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Hideo-Kajita A, Garcia-Garcia HM, Haude M, Joner M, Koolen J, Ince H, Abizaid A, Toelg R, Lemos PA, von Birgelen C, Christiansen EH, Wijns W, Neumann FJ, Kaiser C, Eeckhout E, Teik LS, Escaned J, Azizi V, Kuku KO, Ozaki Y, Dan K, Waksman R. First Report of Edge Vascular Response at 12 Months of Magmaris, A Second-Generation Drug-Eluting Resorbable Magnesium Scaffold, Assessed by Grayscale Intravascular Ultrasound, Virtual Histology, and Optical Coherence Tomography. A Biosolve-II Trial Sub-Study. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:392-398. [PMID: 31079817 DOI: 10.1016/j.carrev.2019.02.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 01/11/2019] [Accepted: 02/13/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION AND OBJECTIVE The edge vascular response (EVR) remains unknown in second generation drug-eluting Resorbable Magnesium Scaffold (RMS), such as Magmaris. The aim of the study was to evaluate tissue modifications in the RMS edges over time, assessed by different invasive imaging modalities. METHODS The patients treated with the device were assessed by optical coherence tomography (OCT), grayscale intravascular ultrasound (IVUS), and virtual histology IVUS at baseline and 12 months. The EVR study performed a segment- and frame-level analysis of the 5 mm segments proximal and distal of the actual RMS. RESULTS The segment-level grayscale IVUS (n = 10), virtual histology IVUS (n = 10), and OCT (n = 18) analysis did not show any significant changes after 12 months, except for a fibrous plaque area (FPA) reduction of 0.5mm2 (p = 0.017) in the proximal segment compared to baseline. In the frame-level analysis, IVUS evaluation revealed a vessel area decreased 2.80 ± 1.43 mm2 (p = 0.012) and 2.49 ± 1.53 mm2 (p = 0.022) in 2 proximal frames. This was accompanied by plaque area reduction of 0.88 ± 0.70 mm2 (p = 0.048) and a FPA decreased by 0.63 ± 0.48 mm2 (p = 0.004) in one proximal frame. In 1 distal frame, there was a dense calcium area reduction of 0.10 ± 0.12 mm2 (p = 0.045), FPA and fibrous fatty plaque increased 0.54 ± 0.53 mm2 (p = 0.023) and 0.17 ± 0.16 mm2 (p = 0.016), respectively. By OCT, there was a lumen area decrease of 0.76 ± 1.51 mm2 (p = 0.045) in a distal frame. CONCLUSION At 12 months, Magmaris EVR assessment does not show overall significant changes, except for a fibrous plaque area reduction in the proximal segment. This could be translated as a benign healing process at the edges of the RMS. SUMMARY The edge vascular response (EVR) remains unknown in second generation drug-eluting absorbable metal scaffolds (RMS), such as Magmaris. Patients treated with the device were assessed by multi invasive imaging modalities [i.e. optical coherence tomography (OCT), grayscale intravascular ultrasound (IVUS), and virtual histology IVUS] evaluating the tissue changes over time in the segment- and frame-level analysis of the 5 mm segments proximal and distal of the actual RMS. As a result, after 12 months, Magmaris EVR assessment does not show overall significant changes, except for a fibrous plaque area reduction in the proximal segment, translating a benign healing process at the edges of the RMS.
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Affiliation(s)
- Alexandre Hideo-Kajita
- Interventional Cardiology Department, MedStar Washington Hospital Center, Washington, DC, USA
| | - Hector M Garcia-Garcia
- Interventional Cardiology Department, MedStar Washington Hospital Center, Washington, DC, USA.
| | - Michael Haude
- Medical Clinic I, Städtische Kliniken Neuss, Lukaskrankenhaus GmbH, Neuss, Germany
| | - Michael Joner
- Deutsches Herzzentrum Muenchen und Deutsches Zentrum fuer Herz-Kreislaufforschung e.V., Munich, Germany
| | - Jacques Koolen
- Cardiologie, Catharina Ziekenhuis, Eindhoven, the Netherlands
| | - Hüseyin Ince
- Vivantes Klinikum im Friedrichshain and Am Urban, Department of Cardiology, University of Rostock, Berlin, Germany
| | | | - Ralph Toelg
- Herzzentrum Segeberger Kliniken, Henstedt-Ulzburg, Germany
| | - Pedro A Lemos
- Instituto do Coração - HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Clemens von Birgelen
- Department of Cardiology, Medisch Spectrum Twente, Thoraxcentrum Twente, Enschede, the Netherlands
| | | | - William Wijns
- Cardiology Department, Cardiovascular Research Center Aalst, OLV Hospital, Aalst, Belgium
| | - Franz-Josef Neumann
- Klinik fur Kardiologie und Angiologie II, Universitats-Herzzentrum Freiburg - Bad Krozingen, Bad Krozingen, Germany
| | - Christoph Kaiser
- Department of Cardiology, University Hospital, Basel, Switzerland
| | - Eric Eeckhout
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Lim Soo Teik
- Department of Cardiology, National Heart Center Singapore, Singapore, Singapore
| | - Javier Escaned
- Department of Cardiology, Hospital Clinico San Carlos, Madrid, Spain
| | - Viana Azizi
- Interventional Cardiology Department, MedStar Washington Hospital Center, Washington, DC, USA
| | - Kayode O Kuku
- Interventional Cardiology Department, MedStar Washington Hospital Center, Washington, DC, USA
| | - Yuichi Ozaki
- Interventional Cardiology Department, MedStar Washington Hospital Center, Washington, DC, USA
| | - Kazuhiro Dan
- Interventional Cardiology Department, MedStar Washington Hospital Center, Washington, DC, USA
| | - Ron Waksman
- Interventional Cardiology Department, MedStar Washington Hospital Center, Washington, DC, USA
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Tateishi H, Suwannasom P, Sotomi Y, Nakatani S, Ishibashi Y, Tenekecioglu E, Abdelghani M, Cavalcante R, Zeng Y, Grundeken MJ, Albuquerque FN, Veldhof S, Onuma Y, Serruys PW. Edge Vascular Response After Resorption of the Everolimus-Eluting Bioresorbable Vascular Scaffold - A 5-Year Serial Optical Coherence Tomography Study. Circ J 2016; 80:1131-41. [PMID: 26936236 DOI: 10.1253/circj.cj-15-1325] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The edge vascular response (EVR) has been linked to important prognostic implications in patients treated with permanent metallic stents. We aimed to investigate the relationship of EVR with the geometric changes in the everolimus-eluting bioresorbable scaffold using serial optical coherence tomography (OCT) analysis. METHODS AND RESULTS In the first-in-man ABSORB trial, 28 patients (29 lesions) underwent serial OCT at 4 different time points (Cohort B1: post-procedure, 6, 24, and 60 months [n=13]; Cohort B2: post-procedure, 12, 36, and 60 months [n=15]) following implantation of the scaffold. In Cohort B1, there was no significant luminal change at the distal or proximal edge segment throughout the entire follow-up. In contrast, there was a significant reduction of the lumen flow area (LFA) of the scaffold between post-procedure and 6 months (-1.03±0.49 mm(2)[P<0.001]), whereas between 6 and 60 months the LFA remained stable (+0.31±1.00 mm(2)[P=0.293]). In Cohort B2, there was a significant luminal reduction of the proximal edge between post-procedure and 12 months (-0.57±0.74 mm(2)[P=0.017]), whereas the lumen area remained stable (-0.26±1.22 mm(2)[P=0.462]) between 12 and 60 months. The scaffold LFA showed a change similar to that observed in Cohort B1. CONCLUSIONS Our study demonstrated a reduction in the scaffold luminal area in the absence of major EVR, suggesting that the physiological continuity of the lumen contour is restored long term. (Circ J 2016; 80: 1131-1141).
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Virtual Histology-Intravascular Ultrasound. CURRENT CARDIOVASCULAR IMAGING REPORTS 2015. [DOI: 10.1007/s12410-015-9357-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Otsuki S, Shiratori Y, Brugaletta S, Cola C, García del Blanco B, Ruiz-Salmeron R, Díaz JF, Pinar E, Martí V, García-Picart J, Martín-Yuste V, Sabaté M. Edge Vascular Response After Polymer-Free vs. Polymer-Based Paclitaxel-Eluting Stent Implantation. Circ J 2014; 78:2657-64. [DOI: 10.1253/circj.cj-14-0345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Shuji Otsuki
- Thorax Institute, Department of Cardiology, Hospital Clinic, IDIBAPS, University of Barcelona
| | - Yoshitaka Shiratori
- Thorax Institute, Department of Cardiology, Hospital Clinic, IDIBAPS, University of Barcelona
| | - Salvatore Brugaletta
- Thorax Institute, Department of Cardiology, Hospital Clinic, IDIBAPS, University of Barcelona
| | | | | | | | | | - Eduardo Pinar
- Department of Cardiology, Virgen de la Arrixaca Hospital
| | | | | | - Victoria Martín-Yuste
- Thorax Institute, Department of Cardiology, Hospital Clinic, IDIBAPS, University of Barcelona
| | - Manel Sabaté
- Thorax Institute, Department of Cardiology, Hospital Clinic, IDIBAPS, University of Barcelona
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Gogas BD, Garcia-Garcia HM, Onuma Y, Muramatsu T, Farooq V, Bourantas CV, Serruys PW. Edge Vascular Response After Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2013; 6:211-21. [DOI: 10.1016/j.jcin.2013.01.132] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 01/24/2013] [Accepted: 01/30/2013] [Indexed: 11/30/2022]
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Ribamar Costa J, Abizaid A, Sousa A, Siqueira D, Chamié D, Feres F, Costa R, Staico R, Maldonado G, Centemero M, Tanajura LF, Viana R, Chaves Á, Abizaid A, Sousa JE. Serial greyscale and radiofrequency intravascular ultrasound assessment of plaque modification and vessel geometry at proximal and distal edges of bare metal and first-generation drug-eluting stents. EUROINTERVENTION 2012; 8:225-34. [PMID: 22717925 DOI: 10.4244/eijv8i2a36] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Little is known about the correlation between modifications in plaque composition at stent edges and the changes in vessel geometry. This study sought to evaluate, by serial greyscale intravascular ultrasound (IVUS) and Virtual Histology intravascular ultrasound (VH-IVUS), the modifications in plaque composition at the edges of drug-eluting and bare metal stents and the correlation of these findings with changes in the measurements of vessel, lumen and plaque area at those segments. METHODS AND RESULTS Single-centre, prospective and randomised (1:1) evaluation of 40 patients with acute coronary syndrome treated with bare metal (Driver; Medtronic, Santa Clara, CA, USA; n=20 patients) or drug-eluting stents (Cypher; Cordis, Miami Lakes, FL, USA; n=20 patients). IVUS and VH-IVUS assessments were done post-procedure and at nine months. Primary endpoint included the modification in vessel, lumen and plaque area and in the composition of the plaque in the mean time between the baseline and follow-up procedure. At the proximal edge of the vessel treated with the Cypher stent, a trend toward positive vessel remodelling (D=+0.6 mm², p=0.06) was observed while at the distal edge, less plaque growth (D=+0.2 mm² vs. D=+1.1 mm², p<0.001), resulted in a larger lumen area at follow-up. By VH, there was a marked reduction in the percentage of fibrotic tissue and necrotic core at the edges of both stents and a positive correlation was seen between increase in percentage of fibro-fatty component and increase in plaque area (r=0.78, p=0.01). CONCLUSION Patients treated with drug-eluting stents (DES) experienced less plaque growth, especially at the distal edge of the stents. Modifications in plaque composition, with increase in fibrofatty tissue component, may partially explain these findings.
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Affiliation(s)
- J Ribamar Costa
- Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil.
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Gogas BD, Serruys PW, Diletti R, Farooq V, Brugaletta S, Radu MD, Heo JH, Onuma Y, van Geuns RJM, Regar E, De Bruyne B, Chevalier B, Thuesen L, Smits PC, Dudek D, Koolen J, Windecker S, Whitbourn R, Miquel-Hebert K, Dorange C, Rapoza R, Garcia-Garcia HM, McClean D, Ormiston JA. Vascular Response of the Segments Adjacent to the Proximal and Distal Edges of the ABSORB Everolimus-Eluting Bioresorbable Vascular Scaffold: 6-Month and 1-Year Follow-Up Assessment. JACC Cardiovasc Interv 2012; 5:656-65. [DOI: 10.1016/j.jcin.2012.02.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 01/09/2012] [Accepted: 02/14/2012] [Indexed: 11/26/2022]
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Brugaletta S, Costa JR, Garcia-Garcia HM. Assessment of drug-eluting stents and bioresorbable stents by grayscale IVUS and IVUS-based imaging modalities. Int J Cardiovasc Imaging 2011; 27:239-48. [PMID: 21279692 DOI: 10.1007/s10554-010-9788-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Accepted: 12/30/2010] [Indexed: 11/28/2022]
Abstract
Grayscale IVUS and IVUS-based imaging modalities during the last years have become useful in the assessment not only of drug eluting stent, but also of new bioresorbable vascular scaffolds. Although IVUS resolution is not sufficient for determining stent coverage (optical coherence tomography is the gold standard), serial IVUS can measure intimal hyperplasia, assess acute and late incomplete stent apposition, detect the presence and persistence of edge dissections, study edge effects and look for causes of restenosis and thrombosis. In addition other IVUS-based imaging modalities, such as IVUS-VH, iMAP or palpography, can be used to study the serial compositional and mechanical changes of the plaque behind stent struts and also to follow the bioresorption of the new bioresorbable scaffolds, analyzing the backscattering signal coming from the polymeric struts. This review details and evaluates grayscale IVUS and IVUS-based techniques findings in clinical trials, highlighting the usefulness of these imaging modalities in the study of drug eluting stents and bioresorbable vascular scaffold.
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Affiliation(s)
- Salvatore Brugaletta
- Thoraxcenter, Z120, Erasmus MC, Dr Molewaterplein 40, 3015 Rotterdam, The Netherlands
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Albarrán A, Mauri J, Pinar E, Baz JA. Actualización en cardiología intervencionista. Rev Esp Cardiol 2010; 63 Suppl 1:86-100. [DOI: 10.1016/s0300-8932(10)70143-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fitzgerald PJ, Otake H. Evaluación de la respuesta vascular al intervencionismo coronario. Rev Esp Cardiol 2008. [DOI: 10.1157/13126038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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