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Torii S, Yamamoto A, Yoshikawa A, Lu L, Sasaki M, Obuchi S, Wada A, Tsukamoto H, Nakazawa G. Degradation of a novel magnesium alloy-based bioresorbable coronary scaffold in a swine coronary artery model. Cardiovasc Interv Ther 2024:10.1007/s12928-024-01023-3. [PMID: 39034338 DOI: 10.1007/s12928-024-01023-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 06/13/2024] [Indexed: 07/23/2024]
Abstract
The objective of the study is to investigate the safety, feasibility, and degradation profile of a novel Mg alloy-based bioresorbable coronary scaffold (JFK-PRODUCT BRS) with thin struts (110 μm). Polymer- or Mg alloy-based BRSs have not replaced nondegradable metal stents because of the higher prevalence of scaffold thrombosis and restenosis in clinical practice; these poor clinical outcomes were due to inadequate scaffold designs, including thick struts (more than 150 μm) and their inappropriate degradation processes. Fourteen healthy pigs received 17 JFK-PRODUCT BRSs in the coronary arteries and were sacrificed at 1, 6, 12, 18, and 26 months after implantation. Angiography, optical coherence tomography, microfocus X-ray computed tomography (µCT), scanning electron microscopy with energy-dispersive X-ray spectrometry (SEM-EDX), and histopathological evaluation were performed. The JFK-PRODUCT had a median percent late recoil of 11.28% at 1 month. The µCT observation confirmed that scaffold discontinuity reached 64.8% at 12 months with increased scaffold inner area thereafter, suggesting artery positive remodeling. The inflammation was mild, peaked at 18 months, and decreased thereafter. The SEM-EDX analysis demonstrated gradual degradation of the scaffold with formation of inorganic deposits, presumed to be calcium phosphates. It also revealed the disappearance of calcium phosphates at 26 months, achieving almost complete replacement of the scaffold by biocomponents. The current study demonstrated the safety and feasibility of JFK-PRODUCT with a lower acute recoil rate despite its thin struts. The scaffolds were almost completely disappeared at 26 months after implantation.
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Affiliation(s)
- Sho Torii
- Department of Cardiology, School of Medicine, Faculty of Medicine, Tokai University, 143 Shimokasuya, Kanagawa, 2591193, Japan
| | - Akiko Yamamoto
- Research Center for Macromolecules and Biomaterials, National Institute for Materials Science, Ibaraki, Japan
| | - Ayako Yoshikawa
- Department of Cardiology, School of Medicine, Faculty of Medicine, Tokai University, 143 Shimokasuya, Kanagawa, 2591193, Japan
| | - Linhai Lu
- Shanghai Kepan Investment and Management CO., LTD, Shanghai, China
| | - Makoto Sasaki
- Faculty of Advanced Science and Technology, Kumamoto University, Kumamoto, Japan
| | - Shoko Obuchi
- Japan Medical Device Technology Co., Ltd, Kumamoto, Japan
| | - Akira Wada
- Japan Medical Device Technology Co., Ltd, Kumamoto, Japan
| | | | - Gaku Nakazawa
- Department of Cardiology, Faculty of Medicine, Kindai University, Osaka, Japan.
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Shi Q, Zhang B, Wang X, Fei J, Qin Q, Zheng B, Chen M. Safety and efficacy of a novel 3D-printed bioresorbable sirolimus-eluting scaffold in a porcine model. ASIAINTERVENTION 2023; 9:133-142. [PMID: 37736208 PMCID: PMC10507451 DOI: 10.4244/aij-d-22-00051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 12/19/2022] [Indexed: 09/23/2023]
Abstract
Background The effect of 3D-printed bioresorbable vascular scaffolds (BRS) in coronary heart disease has not been clarified. Aims We aimed to compare the safety and efficacy of 3D-printed BRS with that of metallic sirolimus-eluting stents (SES). Methods Thirty-two BRS and 32 SES were implanted into 64 porcine coronary arteries. Quantitative coronary angiography (QCA) and optical coherence tomography (OCT) were performed at 14, 28, 97, and 189 days post-implantation. Scanning electron microscopy (SEM) and histopathological analyses were performed at each assessment. Results All stents/scaffolds were successfully implanted. All animals survived for the duration of the study. QCA showed the two devices had a similar stent/scaffold-to-artery ratio and acute percent recoil. OCT showed the lumen area (LA) and scaffold/stent area (SA) of the BRS were significantly smaller than those of the SES at 14 and 28 days post-implantation (14-day LA: BRS vs SES 4.52±0.41 mm2 vs 5.69±1.11 mm2; p=0.03; 14-day SA: BRS vs SES 4.99±0.45 mm2 vs 6.11±1.06 mm2; p=0.03; 28-day LA: BRS vs SES 2.93±1.03 mm2 vs 4.82±0.74 mm2; p=0.003; 28-day SA: BRS vs SES 3.86±0.98 mm2 vs 5.75±0.71 mm2; p=0.03). Both the LA and SA of the BRS increased over time and were similar to those of the SES at the 97-day and 189-day assessments. SEM and histomorphological analyses showed no significant between-group differences in endothelialisation at each assessment. Conclusions The novel 3D-printed BRS showed safety and efficacy similar to that of SES in a porcine model. The BRS also showed a long-term positive remodelling effect.
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Affiliation(s)
- Qiuping Shi
- Department of Cardiology, Peking University First Hospital, Beijing, People's Republic of China
| | - Bin Zhang
- Department of Cardiology, Peking University First Hospital, Beijing, People's Republic of China
| | - Xingang Wang
- Department of Cardiology, Peking University First Hospital, Beijing, People's Republic of China
| | - Jintao Fei
- Department of Cardiology, Peking University First Hospital, Beijing, People's Republic of China
| | - Qiao Qin
- Department of Cardiology, Peking University First Hospital, Beijing, People's Republic of China
| | - Bo Zheng
- Department of Cardiology, Peking University First Hospital, Beijing, People's Republic of China
- Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, People's Republic of China
| | - Ming Chen
- Department of Cardiology, Peking University First Hospital, Beijing, People's Republic of China
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Abrão SR, Campos CM, Cavalcante R, Eggermont J, Lemos P, Lederman A, da Silva ES, Aun R, Belczak SQ, Abizaid A, de Brito FS. Percutaneous endovascular delivery of calcium chloride to the intact porcine carotid artery: A novel animal model of arterial calcification. Catheter Cardiovasc Interv 2020; 96:E484-E492. [PMID: 32558228 DOI: 10.1002/ccd.29070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/26/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The present study evaluated the effect of endovascular administration of calcium chloride to the carotid artery of swines, to create a model of arterial calcification. METHODS Fifteen Large White pigs were used for the study. Via endovascular treatment, carotid arteries were exposed during 9 min to either calcium chloride (experimental artery) or saline (control artery) with the use of the TAPAS catheter. Intravascular ultrasound (IVUS) imaging was obtained at baseline, postprocedure and at 30 days. Optical coherence tomography (OCT) imaging was obtained in vitro after carotids were harvested. Longitudinally cut parallel arterial segments were placed in a system of delicate clamps and underwent uniaxial strain test. All arteries underwent histopathological examination. RESULTS Calcium chloride treated segments showed extensive circumferential parietal calcification evident on both IVUS and OCT. Reduction in minimal lumen area on IVUS was evident in experimental arteries both at 24 hr and 30 days postprocedure. Histopathologic assessment (Von Kossa stain) confirmed medial calcification with mild intimal thickening. Biomechanical testing showed treated segments to have smaller breaking strength and less elastic deformation than controls. CONCLUSION We developed a nonexpensive, reproducible model of early carotid medial calcification in pigs. Our model has the potential to help the development of research to unravel mechanisms underlying arterial calcification, the use of current or new devices to treat calcified lesions as well as to serve as an option for training interventionalists on the use of such devices.
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Affiliation(s)
| | - Carlos M Campos
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil.,Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
| | | | | | - Pedro Lemos
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil.,Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
| | - Alex Lederman
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil.,Department of Vascular Surgery, University of São Paulo Medical School, Sao Paulo, Brazil
| | - Erasmo S da Silva
- Department of Vascular Surgery, University of São Paulo Medical School, Sao Paulo, Brazil
| | - Ricardo Aun
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil.,Department of Vascular Surgery, University of São Paulo Medical School, Sao Paulo, Brazil
| | - Sergio Q Belczak
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil.,Hospital Sao Camilo, Sao Paulo, Brazil
| | - Alexandre Abizaid
- Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
| | - Fabio Sandoli de Brito
- Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil.,Hospital Sao Camilo, Sao Paulo, Brazil
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Roleder T, Pociask E, Wanha W, Gasior P, Dobrolinska M, Garncarek M, Pietraszewski P, Kurzelowski R, Smolka G, Wojakowski W. Multimodality intravascular imaging of bioresorbable vascular scaffolds implanted in vein grafts. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2019; 15:151-157. [PMID: 31497047 PMCID: PMC6727228 DOI: 10.5114/aic.2019.86010] [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] [Received: 12/30/2018] [Accepted: 02/28/2019] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION There are no data presenting a serial assessment of vein graft healing after bioresorbable vascular scaffold (BVS) implantation at long-term follow-up. AIM To describe ABSORB BVS healing in vein grafts by optical coherence tomography (OCT) and high-definition intravascular imaging (HD-IVUS) at long-term follow-up.Material and methods: The study group consisted of 6 patients. The first patient had serial OCT assessment of BVS implanted in the saphenous vein grafts (SVG) at baseline and at 3-, 6-, 18-month follow-up and the second patient had OCT assessment of BVS implanted in the SVG at baseline and 24-, 48-month follow-up. The second and the third patients had OCT and HD-IVUS imaging at baseline and 48-month follow-up. The last 3 patients had OCT imaging of BVS implanted in the native coronary artery at 48-month follow-up. RESULTS There were no differences in neointimal hyperplasia after BVS implantation between each time point. However, complete scaffold coverage was observed only 48 months after implantation. Out of 202 analyzed scaffold struts, there were 67 (33%) black boxes detectable at 48-month follow-up. HD-IVUS presented plaque burden up to 67% at the segment of BVS implantation at 48-months follow-up. There was a difference in neointimal hyperplasia thickness (1.27 (0.953-1.696) vs. 0.757 (0.633-0.848), p < 0.001) between a native coronary artery and BVS scaffolds at 48-month follow-up. CONCLUSIONS Bioresorbable vascular scaffold implanted in SVG characterized moderate neointimal hyperplasia as excessive as compared to native coronary arteries at long-term follow-up. The complete scaffold coverage was observed only 48 months after implantation.
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Affiliation(s)
- Tomasz Roleder
- Regional Specialist Hospital, Research and Development Center, Wroclaw, Poland
| | - Elzbieta Pociask
- Department of Biocybernetics and Biomedical Engineering, AGH University of Science and Technology, Krakow, Poland
| | - Wojciech Wanha
- Department of Cardiology and Structural Heart Diseases, 3 Division of Cardiology, Medical University of Silesia, Katowice, Poland
| | - Pawel Gasior
- Department of Cardiology and Structural Heart Diseases, 3 Division of Cardiology, Medical University of Silesia, Katowice, Poland
| | - Magdalena Dobrolinska
- Department of Cardiology and Structural Heart Diseases, 3 Division of Cardiology, Medical University of Silesia, Katowice, Poland
| | - Magdalena Garncarek
- Regional Specialist Hospital, Research and Development Center, Wroclaw, Poland
| | | | - Radoslaw Kurzelowski
- Department of Cardiology and Structural Heart Diseases, 3 Division of Cardiology, Medical University of Silesia, Katowice, Poland
| | - Grzegorz Smolka
- Department of Cardiology and Structural Heart Diseases, 3 Division of Cardiology, Medical University of Silesia, Katowice, Poland
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, 3 Division of Cardiology, Medical University of Silesia, Katowice, Poland
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Perkins LEL, Rippy MK. Balloons and Stents and Scaffolds: Preclinical Evaluation of Interventional Devices for Occlusive Arterial Disease. Toxicol Pathol 2018; 47:297-310. [DOI: 10.1177/0192623318815604] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Atherosclerosis places a significant burden on humankind; it is the leading cause of mortality globally, and for those living with atherosclerosis, it can significantly impact quality of life. Fortunately, treatment advances have effectively reduced the morbidity and mortality related to atherosclerosis, with one such modality being percutaneous intervention (PCI) to open occluded arteries. Over the 40-year history of PCI, preclinical models have played a critical role in demonstrating proof of concept, characterizing the in vivo behavior (pharmacokinetics, degradation) and providing a reasonable assurance of biologic safety of interventional devices before entering into clinical trials. Further, preclinical models may provide insight into the potential efficacy of these devices with the appropriate study design and end points. While several species have been used in the evaluation of interventional devices, the porcine model has been the principal model used in the evaluation of safety of devices for both coronary and endovascular treatments. This article reviews the fundamentals of permanent stents, transient scaffolds, and drug-coated balloons and the models, objectives, and methods used in their preclinical evaluation.
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Abstract
The quest for an ideal biodegradable stent for both adult coronary and pediatric congenital heart disease applications continues. Over the past few years, a lot of progress has been made toward development of a dedicated pediatric biodegradable stent that can be used for congenital heart disease applications. At present, there are no biodegradable stents available for use in congenital heart disease. In this article, the authors review the different biodegradable materials and their limitations and provide an overview of the current biodegradable stents being evaluated for congenital heart disease applications.
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Affiliation(s)
- Tre R Welch
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Alan W Nugent
- Division of Cardiology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 21, Chicago, IL 60611, USA
| | - Surendranath R Veeram Reddy
- Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Children's Health System of Texas, Childrens Medical Center, 1935 Medical District Drive, Dallas, TX 75235, USA.
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Gasior P, Cheng Y, Xia J, Conditt GB, McGregor JC, Virmani R, Granada JF, Kaluza GL. Two-year longitudinal evaluation of a second-generation thin-strut sirolimus-eluting bioresorbable coronary scaffold with hybrid cell design in porcine coronary arteries. Cardiol J 2018; 27:115-125. [PMID: 30155861 DOI: 10.5603/cj.a2018.0095] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 08/24/2018] [Accepted: 06/30/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The first commercially available bioresorbable scaffold (BRS) had a strut thickness of 156 microns. As such, it had the potential for delivery challenges and higher thrombogenicity. The aim herein, is to evaluate biomechanical performance, pharmacokinetics and vascular healing of a novel thin strut (100 μm) sirolimus eluting BRS (MeRes-100, Meril Life Sciences, Gujarat, India) against the once clinically used BRS (Absorb BVS, Abbott, Santa Clara, CA) in porcine coronary arteries. METHODS Following device implantation, angiographic and optical coherence tomography (OCT) evaluation were performed at 45, 90, 180 days, 1 year and 2 years. Histological evaluation was per-formed at 30, 90 and 180 days. RESULTS At 2 years, both lumen (MeRes-100 7.07 ± 1.82 mm² vs. Absorb BVS 7.57 ± 1.39 mm2, p = NS) and scaffold areas (MeRes-100 9.73 ± 1.80 mm² vs. Absorb BVS 9.67 ± 1.25 mm², p = NS) were comparable between tested and control scaffolds. Also, the late lumen area gain at 2 years was similar in both groups tested (MeRes-100 1.03 ± 1.98 mm² vs. Absorb BVS 0.85 ± 1.56 mm², p = NS). Histologic examination up to 6 months showed comparable healing and inflammation profiles for both devices. CONCLUSIONS The novel sirolimus-eluting BRS with thinner struts and hybrid cell design showed similar biomechanical durability and equivalent inhibition of neointimal proliferation when compared to the first-ever Absorb BVS up to 2 years in normal porcine coronary arteries.
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Affiliation(s)
- Pawel Gasior
- CRF-Skirball Center for Innovation, 8 Corporate Dr., NY, 10965 Orangeburg, United States. .,Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland.
| | - Yanping Cheng
- CRF-Skirball Center for Innovation, 8 Corporate Dr., NY, 10965 Orangeburg, United States
| | - Jinggang Xia
- CRF-Skirball Center for Innovation, 8 Corporate Dr., NY, 10965 Orangeburg, United States
| | - Gerard B Conditt
- CRF-Skirball Center for Innovation, 8 Corporate Dr., NY, 10965 Orangeburg, United States
| | - Jennifer C McGregor
- CRF-Skirball Center for Innovation, 8 Corporate Dr., NY, 10965 Orangeburg, United States
| | - Renu Virmani
- CVPath Institute, 9 Firstfield Rd, 20878 Gaithersburg, MD, United States
| | - Juan F Granada
- CRF-Skirball Center for Innovation, 8 Corporate Dr., NY, 10965 Orangeburg, United States
| | - Grzegorz L Kaluza
- CRF-Skirball Center for Innovation, 8 Corporate Dr., NY, 10965 Orangeburg, United States
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Byrne R, Stefanini G, Capodanno D, Onuma Y, Baumbach A, Escaned J, Haude M, James S, Joner M, Jüni P, Kastrati A, Oktay S, Wijns W, Serruys P, Windecker S. Report of an ESC-EAPCI Task Force on the evaluation and use of bioresorbable scaffolds for percutaneous coronary intervention: executive summary. EUROINTERVENTION 2018; 13:1574-1586. [DOI: 10.4244/eij20170912-01] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Byrne RA, Stefanini GG, Capodanno D, Onuma Y, Baumbach A, Escaned J, Haude M, James S, Joner M, Jüni P, Kastrati A, Oktay S, Wijns W, Serruys PW, Windecker S. Report of an ESC-EAPCI Task Force on the evaluation and use of bioresorbable scaffolds for percutaneous coronary intervention: executive summary. Eur Heart J 2017; 39:1591-1601. [DOI: 10.1093/eurheartj/ehx488] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 08/06/2017] [Indexed: 01/05/2023] Open
Affiliation(s)
- Robert A Byrne
- Deutsches Herzzentrum München, Technische Universität München, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Giulio G Stefanini
- Division of Cardiology, Cardio Center, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Davide Capodanno
- Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Italy
| | - Yoshinobu Onuma
- Department of Interventional Cardiology Erasmus Medical Center Rotterdam, The Netherlands
| | - Andreas Baumbach
- Department of Cardiology, St Bartholomew’s Hospital, William Harvey Research Institute, and Queen Mary University of London, London, UK
| | - Javier Escaned
- Interventional Cardiology, Hospital San Carlos, Madrid, Spain
| | - Michael Haude
- Medical Clinic I, Städtische Kliniken Neuss, Lukaskrankenhaus GmbH, Neuss, Germany
| | - Stefan James
- Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Michael Joner
- Deutsches Herzzentrum München, Technische Universität München, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Peter Jüni
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität München, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Semih Oktay
- Cardio Med Device Consultants, Baltimore, USA
| | - William Wijns
- Saolta University Healthcare Group, Galway, Ireland
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland, Galway, Ireland
| | - Patrick W Serruys
- Erasmus University, Rotterdam, the Netherlands
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, UK
| | - Stephan Windecker
- Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland
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Arat A, Daglioglu E, Akmangit I, Peker A, Arsava M, Topcuoglu MA, Belen D. Bioresorbable Vascular Scaffolds in Interventional Neuroradiology. Clin Neuroradiol 2017; 28:585-592. [DOI: 10.1007/s00062-017-0609-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 07/11/2017] [Indexed: 01/11/2023]
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Liang HW, Kao HL, Lin YH, Hwang JJ, Lin MS, Chiang FT, Lee CM, Yeh CF, Wang TD, Wu CK, Lin LY, Tsai CT, Chen YH. Everolimus-Eluting Bioresorbable Vascular Scaffold in Real World Practice - A Single Center Experience. ACTA CARDIOLOGICA SINICA 2017; 33:250-257. [PMID: 28559655 DOI: 10.6515/acs20160901a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Drug-eluting stents are widely used in coronary artery intervention. However, vessel caging and very late thrombotic events are of persistent and substantial concern. Bioresorbable vascular scaffolds (BVS) were developed to deliver vascular reparative therapy, by eliminating permanent mechanical restraint. However, data regarding its clinical performance is lacking. METHODS After the BVS implantation procedure received national approval in May 2014, patients receiving BVS implantation until November 2014 in National Taiwan University Hospital (NTUH) were enrolled. Clinical variables, angiographic data, procedural details, and follow-up information were collected and compared with those receiving BVS at NTUH as part of the global ABSORB EXTEND trial. RESULTS A total of 35 patients (38 target vessels) with 48 BVS implanted after approval were enrolled, as the "real-world practice" group. Data of the 34 patients (34 target vessels) with 37 BVS implanted in the ABSORB EXTEND trial were also obtained. Differences in lesion complexity (0% type B2/C lesion in ABSORB EXTEND, versus 23.7% in real-world, p = 0.007) and lesion length (20.9 ± 6.1 mm in ABSORB EXTEND, versus 29.5 ± 15.9 mm in real-world, p = 0.008) were noted. The ischemia-driven target vessel revascularization after an average of 732 days follow-up was 11.8% in the ABSORB EXTEND trial. However, there was no ischemia-driven target lesion revascularization (TLR), no scaffold thrombosis, no myocardial infarction (MI), and no patients passed during the follow-up period. In real-world patients, there is 5.3% of MI, 2.6% ischemia-driven TLR, and 2.6% of non-fatal probable scaffold thrombosis. CONCLUSIONS The use of BVS in real-world practice is feasible, with clinical outcomes comparable to those in the ABSORB EXTEND trial.
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Affiliation(s)
- Huai-Wen Liang
- Division of Cardiology, Department of Internal Medicine, Eda Hospital, Kaohsiung
| | - Hsien-Li Kao
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University, Taipei
| | - Yen-Hung Lin
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University, Taipei
| | - Juey-Jen Hwang
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University, Taipei.,Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin
| | - Mao-Shin Lin
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University, Taipei
| | - Fu-Tien Chiang
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University, Taipei.,Fu Jen Catholic University Hospital, New Taipei City, Taiwan
| | - Chii-Ming Lee
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University, Taipei
| | - Chih-Fan Yeh
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University, Taipei
| | - Tzung-Dau Wang
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University, Taipei
| | - Cho-Kai Wu
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University, Taipei
| | - Lian-Yu Lin
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University, Taipei
| | - Chia-Ti Tsai
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University, Taipei
| | - Ying-Hsien Chen
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University, Taipei
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Perkins LEL, Kossuth MB, Fox JC, Rapoza RJ. Paving the way to a bioresorbable technology: Development of the absorb BRS program. Catheter Cardiovasc Interv 2017; 88:1-9. [PMID: 27797462 DOI: 10.1002/ccd.26811] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 09/20/2016] [Indexed: 11/09/2022]
Abstract
Bioresorbable scaffolds (BRS) combine attributes of the preceding generations of percutaneous coronary intervention (PCI) devices with new technologies to result in a novel therapy promoted as being the fourth generation of PCI. By providing mechanical support and drug elution to suppress restenosis, BRS initially function similarly to drug eluting stents. Thereafter, through their degradation, BRS undergo a decline in radial strength, allowing a gradual transition of mechanical function from the scaffold back to the artery in order to provide long term effectiveness similar to balloon angioplasty. The principles of operation of BRS, whether of polymeric or metallic composition, follow three phases of functionality reflective of differing physiological requirements over time: revascularization, restoration, and resorption. In this review, these three fundamental performance phases and the metrics for the nonclinical evaluation of BRS, including both bench and preclinical testing, are discussed. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
| | | | - Julia C Fox
- Abbott Vascular, Research and Development, Santa Clara, CA
| | - Richard J Rapoza
- Abbott Vascular, Divisional Vice President of Research and Development, Santa Clara, CA.
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Vahl T, Gasior P, Gongora C, Ramzipoor K, Lee C, Cheng Y, McGregor J, Shibuya M, Estrada E, Conditt G, Kaluz G, Granada J. Four-year polymer biocompatibility and vascular healing profile of a novel ultrahigh molecular weight amorphous PLLA bioresorbable vascular scaffold: an OCT study in healthy porcine coronary arteries. EUROINTERVENTION 2016; 12:1510-1518. [DOI: 10.4244/eij-d-16-00308] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Herbert CE, Veeram Reddy S, Welch TR, Wang J, Richardson JA, Forbess JM, Nugent AW. Bench and initial preclinical results of a novel 8 mm diameter double opposed helical biodegradable stent. Catheter Cardiovasc Interv 2016; 88:902-911. [PMID: 27471092 DOI: 10.1002/ccd.26647] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 06/04/2016] [Indexed: 11/05/2022]
Abstract
BACKGROUND Metallic endovascular stents are utilized off-label in congenital heart disease. Biodegradable stents (BDS) offer potential advantages in a growing child. We have previously reported double opposed helical (DH) BDS up to 6 mm diameter (DH-6). The objectives are to investigate the bench characteristics of larger 8 mm diameter BDS (DH-8) manufactured with increasing strut thicknesses and the inflammatory profile in a porcine model. METHODS DH-8 were manufactured with strut thicknesses 0.10, 0.12, and 0.18 mm and mechanical testing performed. Stents were deployed into the infrarenal descending aorta (DAO) of nine minipigs. At insertion (nonsurvival = 2), 1 week (n = 2), 1 month (n = 2), and 9 months (n = 3) follow-up angiography, intravascular ultrasound and histopathology were performed. RESULTS There was superior recoil and collapse pressure with increasing strut thickness, with 0.18 mm having 1.0% elastic recoil and collapse pressure 0.75 Atmospheres. There was good wall apposition at insertion with 5 BDS (4 DH-8 and 1 DH-6) but suboptimal in 4 as the minipigs infrarenal DAO were >8 mm (deployed at iliac bifurcation). Structural integrity was maintained in 8 BDS with 1 DH-8 collapsed at 9 months, secondary to strut damage at insertion. No thrombosis was seen. There was mild inflammation and neointimal proliferation at 1 week and 1 month, but a moderate inflammatory response at 9 months. CONCLUSIONS DH-8 with increased strut thickness had acceptable mechanical properties at the cost of an increased inflammatory response. Miniaturization to improve delivery and further investigation on the long-term inflammatory profile of thicker struts, including through degradation, is needed. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Carrie E Herbert
- Division of Cardiology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas
| | | | - Tré R Welch
- Division of Pediatric Cardiothoracic Surgery, Department of Cardiovascular and Thoracic Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Jian Wang
- Division of Pediatric Cardiothoracic Surgery, Department of Cardiovascular and Thoracic Surgery, UT Southwestern Medical Center, Dallas, Texas
| | | | - Joseph M Forbess
- Division of Pediatric Cardiothoracic Surgery, Department of Cardiovascular and Thoracic Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Alan W Nugent
- Division of Cardiology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas
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Abstract
The concept for a bioresorbable vascular scaffold combines the best features of the first 3 generations of percutaneous coronary intervention (namely), balloon angioplasty, bare metallic stents, and drug-eluting stents, into a single device. The principles of operation of a BRS follow 3 phases of functionality that reflect the different physiologic requirements over time; revascularization, restoration, and resorption. Most BRS designs make use of the continuum of hydrolytic degradation in aliphatic polyesters, such as poly(l-lactide), in which molecular weight, strength, and mass decrease progressively in 3 distinct stages, consistent with the in vivo requirements of each performance phase.
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Affiliation(s)
| | | | - Richard J Rapoza
- Abbott Vascular, 3200 Lakeside Drive, Santa Clara, CA 95054, USA
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Bioresorbable Everolimus-Eluting Vascular Scaffold for Patients With Peripheral Artery Disease (ESPRIT I). JACC Cardiovasc Interv 2016; 9:1178-87. [DOI: 10.1016/j.jcin.2016.02.051] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 02/16/2016] [Accepted: 02/25/2016] [Indexed: 11/17/2022]
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Nakatani S, Ishibashi Y, Sotomi Y, Perkins L, Eggermont J, Grundeken MJ, Dijkstra J, Rapoza R, Virmani R, Serruys PW, Onuma Y. Bioresorption and Vessel Wall Integration of a Fully Bioresorbable Polymeric Everolimus-Eluting Scaffold. JACC Cardiovasc Interv 2016; 9:838-851. [DOI: 10.1016/j.jcin.2016.01.030] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 01/15/2016] [Indexed: 10/21/2022]
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Gielen S, Haude M, Tebbe U, Frantz S. Moderne Koronarstents und „vascular scaffolds“. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2016. [DOI: 10.1007/s00398-016-0065-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abizaid A, Costa RA, Schofer J, Ormiston J, Maeng M, Witzenbichler B, Botelho RV, Costa JR, Chamié D, Abizaid AS, Castro JP, Morrison L, Toyloy S, Bhat V, Yan J, Verheye S. Serial Multimodality Imaging and 2-Year Clinical Outcomes of the Novel DESolve Novolimus-Eluting Bioresorbable Coronary Scaffold System for the Treatment of Single De Novo Coronary Lesions. JACC Cardiovasc Interv 2016; 9:565-74. [DOI: 10.1016/j.jcin.2015.12.004] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 11/23/2015] [Accepted: 12/01/2015] [Indexed: 10/22/2022]
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Suwannasom P, Sotomi Y, Tateishi H, Tenekecioglu E, Zeng Y, Kraak RP, Wykrzykowska JJ, De Winter RJ, Serruys PW, Onuma Y. Bioresorbable drug-eluting scaffolds for treatment of vascular disease. Expert Opin Drug Deliv 2016; 13:725-39. [PMID: 26865247 DOI: 10.1517/17425247.2016.1153062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Theoretical advantages of fully bioresorbable scaffold (BRS) stem from transient vessel support without rigid caging. Therefore, it could reduce long-term adverse events associated with the presence of foreign materials. AREAS COVERED This article will provide an overview of: drug-eluting BRS for various applications in the treatment of vascular disease; The mechanisms of active agent release from such scaffolds; currently available drug-eluting BRS and their future applications are also discussed. EXPERT OPINION The current BRS have been developed in order to achieve optimal vascular patency while providing long-term safety. The clinical efficacy and safety of BRS in coronary treatment have been reported as equal to that of the current metallic drug eluting stents in simple lesions. The application of BRS can potentially be expanded to other vascular beds. The research in bioengineering for the appropriate materials should not only focus on biocompatibility but also should be tailored according to the sites of implantation, which may require different strength and supporting period. The ultimate goal in this field is to develop a biocompatible device that provides equivalent and complementary therapy to other devices, and is able to disappear when the mechanical support and drug delivery are no longer required.
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Affiliation(s)
- Pannipa Suwannasom
- a AMC Heartcenter, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands.,b ThoraxCenter , Erasmus Medical Center , Rotterdam , The Netherlands.,c Northern Region Heart Center, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand
| | - Yohei Sotomi
- a AMC Heartcenter, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Hiroki Tateishi
- b ThoraxCenter , Erasmus Medical Center , Rotterdam , The Netherlands
| | | | - Yaping Zeng
- b ThoraxCenter , Erasmus Medical Center , Rotterdam , The Netherlands
| | - Robin P Kraak
- a AMC Heartcenter, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Joanna J Wykrzykowska
- a AMC Heartcenter, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Robbert J De Winter
- a AMC Heartcenter, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Patrick W Serruys
- d International Centre for Circulatory Health, NHLI , Imperial College London , London , UK
| | - Yoshinobu Onuma
- b ThoraxCenter , Erasmus Medical Center , Rotterdam , The Netherlands
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Soares JS, Moore JE. Biomechanical Challenges to Polymeric Biodegradable Stents. Ann Biomed Eng 2015; 44:560-79. [DOI: 10.1007/s10439-015-1477-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 09/26/2015] [Indexed: 10/23/2022]
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Everolimus-eluting Bioresorbable Vascular Scaffold Implantation in Real World and Complex Coronary Disease: Procedural and 30-day Outcomes at Two Australian Centres. Heart Lung Circ 2015; 24:854-9. [DOI: 10.1016/j.hlc.2015.02.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 01/12/2015] [Accepted: 02/16/2015] [Indexed: 11/19/2022]
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Gongora CA, Shibuya M, Ramzipoor K, Lee C, Cheng Y, McGregor JC, Estrada EA, Granada JF, Kaluza GL. Vessel Caging Versus Vascular Restoration in the Same Artery. JACC Cardiovasc Interv 2015; 8:631-2. [DOI: 10.1016/j.jcin.2014.10.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Revised: 10/15/2014] [Accepted: 10/24/2014] [Indexed: 11/16/2022]
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Echogenicity as a surrogate for bioresorbable everolimus-eluting scaffold degradation: analysis at 1-, 3-, 6-, 12- 18, 24-, 30-, 36- and 42-month follow-up in a porcine model. Int J Cardiovasc Imaging 2015; 31:471-82. [PMID: 25627777 PMCID: PMC4368838 DOI: 10.1007/s10554-015-0591-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 01/10/2015] [Indexed: 01/01/2023]
Abstract
The objective of the study is to validate intravascular quantitative echogenicity as a surrogate for molecular weight assessment of poly-l-lactide-acid (PLLA) bioresorbable scaffold (Absorb BVS, Abbott Vascular, Santa Clara, California). We analyzed at 9 time points (from 1- to 42-month follow-up) a population of 40 pigs that received 97 Absorb scaffolds. The treated regions were analyzed by echogenicity using adventitia as reference, and were categorized as more (hyperechogenic or upperechogenic) or less bright (hypoechogenic) than the reference. The volumes of echogenicity categories were correlated with the measurements of molecular weight (Mw) by gel permeation chromatography. Scaffold struts appeared as high echogenic structures. The quantification of grey level intensity in the scaffold-vessel compartment had strong correlation with the scaffold Mw: hyperechogenicity (correlation coefficient = 0.75; P < 0.01), upperechogenicity (correlation coefficient = 0.63; P < 0.01) and hyper + upperechogenicity (correlation coefficient = 0.78; P < 0.01). In the linear regression, the R2 for high echogenicity and Mw was 0.57 for the combination of hyper and upper echogenicity. IVUS high intensity grey level quantification is correlated to Absorb BVS residual molecular weight and can be used as a surrogate for the monitoring of the degradation of semi-crystalline polymers scaffolds.
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OCT assessment of the long-term vascular healing response 5 years after everolimus-eluting bioresorbable vascular scaffold. J Am Coll Cardiol 2014; 64:2343-56. [PMID: 25465421 DOI: 10.1016/j.jacc.2014.09.029] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 08/28/2014] [Accepted: 09/05/2014] [Indexed: 12/29/2022]
Abstract
BACKGROUND Although recent observations suggest a favorable initial healing process of the everolimus-eluting bioresorbable vascular scaffold (BVS), little is known regarding long-term healing response. OBJECTIVES This study assessed the in vivo vascular healing response using optical coherence tomography (OCT) 5 years after elective first-in-man BVS implantation. METHODS Of the 14 living patients enrolled in the Thoraxcenter Rotterdam cohort of the ABSORB A study, 8 patients underwent invasive follow-up, including OCT, 5 years after implantation. Advanced OCT image analysis included luminal morphometry, assessment of the adluminal signal-rich layer separating the lumen from other plaque components, visual and quantitative tissue characterization, and assessment of side-branch ostia "jailed" at baseline. RESULTS In all patients, BVS struts were integrated in the vessel and were not discernible. Both minimum and mean luminal area increased from 2 to 5 years, whereas lumen eccentricity decreased over time. In most patients, plaques were covered by a signal-rich, low-attenuating layer. Minimum cap thickness over necrotic core was 155 ± 90 μm. One patient showed plaque progression and discontinuity of this layer. Side-branch ostia were preserved with tissue bridge thinning that had developed in the place of side-branch struts, creating a neo-carina. CONCLUSIONS At long-term BVS follow-up, we observed a favorable tissue response, with late luminal enlargement, side-branch patency, and development of a signal-rich, low-attenuating tissue layer that covered thrombogenic plaque components. The small size of the study and the observation of a different tissue response in 1 patient warrant judicious interpretation of our results and confirmation in larger studies.
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Zhang YJ, Iqbal J, Nakatani S, Bourantas CV, Campos CM, Ishibashi Y, Cho YK, Veldhof S, Wang J, Onuma Y, Garcia-Garcia HM, Dudek D, van Geuns RJ, Serruys PW. Scaffold and edge vascular response following implantation of everolimus-eluting bioresorbable vascular scaffold: a 3-year serial optical coherence tomography study. JACC Cardiovasc Interv 2014; 7:1361-9. [PMID: 25457053 DOI: 10.1016/j.jcin.2014.06.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 04/30/2014] [Accepted: 06/19/2014] [Indexed: 12/23/2022]
Abstract
OBJECTIVES This study sought to investigate the in-scaffold vascular response (SVR) and edge vascular response (EVR) after implantation of an everolimus-eluting bioresorbable scaffold (BRS) using serial optical coherence tomography (OCT) imaging. BACKGROUND Although studies using intravascular ultrasound have evaluated the EVR in metal stents and BRSs, there is a lack of OCT-based SVR and EVR assessment after BRS implantation. METHODS In the ABSORB Cohort B (ABSORB Clinical Investigation, Cohort B) study, 23 patients (23 lesions) in Cohort B1 and 17 patients (18 lesions) in Cohort B2 underwent truly serial OCT examinations at 3 different time points (Cohort B1: post-procedure, 6 months, and 2 years; B2: post-procedure, 1 year, and 3 years) after implantation of an 18-mm scaffold. A frame-by-frame OCT analysis was performed at the 5-mm proximal, 5-mm distal edge, and 2-mm in-scaffold margins, whereas the middle 14-mm in-scaffold segment was analyzed at 1-mm intervals. RESULTS The in-scaffold mean luminal area significantly decreased from baseline to 6 months or 1 year (7.22 ± 1.24 mm(2) vs. 6.05 ± 1.38 mm(2) and 7.64 ± 1.19 mm(2) vs. 5.72 ± 0.89 mm(2), respectively; both p < 0.01), but remained unchanged from then onward. In Cohort B1, a significant increase in mean luminal area of the distal edge was observed (5.42 ± 1.81 mm(2) vs. 5.58 ± 1.53 mm(2); p < 0.01), whereas the mean luminal area of the proximal edge remained unchanged at 6 months. In Cohort B2, the mean luminal areas of the proximal and distal edges were significantly smaller than post-procedure measurements at 3 years. The mean luminal area loss at both edges was significantly less than the mean luminal area loss of the in-scaffold segment at both 6-month and 2-year follow-up in Cohort B1 or at 1 year and 3 years in Cohort B2. CONCLUSIONS This OCT-based serial EVR and SVR evaluation of the Absorb Bioresorbable Vascular Scaffold (Abbott Vascular, Santa Clara, California) showed less luminal loss at the edges than luminal loss within the scaffold. The luminal reduction of both edges is not a nosologic entity, but an EVR in continuity with the SVR, extending from the in-scaffold margin to both edges. (ABSORB Clinical Investigation, Cohort B [ABSORB B]; NCT00856856).
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Affiliation(s)
- Yao-Jun Zhang
- Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands; Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Javaid Iqbal
- Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Cardiovascular Science, University of Sheffield, Sheffield, United Kingdom
| | - Shimpei Nakatani
- Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Carlos M Campos
- Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Yuki Ishibashi
- Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Yun-Kyeong Cho
- Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Jin Wang
- Abbott Vascular, Diegem, Belgium
| | - Yoshinobu Onuma
- Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | | | | | - Patrick W Serruys
- Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands; International Centre for Circulatory Health, NHLI, Imperial College London, London, United Kingdom.
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Wang Y, Zhang X. Vascular restoration therapy and bioresorbable vascular scaffold. Regen Biomater 2014; 1:49-55. [PMID: 26816624 PMCID: PMC4669005 DOI: 10.1093/rb/rbu005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 08/22/2014] [Indexed: 12/31/2022] Open
Abstract
This article describes the evolution of minimally invasive intervention technologies for vascular restoration therapy from early-stage balloon angioplasty in 1970s, metallic bare metal stent and metallic drug-eluting stent technologies in 1990s and 2000s, to bioresorbable vascular scaffold (BVS) technology in large-scale development in recent years. The history, the current stage, the challenges and the future of BVS development are discussed in detail as the best available approach for vascular restoration therapy. The criteria of materials selection, design and processing principles of BVS, and the corresponding clinical trial results are also summarized in this article.
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Affiliation(s)
- Yunbing Wang
- National Engineering Research Center For Biomaterials, Sichuan University, Chengdu 610064, China
| | - Xingdong Zhang
- National Engineering Research Center For Biomaterials, Sichuan University, Chengdu 610064, China
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Veeram Reddy SR, Welch TR, Wang J, Richardson JA, Forbess JM, Riegel M, Nugent AW. A novel design biodegradable stent for use in congenital heart disease: mid-term results in rabbit descending aorta. Catheter Cardiovasc Interv 2014; 85:629-39. [PMID: 25157439 DOI: 10.1002/ccd.25648] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 07/23/2014] [Accepted: 08/17/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVES This study evaluates the feasibility of delivery and deployment of low and medium molecular weight (LMW and MMW, respectively) double-opposing helical (DH) poly-l-lactic acid biodegradable stent (BDS) in rabbit descending aorta (DAO). Secondary objectives were to assess patency and inflammation of stented vessels at 9 months and to investigate safety following intentional embolization of stent fragments in DAO. BACKGROUND A BDS that will relieve aortic obstruction and disappears as the child grows older allowing for preservation of aortic wall elasticity and natural growth of aorta will be ideal to treat Coarctation (CoA). BDS have never been evaluated in the DAO. METHODS Seven New Zealand white rabbits underwent implantation of DH-LMW (n = 7), DH-MMW (n = 3), and metal stents (n = 7) in DAO. BDS fragments were intentionally embolized into DAO in two rabbits. RESULTS All stents were deployed via a 6-French sheath. Five BDS covered the origin of major DAO side branches. Angiography and intravascular ultrasound showed good stent apposition to the wall of DAO with minimal luminal loss at 9 months follow-up. All stents had minimal neointimal hyperplasia on histopathology. Adverse events included 1 death, 1 aortic aneurysm, and lower extremity ulceration due to self-mutilation in an embolization rabbit. CONCLUSIONS Pilot study confirms the feasibility of delivery and deployment of up to 6-millimeter diameter DH BDS in rabbit DAO. Stent integrity with DH design was maintained at 9 months with minimal vessel inflammation. Potential morbidity due to embolized BD fragments cannot be ruled out and needs further evaluation.
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Terapia de restauración vascular con plataformas biorreabsorbibles. La cuarta revolución. REVISTA COLOMBIANA DE CARDIOLOGÍA 2014. [DOI: 10.1016/j.rccar.2014.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Lane JP, Perkins LE, Sheehy AJ, Pacheco EJ, Frie MP, Lambert BJ, Rapoza RJ, Virmani R. Lumen Gain and Restoration of Pulsatility After Implantation of a Bioresorbable Vascular Scaffold in Porcine Coronary Arteries. JACC Cardiovasc Interv 2014; 7:688-95. [DOI: 10.1016/j.jcin.2013.11.024] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 10/30/2013] [Accepted: 11/21/2013] [Indexed: 10/25/2022]
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Verheye S, Ormiston JA, Stewart J, Webster M, Sanidas E, Costa R, Costa JR, Chamie D, Abizaid AS, Pinto I, Morrison L, Toyloy S, Bhat V, Yan J, Abizaid A. A Next-Generation Bioresorbable Coronary Scaffold System: From Bench to First Clinical Evaluation. JACC Cardiovasc Interv 2014; 7:89-99. [DOI: 10.1016/j.jcin.2013.07.007] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 07/16/2013] [Accepted: 07/17/2013] [Indexed: 10/26/2022]
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Durand E, Sharkawi T, Leclerc G, Raveleau M, van der Leest M, Vert M, Lafont A. Head-to-head comparison of a drug-free early programmed dismantling polylactic acid bioresorbable scaffold and a metallic stent in the porcine coronary artery: six-month angiography and optical coherence tomographic follow-up study. Circ Cardiovasc Interv 2013; 7:70-9. [PMID: 24368820 DOI: 10.1161/circinterventions.113.000738] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We aimed to evaluate a new drug-free fully bioresorbable lactic acid-based scaffold designed to allow early dismantling synchronized with artery wall healing in comparison with a bare metal stent (BMS). METHODS AND RESULTS Twenty-three BMS (3.0×12 mm) and 36 lactic acid-based bioresorbable scaffolds (BRS, 3.0×11 mm) were implanted in porcine coronary arteries. QCA and optical coherence tomographic analyses were performed immediately after implantation and repeated after 1, 3, and 6 months. Microcomputed tomography was used to detect scaffold dismantling. Polymer degradation was evaluated throughout the study. The primary end-point was late lumen loss, and the secondary end-points were scaffold/stent diameter and acute recoil. Acute recoil was low and comparable between the BRS and the BMS groups (4.6±6.7 versus 4.6±5.1%; P=0.98). BRS outer diameter increased significantly from 1 to 6 months indicating late positive scaffold remodeling (P<0.0001), whereas BMS diameter remained constant (P=0.159). Late lumen loss decreased significantly from 1 to 6 months in the BRS group (P=0.003) without significant difference between BRS and BMS groups at 6 months (P=0.68). Microcomputed tomography identified BRS dismantling starting at 3 months, and weight-average molar masses of scaffold parts were 20% and 14% of their initial values at 3 and 6 months. CONCLUSIONS BRS and BMS have similar 6-month outcomes in porcine coronary arteries. Interestingly, BRS dismantling was detected from 3 months and resulted in late lumen enlargement by increased scaffold diameter at 6 months.
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Affiliation(s)
- Eric Durand
- From the Cardiology Department, European Georges Pompidou Hospital, Paris Centre de Recherche Cardiovasculaire, INSERM U 970, Université Paris-Descartes, Paris, France (E.D., M.R., A.L.); Faculty of Pharmacy, Institut Charles Gherardt, MACS (T.S.) UMR CNRS 5253 and Faculty of Pharmacy, Research Center for Artificial Biopolymers, Institut de Biomolecules Max Mousseron, University Montpellier 1-CNRS, Montpellier, France (M.V.); AccelLAB Inc, Boisbriand, Quebec, Canada (G.L.); and Arterial Remodeling Technologies, Noisy le Roi, France (M.v.d.L.)
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Lewitus DY, Rios F, Rojas R, Kohn J. Molecular design and evaluation of biodegradable polymers using a statistical approach. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2013; 24:2529-2535. [PMID: 23888354 PMCID: PMC3809329 DOI: 10.1007/s10856-013-5008-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 07/16/2013] [Indexed: 06/02/2023]
Abstract
The challenging paradigm of bioresorbable polymers, whether in drug delivery or tissue engineering, states that a fine-tuning of the interplay between polymer properties (e.g., thermal, degradation), and the degree of cell/tissue replacement and remodeling is required. In this paper we describe how changes in the molecular architecture of a series of terpolymers allow for the design of polymers with varying glass transition temperatures and degradation rates. The effect of each component in the terpolymers is quantified via design of experiment (DoE) analysis. A linear relationship between terpolymer components and resulting Tg (ranging from 34 to 86 °C) was demonstrated. These findings were further supported with mass-per-flexible-bond analysis. The effect of terpolymer composition on the in vitro degradation of these polymers revealed molecular weight loss ranging from 20 to 60 % within the first 24 h. DoE modeling further illustrated the linear (but reciprocal) relationship between structure elements and degradation for these polymers. Thus, we describe a simple technique to provide insight into the structure property relationship of degradable polymers, specifically applied using a new family of tyrosine-derived polycarbonates, allowing for optimal design of materials for specific applications.
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Affiliation(s)
- Dan Y Lewitus
- Department of Plastics and Polymer Engineering, The Shenkar College of Engineering and Design, 52526, Ramat-Gan, Israel,
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Zhang Y, Bourantas CV, Farooq V, Muramatsu T, Diletti R, Onuma Y, Garcia-Garcia HM, Serruys PW. Bioresorbable scaffolds in the treatment of coronary artery disease. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2013; 6:37-48. [PMID: 23662091 PMCID: PMC3647349 DOI: 10.2147/mder.s22547] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Indexed: 12/23/2022] Open
Abstract
Drug-eluting stents have reduced the risk of in-stent restenosis and have broadened the application in percutaneous coronary intervention in coronary artery disease. However, the concept of using a permanent metallic endovascular device to restore the patency of a stenotic artery has inherited pitfalls, namely the presence of a foreign body within the artery causing vascular inflammation, late complications such as restenosis and stent thrombosis, and impeding the restoration of the physiologic function of the stented segment. Bioresorbable scaffolds (BRS) were introduced to potentially overcome these limitations, as they provide temporary scaffolding and then disappear, liberating the treated vessel from its cage. Currently, several BRSs are available, undergoing evaluation either in clinical trials or in preclinical settings. The aim of this review is to present the new developments in BRS technology, describe the mechanisms involved in the resorption process, and discuss the potential future prospects of this innovative therapy.
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Affiliation(s)
- Yaojun Zhang
- Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands; ; Division of Cardiovascular Diseases, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China
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Bourantas CV, Zhang Y, Farooq V, Garcia-Garcia HM, Onuma Y, Serruys PW. Bioresorbable scaffolds: current evidence and ongoing clinical trials. Curr Cardiol Rep 2013; 14:626-34. [PMID: 22810889 PMCID: PMC3432788 DOI: 10.1007/s11886-012-0295-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Bioresorbable scaffolds (BRS) represent a novel approach in coronary stent technology. In contrast to the metallic stents, they provide transient scaffolding, thereby safeguarding early vessel patency and acute gain. Subsequently a process of “decomposition” occurs, that results in the complete absorption of the scaffold. This reduces the risk of late complications, allowing the vessel to maintain its integrity and physiological function. This unique ability has attracted interest and nowadays several BRS are available. The aim of this review article is to describe the advances in the field, present the evidence from the preclinical and clinical evaluation of these devices, and provide an overview of the ongoing clinical trials that were designed to examine the effectiveness of BRS in the clinical setting.
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Affiliation(s)
- Christos V Bourantas
- Thoraxcenter, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
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