present for TVF (p = 0.02), but was not seen for definite/probable device thrombosis (p = 0.08). CONCLUSIONS In this subgroup analysis, Absorb BVS used in routine practice tends to result in better clinical outcomes in females compared to males.
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Ni L, Chen H, Luo Z, Yu Y. Bioresorbable vascular stents and drug-eluting stents in treatment of coronary heart disease: a meta-analysis. J Cardiothorac Surg 2020; 15:26. [PMID: 31992360 PMCID: PMC6986072 DOI: 10.1186/s13019-020-1041-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 01/02/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To compare the efficacy and safety of bioresorbable vascular stents (BVS) and drug-eluting stents (DES) in coronary heart disease. METHODS The full text of clinical studies involving BVS and DES was retrieved in PubMed, Springer, EMBASE, Wiley-Blackwell, and Chinese Journal Full-text Database. Review Manager 5.3 was used for meta-analysis to evaluate the risk of target lesion failure, stent thrombosis and cardiac death in BVS and DES. RESULTS Finally, 10 studies with 6383 patients were included in the meta-analysis. Compared with DES group, BVS group had significantly increased risk of target lesion failure (OR = 1.46, 95%CI 1.20-1.79, P = 0.0002; P Heterogeneity = 0.68, I2 = 0%), stent thrombosis (OR = 2.70, 95%CI 1.57-4.66, P = 0.0003; P Heterogeneity = 1.00, I2 = 0%) and cardiac death (OR = 2.19, 95%CI 1.17-4.07, P = 0.01; P Heterogeneity = 0.93, I2 = 0%). CONCLUSION This study shows that DES is a safer treatment than BVS for coronary revascularization.
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Affiliation(s)
- Le Ni
- The 900th Hospital of PLA Joint Logistics Support Force, 156 West Second Ring Road, Fuzhou City, Fujian Province, China
| | - Hao Chen
- The 900th Hospital of PLA Joint Logistics Support Force, 156 West Second Ring Road, Fuzhou City, Fujian Province, China
| | - Zhurong Luo
- The 900th Hospital of PLA Joint Logistics Support Force, 156 West Second Ring Road, Fuzhou City, Fujian Province, China.
| | - Yunqiang Yu
- The 900th Hospital of PLA Joint Logistics Support Force, 156 West Second Ring Road, Fuzhou City, Fujian Province, China.
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Abstract
Fully bioresorbable scaffolds (BRS) were designed to overcome the limitations of metallic drug-eluting stents, which permanently cage the vessel wall, thereby preventing normal coronary vasomotion, preclude bypass grafting and can provoke long-term foreign-body responses. Although multiple scaffolds have been or are in development, the Absorb Bioresorbable Vascular Scaffold (BVS; Abbott Vascular) was the first FDA-approved device and was widely expected to fulfil the dream of interventional cardiologists of a transient scaffold that would disappear 'when the job was done' and would not hamper further treatment options. Although early, small studies and even large, randomized trials showed beneficial outcomes up to 1 year of follow-up, longer-term results have been disappointing, with increased rates of device thrombosis and target-lesion revascularization. The Absorb BVS device was withdrawn from the market because of low demand. In this Review, we summarize the preclinical and clinical data available for BRS to understand how the vascular biological reactions to these devices differ from biological reactions to metallic drug-eluting stents and how these responses translate into clinical outcomes. We also discuss next-generation BRS and outline modifications that are needed to improve the long-term outcomes with these devices so that they eventually become a viable option for patients with symptomatic obstructive coronary artery disease.
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Mechanistic evaluation of long-term in-stent restenosis based on models of tissue damage and growth. Biomech Model Mechanobiol 2020; 19:1425-1446. [PMID: 31912322 PMCID: PMC7502446 DOI: 10.1007/s10237-019-01279-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 12/17/2019] [Indexed: 02/06/2023]
Abstract
Development and application of advanced mechanical models of soft tissues and their growth represent one of the main directions in modern mechanics of solids. Such models are increasingly used to deal with complex biomedical problems. Prediction of in-stent restenosis for patients treated with coronary stents remains a highly challenging task. Using a finite element method, this paper presents a mechanistic approach to evaluate the development of in-stent restenosis in an artery following stent implantation. Hyperelastic models with damage, verified with experimental results, are used to describe the level of tissue damage in arterial layers and plaque caused by such intervention. A tissue-growth model, associated with vessel damage, is adopted to describe the growth behaviour of a media layer after stent implantation. Narrowing of lumen diameter with time is used to quantify the development of in-stent restenosis in the vessel after stenting. It is demonstrated that stent designs and materials strongly affect the stenting-induced damage in the media layer and the subsequent development of in-stent restenosis. The larger the artery expansion achieved during balloon inflation, the higher the damage introduced to the media layer, leading to an increased level of in-stent restenosis. In addition, the development of in-stent restenosis is directly correlated with the artery expansion during the stent deployment. The correlation is further used to predict the effect of a complex clinical procedure, such as stent overlapping, on the level of in-stent restenosis developed after percutaneous coronary intervention.
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Jeżewski MP, Kubisa MJ, Eyileten C, De Rosa S, Christ G, Lesiak M, Indolfi C, Toma A, Siller-Matula JM, Postuła M. Bioresorbable Vascular Scaffolds-Dead End or Still a Rough Diamond? J Clin Med 2019; 8:E2167. [PMID: 31817876 PMCID: PMC6947479 DOI: 10.3390/jcm8122167] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/02/2019] [Accepted: 12/04/2019] [Indexed: 02/06/2023] Open
Abstract
Percutaneous coronary interventions with stent-based restorations of vessel patency have become the gold standard in the treatment of acute coronary states. Bioresorbable vascular scaffolds (BVS) have been designed to combine the efficiency of drug-eluting stents (DES) at the time of implantation and the advantages of a lack of foreign body afterwards. Complete resolution of the scaffold was intended to enable the restoration of vasomotor function and reduce the risk of device thrombosis. While early reports demonstrated superiority of BVS over DES, larger-scale application and longer observation exposed major concerns about their use, including lower radial strength and higher risk of thrombosis resulting in higher rate of major adverse cardiac events. Further focus on procedural details and research on the second generation of BVS with novel properties did not allow to unequivocally challenge position of DES. Nevertheless, BVS still have a chance to present superiority in distinctive indications. This review presents an outlook on the available first and second generation BVS and a summary of results of clinical trials on their use. It discusses explanations for unfavorable outcomes, proposed enhancement techniques and a potential niche for the use of BVS.
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Affiliation(s)
- Mateusz P. Jeżewski
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology, Medical University of Warsaw, 02091 Warsaw, Poland; (M.P.J.); (M.J.K.); (C.E.); (M.P.)
| | - Michał J. Kubisa
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology, Medical University of Warsaw, 02091 Warsaw, Poland; (M.P.J.); (M.J.K.); (C.E.); (M.P.)
| | - Ceren Eyileten
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology, Medical University of Warsaw, 02091 Warsaw, Poland; (M.P.J.); (M.J.K.); (C.E.); (M.P.)
| | - Salvatore De Rosa
- Department of Medical and Surgical Sciences, Division of Cardiology, “Magna Graecia” University, 88100 Catanzaro, Italy; (S.D.R.); (C.I.)
| | - Günter Christ
- Department of Cardiology, 5th Medical Department with Cardiology, Kaiser Franz Josef Hospital, 31100 Vienna, Austria;
| | - Maciej Lesiak
- 1st Department of Cardiology, Poznan University of Medical Sciences, 1061701 Poznań, Poland;
| | - Ciro Indolfi
- Department of Medical and Surgical Sciences, Division of Cardiology, “Magna Graecia” University, 88100 Catanzaro, Italy; (S.D.R.); (C.I.)
| | - Aurel Toma
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 231090 Vienna, Austria;
| | - Jolanta M. Siller-Matula
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology, Medical University of Warsaw, 02091 Warsaw, Poland; (M.P.J.); (M.J.K.); (C.E.); (M.P.)
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 231090 Vienna, Austria;
| | - Marek Postuła
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology, Medical University of Warsaw, 02091 Warsaw, Poland; (M.P.J.); (M.J.K.); (C.E.); (M.P.)
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Kagiyama K, Ueno T, Mitsutake Y, Yamaji K, Ishimatsu T, Sasaki KI, Fukumoto Y. First Experience of Robotic-assisted Percutaneous Coronary Intervention in Japan. Intern Med 2019; 58:3415-3419. [PMID: 31366804 PMCID: PMC6928489 DOI: 10.2169/internalmedicine.3272-19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
In 2018, the CorPath GRX system (Corindus) was approved for use in Japan, marking the introduction of the first robotic-assisted system for percutaneous coronary intervention (PCI) in the country. The present report describes the first experience of robotic-assisted PCI for four coronary lesions in two cases in a single center. All procedures succeeded without any complications, although one procedure was converted to manual PCI by the operator's decision. Post-marketing surveillance to assess the impact of this novel system on both Japanese patients and physicians is currently ongoing in Japan.
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Affiliation(s)
- Koutaro Kagiyama
- Division of Cardiovascular Medicine, Kurume University School of Medicine, Japan
| | - Takafumi Ueno
- Division of Cardiovascular Medicine, Kurume University School of Medicine, Japan
| | - Yoshiaki Mitsutake
- Division of Cardiovascular Medicine, Kurume University School of Medicine, Japan
| | - Kazunori Yamaji
- Division of Cardiovascular Medicine, Kurume University School of Medicine, Japan
| | - Takashi Ishimatsu
- Division of Cardiovascular Medicine, Kurume University School of Medicine, Japan
| | - Ken-Ichiro Sasaki
- Division of Cardiovascular Medicine, Kurume University School of Medicine, Japan
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Kurume University School of Medicine, Japan
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Suzuki N, Kozuma K, Nakamura S, Aramaki K, Saito S, Shibata Y, Nanasato M, Fujii K, Kusano H, Ediebah D, Nakamura M. Absorb GT1 Bioresorbable Vascular Scaffold System - 1-Year Post-Marketing Surveillance in Japan. Circ J 2019; 83:2460-2465. [PMID: 31708522 DOI: 10.1253/circj.cj-19-0636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The Japan post-marketing surveillance (PMS) for the Absorb GT1 bioresorbable vascular scaffold (BVS) mandated an intracoronary imaging-guided implantation technique.Methods and Results:We enrolled 135 patients who were planned to undergo PCI with THE Absorb GT1. Adequate lesion preparation, imaging-guided appropriate sizing, and high-pressure post-dilatation using a noncompliant balloon to minimize final diameter stenosis were recommended. The primary endpoint was the scaffold thrombosis rate at 3 months. All patients successfully received at least 1 Absorb GT1 at the index procedure and completed 1-year follow-up. All 139 lesions were predilatated: cutting/scoring balloon and noncompliant balloon were used in 48 (34.5%) and 58 (41.7%) lesions, respectively. Post-dilatation was performed in 137 (98.5%) lesions with mean high pressure of 18.8 atm. Optical coherence tomography (OCT) was used in 127 of 139 (91.4%) lesions, and revealed 56.7% of lesions had incomplete scaffold apposition (ISA) but only in 1.89% in the per strut analysis. All patients received adenosine diphosphate receptor antagonist at discharge, and 132 (97.8%) patients continued therapy through the year. No definite/probable scaffold thrombosis, cardiac death, myocardial infarction, or ischemia-driven target lesion revascularization was reported up to 1 year follow-up. CONCLUSIONS Appropriate OCT-guided BVS implantation may prevent incomplete strut apposition, thereby reducing the risk of target lesion failure and scaffold thrombosis.
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Affiliation(s)
- Nobuaki Suzuki
- Fourth Department of Internal Medicine, Teikyo University School of Medicine
| | - Ken Kozuma
- Department of Medicine, Teikyo University School of Medicine
| | | | - Kazuhiko Aramaki
- Department of Cardiovascular Medicine, Saitama Sekishinkai Hospital
| | - Shigeru Saito
- Department of Cardiovascular Medicine, Shonan Kamakura General Hospital
| | - Yoshisato Shibata
- Department of Cardiovascular Medicine, Miyazaki Medical Association Hospital
| | - Mamoru Nanasato
- Department of Second Cardiovascular Medicine, Red Cross Nagoya Daini Hospital.,Department of Cardiovascular Medicine, Sakakibara Heart Institute
| | - Kenshi Fujii
- Department of Cardiovascular Medicine, Sakurabashi Watanabe Hospital
| | | | | | - Masato Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
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Omar WA, Kumbhani DJ. The Current Literature on Bioabsorbable Stents: a Review. Curr Atheroscler Rep 2019; 21:54. [DOI: 10.1007/s11883-019-0816-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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49
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Moriyama N, Shishido K, Tanaka Y, Laine M, Saito S. Neoatherosclerosis - Long-Term Assessment of Bioresorbable Vascular Scaffold. Circ Rep 2019; 1:543-549. [PMID: 33693100 PMCID: PMC7897685 DOI: 10.1253/circrep.cr-19-0100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Although metallic stents improved the safety and efficacy of percutaneous coronary intervention (PCI), even the latest generation of drug-eluting stents (DES) is still limited by several factors. The limitations of DES are mainly related to the permanent metallic caging in vessel, chronic inflammatory response to the polymer and adverse effects of antiproliferative drug on endothelial tissue, leading to impaired physiological vasomotor response and late stent-related adverse events such as stent thrombosis and neoatherosclerosis. Bioresorbable vascular scaffold (Absorb BVS; Abbott Vascular) was designed to overcome these drawbacks of DES by disappearing from the vessel wall. Absorb BVS, however, was withdrawn from the world market because of increased incidence of scaffold thrombosis compared with DES. Importantly, only very limited long-term post-BVS implantation data are available, especially with regard to neoatherosclerosis, which can lead to very late adverse events even after resorption of the scaffold. Therefore, the goal of this review was to highlight the mid to long term clinical outcomes published to date, and to describe the features of the intimal healing process and neoatherosclerosis in the 5 years following Absorb BVS implantation, mainly based on our previous study. This may provide important information on the pathophysiology of the scaffolded vessel for clinicians, and promote identification of future bioresorbable materials for PCI that will minimize the stimulus for neoatherosclerosis.
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Affiliation(s)
- Noriaki Moriyama
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital Kamakura Japan.,Department of Cardiology, Heart and Lung Center, Helsinki University and Helsinki University Central Hospital Helsinki Finland
| | - Koki Shishido
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital Kamakura Japan
| | - Yutaka Tanaka
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital Kamakura Japan
| | - Mika Laine
- Department of Cardiology, Heart and Lung Center, Helsinki University and Helsinki University Central Hospital Helsinki Finland
| | - Shigeru Saito
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital Kamakura Japan
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Absorbing the Absorb experience-don't let the concept fade away. Neth Heart J 2019; 27:523-524. [PMID: 31628585 PMCID: PMC6823327 DOI: 10.1007/s12471-019-01334-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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