1
|
Rola P, Włodarczak A, Łanocha M, Barycki M, Szudrowicz M, Kulczycki JJ, Jaroszewska-Pozorska J, Gosiewska A, Woźnica K, Lesiak M, Doroszko A. Outcomes of the two generations of bioresorbable scaffolds (Magmaris vs. Absorb) in acute coronary syndrome in routine clinical practice. Cardiol J 2022; 30:VM/OJS/J/86514. [PMID: 35621089 PMCID: PMC10713223 DOI: 10.5603/cj.a2022.0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 03/08/2022] [Accepted: 05/10/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Acute coronary syndrome (ACS) as a clinical manifestation of coronary artery disease (CAD) remains a significant cause of mortality and morbidity, as reported worldwide annually. The second generation of drug-eluting stents (DES) is a gold standard in percutaneous interventions in ACS patients however, permanent caging of the vessel with metallic DES has some drawbacks. Bioresorbable vascular scaffolds (BRS) were designed as a temporal vessel-supporting technology allowing for anatomical and functional restoration. Nevertheless, following the initial encouraging reports, numerous concerns about the safety of BRS occurred. METHODS In this study, a 1-year performance of 193 patients with magnesium BRS - Magmaris (Biotronik, Berlin, Germany) was evaluated in comparison to 160 patients with polymer BRS - Absorb (Abbott-Vascular, Chicago, USA) in the non-ST-segment elevation-ACS setting. RESULTS The Magmaris, when compared to Absorb showed a significantly lower rate of primary endpoint (death from cardiac causes, myocardial infarction, stent thrombosis) as well as target lesion failure in 30-day and 1 year follow-up. In the Absorb group, a significantly higher rate of stent thrombosis was observed. CONCLUSIONS Data from the present study suggests encouraging safety a profile and more favorable clinical outcomes of Magnesium BRS in comparison to the polymer Absorb - BRS.
Collapse
Affiliation(s)
- Piotr Rola
- Department of Cardiology, The Copper Health Center (MCZ), Lubin, Poland.
- Department of Cardiology, Provincial Specialized Hospital, Legnica, Poland.
| | - Adrian Włodarczak
- Department of Cardiology, The Copper Health Center (MCZ), Lubin, Poland
| | | | - Mateusz Barycki
- Department of Cardiology, Provincial Specialized Hospital, Legnica, Poland
| | - Marek Szudrowicz
- Department of Cardiology, The Copper Health Center (MCZ), Lubin, Poland
| | - Jan J Kulczycki
- Department of Cardiology, The Copper Health Center (MCZ), Lubin, Poland
| | | | - Alicja Gosiewska
- Faculty of Mathematics and Information Science, Warsaw University of Technology, Warsaw, Poland
| | - Katarzyna Woźnica
- Faculty of Mathematics and Information Science, Warsaw University of Technology, Warsaw, Poland
| | - Maciej Lesiak
- 1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Adrian Doroszko
- Department of Internal Medicine, Hypertension and Clinical Oncology, Wroclaw Medical University, Wroclaw, Poland
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Nakamura M, Yaku H, Ako J, Arai H, Asai T, Chikamori T, Daida H, Doi K, Fukui T, Ito T, Kadota K, Kobayashi J, Komiya T, Kozuma K, Nakagawa Y, Nakao K, Niinami H, Ohno T, Ozaki Y, Sata M, Takanashi S, Takemura H, Ueno T, Yasuda S, Yokoyama H, Fujita T, Kasai T, Kohsaka S, Kubo T, Manabe S, Matsumoto N, Miyagawa S, Mizuno T, Motomura N, Numata S, Nakajima H, Oda H, Otake H, Otsuka F, Sasaki KI, Shimada K, Shimokawa T, Shinke T, Suzuki T, Takahashi M, Tanaka N, Tsuneyoshi H, Tojo T, Une D, Wakasa S, Yamaguchi K, Akasaka T, Hirayama A, Kimura K, Kimura T, Matsui Y, Miyazaki S, Okamura Y, Ono M, Shiomi H, Tanemoto K. JCS 2018 Guideline on Revascularization of Stable Coronary Artery Disease. Circ J 2022; 86:477-588. [DOI: 10.1253/circj.cj-20-1282] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Masato Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
| | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences
| | - Hirokuni Arai
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Tohru Asai
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine
| | | | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Kiyoshi Doi
- General and Cardiothoracic Surgery, Gifu University Graduate School of Medicine
| | - Toshihiro Fukui
- Department of Cardiovascular Surgery, Graduate School of Medical Sciences, Kumamoto University
| | - Toshiaki Ito
- Department of Cardiovascular Surgery, Japanese Red Cross Nagoya Daiichi Hospital
| | | | - Junjiro Kobayashi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital
| | - Ken Kozuma
- Department of Internal Medicine, Teikyo University Faculty of Medicine
| | - Yoshihisa Nakagawa
- Department of Cardiovascular Medicine, Shiga University of Medical Science
| | - Koichi Nakao
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center
| | - Hiroshi Niinami
- Department of Cardiovascular Surgery, Tokyo Women’s Medical University
| | - Takayuki Ohno
- Department of Cardiovascular Surgery, Mitsui Memorial Hospital
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University Hospital
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | | | - Hirofumi Takemura
- Department of Cardiovascular Surgery, Graduate School of Medical Sciences, Kanazawa University
| | | | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hitoshi Yokoyama
- Department of Cardiovascular Surgery, Fukushima Medical University
| | - Tomoyuki Fujita
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Tokuo Kasai
- Department of Cardiology, Uonuma Institute of Community Medicine, Niigata University Uonuma Kikan Hospital
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Takashi Kubo
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Susumu Manabe
- Department of Cardiovascular Surgery, Tsuchiura Kyodo General Hospital
| | | | - Shigeru Miyagawa
- Frontier of Regenerative Medicine, Graduate School of Medicine, Osaka University
| | - Tomohiro Mizuno
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Noboru Motomura
- Department of Cardiovascular Surgery, Graduate School of Medicine, Toho University
| | - Satoshi Numata
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine
| | - Hiroyuki Nakajima
- Department of Cardiovascular Surgery, Saitama Medical University International Medical Center
| | - Hirotaka Oda
- Department of Cardiology, Niigata City General Hospital
| | - Hiromasa Otake
- Department of Cardiovascular Medicine, Kobe University Graduate School of Medicine
| | - Fumiyuki Otsuka
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Ken-ichiro Sasaki
- Division of Cardiovascular Medicine, Kurume University School of Medicine
| | - Kazunori Shimada
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Tomoki Shimokawa
- Department of Cardiovascular Surgery, Sakakibara Heart Institute
| | - Toshiro Shinke
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Tomoaki Suzuki
- Department of Cardiovascular Surgery, Shiga University of Medical Science
| | - Masao Takahashi
- Department of Cardiovascular Surgery, Hiratsuka Kyosai Hospital
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center
| | | | - Taiki Tojo
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences
| | - Dai Une
- Department of Cardiovascular Surgery, Okayama Medical Center
| | - Satoru Wakasa
- Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine
| | - Koji Yamaguchi
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | | | - Kazuo Kimura
- Cardiovascular Center, Yokohama City University Medical Center
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Yoshiro Matsui
- Department of Cardiovascular and Thoracic Surgery, Graduate School of Medicine, Hokkaido University
| | - Shunichi Miyazaki
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Kindai University
| | | | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School
| | | |
Collapse
|
4
|
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).
Collapse
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
| | | |
Collapse
|
5
|
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.
Collapse
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
Collapse
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
| | | |
Collapse
|
6
|
Seo J, Ahn JM, Hong SJ, Kang DY, Hong SJ, Her AY, Kim YH, Ahn CM, Kim JS, Kim BK, Ko YG, Choi D, Jang Y, Park SJ, Park DW, Hong MK. Bioresorbable Vascular Scaffolds Versus Drug-Eluting Stents for Diffuse Long Coronary Narrowings. Am J Cardiol 2020; 125:1624-1630. [PMID: 32279841 DOI: 10.1016/j.amjcard.2020.02.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 02/20/2020] [Accepted: 02/24/2020] [Indexed: 10/24/2022]
Abstract
Clinical benefits of bioresorbable vascular scaffold (BVS) implantation for long coronary lesions were not sufficiently evaluated. The efficacy and safety of BVS and metallic everolimus-eluting stent (EES) were compared for the treatment of long coronary narrowings. A total of 341 patients with diffuse long lesions (requiring device length ≥28 mm) were randomized to receive either BVS (n = 171) or EES (n = 170) implantation. The primary endpoint was major adverse cardiovascular events which included death from cardiac cause, myocardial infarction, device thrombosis, or ischemia-driven target-lesion revascularization at 12 months. The trial was terminated early because the manufacturer stopped supplying BVS. The mean lesion length was 32.2 ± 13.1 mm in the BVS group and 35.3 ± 13.0 mm in the EES group. The 12-month follow-up was completed in 332 patients (97.4%). At 12 months, the primary endpoint events occurred in 2 patients (1.2%) in the BVS group and in 4 patients (2.4%) in the EES group (hazard ratio = 0.49, 95% confidence interval = 0.09 to 2.67, p = 0.398). Definite or probable device thrombosis occurred in 1 patient (0.6%) in the BVS group and 1 patient (0.6%) in the EES group (hazard ratio = 1.00, 95% confidence interval = 0.06 to 15.94, p = 0.998). In conclusion, in patients with long native coronary artery disease, significant differences between BVS and EES were not observed regarding the primary composite endpoint of death from cardiac cause, myocardial infarction, device thrombosis, or target-lesion revascularization at 12 months. However, due to the early termination of this trial and a low number of events, the results cannot be considered clinically relevant (clinicalTrials.gov Identifier: NCT02796157).
Collapse
|
7
|
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
| | | |
Collapse
|
8
|
Comparison of the everolimus-eluting bioresorbable vascular scaffold versus the everolimus-eluting metallic stent in real-world patients with ST-segment elevation myocardial infarction. Adv Cardiol 2020; 16:49-57. [PMID: 32368236 PMCID: PMC7189143 DOI: 10.5114/aic.2020.93912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 11/03/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Despite the withdrawal of the ABSORB bioresorbable vascular scaffold (BVS) from clinical use, continuous observation of BVS-treated patients is necessary. In the vast majority of clinical trials, patients with ST-segment elevation myocardial infarction (STEMI) were excluded from the analysis. AIM To compare the early and long-term outcomes of the BVS with the everolimus-eluting metallic stent (EES) in patients with STEMI. MATERIAL AND METHODS Consecutive patients treated with BVS or EES in our center were screened. For analysis, only patients with STEMI were enrolled. The primary endpoint was a comparison of the target lesion failure at 12 and 24 months. The secondary endpoints encompass occurrence of the patient-oriented cardiovascular endpoint (PoCE), stent thrombosis (ST), device, and procedural success. RESULTS Between 2012 and 2016, 2,137 patients were hospitalized for STEMI. Of these, 123 patients received the BVS (163 scaffolds; 151 lesions), whereas in 141 patients the EES (203 stents; 176 lesions) was implanted. The median follow-up was 931 ±514 days. The primary endpoint at 12 months occurred in 9.7% in the BVS group and in 8.5% in the EES group (hazard ratio (HR) = 2.61; 95% confidence interval (CI): 0.90-7.56; p = 0.076). At 24 months the incidence of the primary endpoint was 15.2% in the BVS group and 14.9% in the EES group (HR = 2.46; 95% CI: 0.85-7.07; p = 0.095). The rates of PoCE, ST, device, and procedural success were also comparable in both groups. CONCLUSIONS STEMI patients treated with the BVS showed statistically similar rates of primary and secondary endpoints compared with the EES.
Collapse
|
9
|
Florin Ferent I, Mester A, Hlinomaz O, Groch L, Rezek M, Sitar J, Semenka J, Novak M, Benedek I. Intracoronary Imaging for Assessment of Vascular Healing and Stent Follow-up in Bioresorbable Vascular Scaffolds. Curr Med Imaging 2020; 16:123-134. [PMID: 32003312 DOI: 10.2174/1573405614666180604093621] [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: 12/15/2016] [Revised: 08/10/2017] [Accepted: 03/19/2018] [Indexed: 11/22/2022]
Abstract
Bioresorbable Vascular Scaffolds (BVS) are polymer-based materials implanted in the coronary arteries in order to treat atherosclerotic lesions, based on the concept that once the lesion has been treated, the material of the implanted stent will undergo a process of gradual resorption that will leave, in several years, the vessel wall smooth, free of any foreign material and with its vasomotion restored. However, after the first enthusiastic reports on the efficacy of BVSs, the recently published trials demonstrated disappointing results regarding long-term patency following BVS implantation, which were mainly attributed to technical deficiencies during the stenting procedure. Intracoronary imaging could play a crucial role for helping the operator to correctly implant a BVS into the coronary artery, as well as providing relevant information in the follow-up period. This review aims to summarize the role of intracoronary imaging in the follow-up of coronary stents, with a particular emphasis on the role of intravascular ultrasound and optical coherence tomography for procedural guidance during stent implantation and also for follow-up of bioabsorbable scaffolds.
Collapse
Affiliation(s)
- Ioan Florin Ferent
- Department of Cardiology, Laboratory of Advanced Research in Multimodality Cardiac Imaging, University of Medicine and Pharmacy of Targu Mures, Targu Mures, Romania
| | - Andras Mester
- Department of Cardiology, Laboratory of Advanced Research in Multimodality Cardiac Imaging, University of Medicine and Pharmacy of Targu Mures, Targu Mures, Romania
| | - Ota Hlinomaz
- International Clinical Research Center, St. Anne´s Hospital and Masaryk University, Brno, Czech Republic
| | - Ladislav Groch
- International Clinical Research Center, St. Anne´s Hospital and Masaryk University, Brno, Czech Republic
| | - Michal Rezek
- International Clinical Research Center, St. Anne´s Hospital and Masaryk University, Brno, Czech Republic
| | - Jan Sitar
- International Clinical Research Center, St. Anne´s Hospital and Masaryk University, Brno, Czech Republic
| | - Jiri Semenka
- International Clinical Research Center, St. Anne´s Hospital and Masaryk University, Brno, Czech Republic
| | - Martin Novak
- International Clinical Research Center, St. Anne´s Hospital and Masaryk University, Brno, Czech Republic
| | - Imre Benedek
- Department of Cardiology, Laboratory of Advanced Research in Multimodality Cardiac Imaging, University of Medicine and Pharmacy of Targu Mures, Targu Mures, Romania
| |
Collapse
|
10
|
Lee SY, Kang DY, Hong SJ, Ahn JM, Ahn CM, Park DW, Kim JS, Kim BK, Ko YG, Choi D, Jang Y, Park SJ, Hong MK. Optical Coherence Tomography for Coronary Bioresorbable Vascular Scaffold Implantation: A Randomized Controlled Trial. Circ Cardiovasc Interv 2020; 13:e008383. [PMID: 32525410 DOI: 10.1161/circinterventions.119.008383] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND We investigated whether optical coherence tomography (OCT) guidance would reduce nonoptimal bioresorbable vascular scaffold (BVS) deployment. METHODS This was a randomized controlled trial. Patients who required percutaneous coronary intervention for ischemic heart disease were recruited from 2 centers in Korea. The enrolled patients were randomly assigned to receive either OCT-guided BVS (Absorb; Abbott Vascular) implantation or angiography-guided BVS implantation using an optimized technique. The primary outcome was nonoptimal deployment, which was a composite outcome of the following parameters assessed by OCT: a minimal scaffold area <5 mm2, residual area stenosis >20%, incomplete apposition of the scaffold struts >5%, major edge dissection, or scaffold disruption. The secondary outcome was a procedural complication defined by the occurrence of no reflow, coronary perforation, or flow-limiting dissection. RESULTS Between September 2016 and January 2018, 88 patients (90 lesions) were assigned to OCT guidance, while 88 patients (89 lesions) were assigned to angiography guidance. The recruitment was prematurely terminated in March 2018 because the manufacturer stopped supplying BVS. Postprocedural OCT data were available for 88 lesions with OCT guidance and for 88 lesions with angiography guidance. There was nonoptimal BVS deployment postprocedurally in 35.2% of patients in the OCT-guidance group and in 38.6% in the angiography-guidance group (absolute difference, -3.7% [95% CI, -19.0% to 11.6%]; P=0.64). There were no procedural complications in either group. CONCLUSIONS OCT-guided BVS implantation did not reduce the incidence of nonoptimal deployment compared to that of angiography-guided BVS implantation (using optimized techniques). CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT02894697.
Collapse
Affiliation(s)
- Seung-Yul Lee
- Department of Cardiovascular Medicine, Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Korea (S.-Y.L.)
| | - Do-Yoon Kang
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan, Seoul, Korea (D.-Y.K., J.-M.A., D.-W.P., S.-J.P.)
| | - Sung-Jin Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea (S.-J.H., C.-M.A., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.)
| | - Jung-Min Ahn
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan, Seoul, Korea (D.-Y.K., J.-M.A., D.-W.P., S.-J.P.)
| | - Chul-Min Ahn
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea (S.-J.H., C.-M.A., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.)
| | - Duk-Woo Park
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan, Seoul, Korea (D.-Y.K., J.-M.A., D.-W.P., S.-J.P.)
| | - Jung-Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea (S.-J.H., C.-M.A., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.)
| | - Byeong-Keuk Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea (S.-J.H., C.-M.A., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.)
| | - Young-Guk Ko
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea (S.-J.H., C.-M.A., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.)
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea (S.-J.H., C.-M.A., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.)
| | - Yangsoo Jang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea (S.-J.H., C.-M.A., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.)
| | - Seung-Jung Park
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan, Seoul, Korea (D.-Y.K., J.-M.A., D.-W.P., S.-J.P.)
| | - Myeong-Ki Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea (S.-J.H., C.-M.A., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.)
| |
Collapse
|
11
|
Seth A, Onuma Y, Chandra P, Bahl VK, Manjunath CN, Mahajan AU, Kumar V, Goel PK, Wander GS, Kaul U, Ajit Kumar VK, Abizaid A, Serruys PW. Three-year clinical and two-year multimodality imaging outcomes of a thin-strut sirolimus-eluting bioresorbable vascular scaffold: MeRes-1 trial. EUROINTERVENTION 2019; 15:607-614. [PMID: 31147308 DOI: 10.4244/eij-d-19-00324] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Although the proof of concept of the bioresorbable vascular scaffold (BRS) is well documented, device-related adverse outcomes with first-generation BRS indicate longer-term surveillance. The current study provides insights into the safety and performance of the MeRes100, a novel second-generation sirolimus-eluting BRS, beyond one-year up to three-year follow-up (FU). METHODS AND RESULTS A total of 108 enrolled patients with de novo coronary artery lesions who underwent implantation of MeRes100 as part of the first-in-human MeRes-1 trial were followed up clinically beyond one year at two and three years and with multiple modality imaging at six months and two years. At three-year FU, the cumulative major adverse cardiac events rate was 1.87%, in the form of two ischaemia-driven target lesion revascularisations. No scaffold thrombosis was reported. Between six months and two years at quantitative coronary angiography, in-segment late lumen loss (LLL) (0.15±0.22 mm vs. 0.23±0.32 mm; p=0.18) and in-scaffold LLL (0.13±0.22 mm vs. 0.24±0.34 mm; p=0.10) changed insignificantly. IVUS subset analysis revealed a non-significant reduction in mean lumen area (6.17±1.28 mm2 vs. 5.47±1.50 mm2; p=0.21) and minimum lumen area (5.14±1.19 mm2 vs. 4.05±1.42 mm2; p=0.10) at two years compared to post-procedural measurements. OCT subset analysis demonstrated 99.24±2.27% neointimal strut coverage. CONCLUSIONS The extended outcomes of the MeRes-1 trial demonstrated sustained efficacy and safety of the MeRes100 BRS with maintained lumen patency up to two years by multimodality imaging and no very late scaffold thrombosis up to three-year clinical FU.The MeRes-1 trial is registered at the Clinical Trials Registry-India. CTRI Number: CTRI/2015/04/005706.
Collapse
Affiliation(s)
- Ashok Seth
- Fortis Escorts Heart Institute, New Delhi, India
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Nef HM, Wiebe J, Schmidt G, Möllmann H, Boeder NF, Dörr O, Bauer T, Blachutzik F, Liebetrau C, Elsässer A, Foin N, Hamm CW. Everolimus- vs. novolimus-eluting bioresorbable scaffolds in patients with acute coronary syndrome. Herz 2019; 45:95-104. [PMID: 31209520 DOI: 10.1007/s00059-019-4822-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/08/2019] [Accepted: 05/14/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Limited data exist on bioresorbable scaffolds (BRS) in patients with acute coronary syndrome (ACS). The aim of the present study was to evaluate novolimus-eluting BRS (DESolve) as interventional treatment for patients with ACS, and to compare its 12-month outcomes with the everolimus-eluting bioresorbable scaffolds (Absorb). METHODS In this retrospective study, patients with ACS (including unstable angina pectoris, ST-segment elevation myocardial infarction, or non-ST-segment elevation myocardial infarction) treated with either the Absorb or the DESolve BRS were evaluated in a 1:1 matched-pair analysis. Major adverse cardiac events (MACE), including death, myocardial infarction, and target lesion revascularization, were evaluated as a major endpoint. The occurrence of scaffold thrombosis was also assessed. RESULTS A total of 102 patients were eligible for this analysis. The rate of MACE at 12 months was comparable between the Absorb and the DESolve group (8.3% vs. 6.8%, p = 0.738). The occurrence of target lesion revascularization (6.2% vs. 4.7%; p = 0.700) and scaffold thrombosis (4.1% vs. 2.1%; p = 0.580) was comparable as well. All instances of scaffold thrombosis occurred within 30 days of the index procedure. CONCLUSION In this study, similar 12-month event rates were observed for both BRS types after implantation for the treatment of ACS.
Collapse
Affiliation(s)
- H M Nef
- Medizinische Klinik I, Department of Cardiology and Angiology, University of Giessen, Klinikstraße 33, 35392, Giessen, Germany.
| | - J Wiebe
- Deutsches Herzzentrum Muenchen, Munich, Germany
| | - G Schmidt
- Medizinische Klinik I, Department of Cardiology and Angiology, University of Giessen, Klinikstraße 33, 35392, Giessen, Germany
| | - H Möllmann
- Department of Cardiology, St. Johannes Hospital, Dortmund, Germany
| | - N F Boeder
- Medizinische Klinik I, Department of Cardiology and Angiology, University of Giessen, Klinikstraße 33, 35392, Giessen, Germany
| | - O Dörr
- Medizinische Klinik I, Department of Cardiology and Angiology, University of Giessen, Klinikstraße 33, 35392, Giessen, Germany
| | - T Bauer
- Medizinische Klinik I, Department of Cardiology and Angiology, University of Giessen, Klinikstraße 33, 35392, Giessen, Germany
| | - F Blachutzik
- Department of Cardiology, University of Erlangen, Erlangen, Germany
| | - C Liebetrau
- Kerckhoff Heart Center, Bad Nauheim, Germany
| | - A Elsässer
- Department of Cardiology, University of Oldenburg, Oldenburg, Germany
| | - N Foin
- Duke-NUS Medical School, National Heart Centre Singapore, Singapore, Singapore
| | - C W Hamm
- Medizinische Klinik I, Department of Cardiology and Angiology, University of Giessen, Klinikstraße 33, 35392, Giessen, Germany.,Kerckhoff Heart Center, Bad Nauheim, Germany
| |
Collapse
|
13
|
Holck EN, Fox-Maule C, Barkholt TØ, Jakobsen L, Tu S, Maeng M, Dijkstra J, Christiansen EH, Holm NR. Procedural findings and early healing response after implantation of a self-apposing bioresorbable scaffold in coronary bifurcation lesions. Int J Cardiovasc Imaging 2019; 35:1199-1210. [PMID: 31053981 DOI: 10.1007/s10554-019-01537-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 01/16/2019] [Indexed: 11/24/2022]
Abstract
We aimed to evaluate feasibility, early healing and self-correcting properties of the Desolve 150 bioresorbable scaffold (BRS) implanted in bifurcation lesions, using the simple, provisional side branch (SB) stenting technique. BIFSORB pilot was a proof-of-concept study enrolling 10 patients with stable angina pectoris and a bifurcation lesion with SB ≥ 2.5 mm and less than 50% diameter stenosis. Procedure and 1-month outcome was evaluated by optical coherence tomography (OCT) to assess scaffold performance and healing patterns. Nine patients were treated with Desolve 150 BRS and one delivery to the target bifurcation failed. Thrombus formation in the jailed SB ostium was seen in three cases, but was completely resolved at 1-month. OCT confirmed acute self-correcting properties. No clinical events were reported after six months. Scaffold diameter by OCT increased in the proximal main vessel from 3.09 ± 0.16 mm to 3.34 ± 0.18 mm (p = 0.01) and in distal main vessel from 2.82 ± 0.26 mm to 3.02 ± 0.29 mm (p < 0.01) at one-month follow-up. SB ostial diameter stenosis improved from 42 ± 15% to 34 ± 12% (p = 0.01). Malapposition was effectively reduced after 1 month from 4.1 (1.4; 6.1)% to 0.1 (0; 0.6)% (p = 0.002). Treatment of bifurcation lesions using Desolve 150 BRS was feasible except for a delivery failure and unsettling thrombus formation behind jailing SB struts, which was completely resolved at 1-month. Self-correcting and even self-expanding properties were confirmed.
Collapse
Affiliation(s)
- Emil Nielsen Holck
- Department of Cardiology, Aarhus University Hospital Skejby, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Camilla Fox-Maule
- Department of Cardiology, Aarhus University Hospital Skejby, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Trine Ørhøj Barkholt
- Department of Cardiology, Aarhus University Hospital Skejby, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Lars Jakobsen
- Department of Cardiology, Aarhus University Hospital Skejby, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Wenxuan Building, 800 Dongchuan RD, Minhang District, Shanghai, China
| | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital Skejby, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Jouke Dijkstra
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Evald Høj Christiansen
- Department of Cardiology, Aarhus University Hospital Skejby, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Niels Ramsing Holm
- Department of Cardiology, Aarhus University Hospital Skejby, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| |
Collapse
|
14
|
Kang SH, Gogas BD, Jeon KH, Park JS, Lee W, Yoon CH, Suh JW, Hwang SS, Youn TJ, Chae IH, Kim HS. Long-term safety of bioresorbable scaffolds: insights from a network meta-analysis including 91 trials. EUROINTERVENTION 2019; 13:1904-1913. [PMID: 29278353 DOI: 10.4244/eij-d-17-00646] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AIMS The aim of this study was to investigate the long-term safety and efficacy of biodegradable scaffolds and metallic stents. METHODS AND RESULTS We analysed a total of 91 randomised controlled trials with a mean follow-up of 3.7 years in 105,842 patients which compared two or more coronary metallic stents or biodegradable scaffolds and reported the long-term clinical outcomes (≥2 years). Network meta-analysis showed that patients treated with the Absorb bioresorbable vascular scaffold (BVS) had a significantly higher risk of definite or probable scaffold thrombosis (ScT) compared to those treated with metallic DES. The risk of very late ScT was highest with the Absorb BVS among comparators. Pairwise conventional meta-analysis demonstrated that the elevated risk of ScT with Absorb BVS compared to cobalt-chromium everolimus-eluting stents was consistent across the time points of ≤30 days (early), 31 days - 1 year (late) and >1 year (very late) ScT. In addition, target lesion failure rates were significantly higher in the Absorb BVS cohort, driven by both increased risk of target vessel myocardial infarction and ischaemia-driven target lesion revascularisation. CONCLUSIONS Absorb BVS implantation was associated with increased risk of long-term and very late ScT compared to current-generation metallic DES. The risk of ScT occurred with a rising trend beyond one year.
Collapse
Affiliation(s)
- Si-Hyuck Kang
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Floré V, Brown AJ, Giblett JP, Liou K, Cranley J, Hoole SP, West NEJ. Clinical outcomes of bioresorbable vascular scaffolds implanted with routine versus selective optical coherence tomography guidance: results from a single-centre experience. EUROINTERVENTION 2019; 14:1776-1783. [PMID: 30375333 DOI: 10.4244/eij-d-18-00262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS We aimed to investigate the effects of an initial learning period with mandatory optical coherence tomography (OCT) guidance for the implantation of everolimus-eluting bioresorbable vascular scaffolds (BVS). METHODS AND RESULTS We analysed procedural and clinical outcomes of all BVS implantations at a single centre where OCT guidance was mandatory in the initial rollout (OCT-mandatory) phase. We compared these data with the later phase where use of OCT was at operator discretion (OCT-selective or angiography). We implanted 406 BVS in 306 vessels (201 OCT, 105 angiography) in 272 patients. Follow-up duration was 38±10 months. Annualised rates of device-oriented cardiac events (DOCE) and scaffold thrombosis (ScT) were 1.4% and 0.4%, respectively. The risks of DOCE (HR 1.06, 95% CI: 0.33-3.34; p=0.71) and ScT (HR 0.48, 95% CI: 0.07-3.85; p=0.49) were not significantly different when comparing the OCT and angiography groups. CONCLUSIONS Routine use of OCT to guide and optimise BVS implants results in very acceptable outcomes. Further, the benefits of such an early OCT-mandatory "learning" period persist after cessation of routine OCT usage when imaging is not routinely used. A period of mandatory OCT usage for BVS implants may therefore be beneficial in improving patient outcomes with these devices.
Collapse
Affiliation(s)
- Vincent Floré
- Department of Interventional Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | | | | | | | | | | | | |
Collapse
|
16
|
Hommels TM, Hermanides RS, Rasoul S, Berta B, IJsselmuiden AJJ, Jessurun GAJ, Benit E, Pereira B, De Luca G, Kedhi E. Everolimus-eluting bioresorbable scaffolds for treatment of coronary artery disease in patients with diabetes mellitus: the midterm follow-up of the prospective ABSORB DM Benelux study. Cardiovasc Diabetol 2019; 18:25. [PMID: 30851731 PMCID: PMC6408833 DOI: 10.1186/s12933-019-0827-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 02/18/2019] [Indexed: 02/07/2023] Open
Abstract
Background Percutaneous coronary intervention (PCI) in patients with diabetes mellitus (DM) remains challenging even with modern drug-eluting stents (DES) due to high rates of repeat revascularization. Everolimus-eluting bioresorbable scaffolds (EE-BRS) might allow for repeat intervention prolonging the time interval of percutaneous treatment options. Methods The ABSORB DM Benelux Study is a dedicated prospective, international study to evaluate the midterm safety and efficacy of EE-BRS in DM patients. All DM patients that received ≥ 1 EE-BRS for any indication were enrolled and prospectively followed. Study endpoints were major adverse cardiac events (MACE): a composite of all-cause death, any myocardial infarction (MI) and ischemic-driven target vessel revascularization (TVR); target lesion failure (TLF): a composite of cardiac death (CD), target vessel MI, and ischemic-driven target lesion revascularization (TLR), as well as definite or probable scaffold thrombosis (ScT). Results Between April 2015 till March 2017, 150 DM patients and 188 lesions were treated and followed up to 3 years. Device implantation success was 100%. MACE occurred in 15.2% (event rate of 8.8 per 100 PY). TLF was reported in 11.7% (7.0 events per 100 PY). CD, target vessel MI, ischemic-driven TLR occurred in 3.4%, 3.6% and 5.5% respectively, while ScT was observed in 1.4%. There were no occurrences of late or very late ScT. Conclusion EE-BRS treatment in DM patients shows comparable midterm safety and efficacy outcomes when historically compared with modern DES. New-generation EE-BRS might offer an attractive alternative to metallic DES in treatment of fast progressing atherosclerosis population as in DM patients. Trial registration NTR5447. Registered 05 October 2015, retrospectively registered
Collapse
Affiliation(s)
- T M Hommels
- Isala Klinieken, Isala Hartcentrum, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - R S Hermanides
- Isala Klinieken, Isala Hartcentrum, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - S Rasoul
- Zuyderland Medisch Centrum, Heerlen, The Netherlands
| | - B Berta
- Isala Klinieken, Isala Hartcentrum, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | | | | | - E Benit
- Virga Jesse Ziekenhuis, Hasselt, Belgium
| | - B Pereira
- Institut National de Chirurgie Cardiaque et de Cardiologie Interventionnelle, Luxembourg, Luxembourg
| | - G De Luca
- Isala Klinieken, Isala Hartcentrum, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - E Kedhi
- Isala Klinieken, Isala Hartcentrum, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands. .,, Dokter van Heesweg 2, Postbus 10400, 8000 GK, Zwolle, The Netherlands.
| |
Collapse
|
17
|
Regazzoli D, Latib A, Ezhumalai B, Tanaka A, Leone PP, Khan S, Kumar V, Rastogi V, Ancona MB, Mangieri A, Giannini F, Mitomo S, Seth A, Colombo A. Long-term follow-up of BVS from a prospective multicenter registry: Impact of a dedicated implantation technique on clinical outcomes. Int J Cardiol 2018; 270:113-117. [PMID: 29983253 DOI: 10.1016/j.ijcard.2018.06.094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 06/03/2018] [Accepted: 06/21/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the impact of a consistent and dedicated implantation strategy on long-term outcomes after implantation of bioresorbable vascular scaffold (BVS) in a real-world cohort of patients with a high prevalence of complex lesions. BACKGROUND Bioresorbable vascular scaffolds may result in a reduced incidence of late and very-late scaffold thrombosis (ScT) after the complete reabsorption of the scaffold, but this hypothesis is hampered by data from RCTs that showed a higher than expected incidence of late events. However, these studies did not adopt a dedicated implantation technique, that proved to be fundamental in reducing the incidence of adverse events. METHODS 573 consecutive patients (912 lesions) treated with bioresorbable scaffolds between May 2012 and December 2014 were enrolled in 3 high-volume centers that used a dedicated implantation strategy from the beginning. Primary endpoints were target-lesion failure (TLF) and definite and probable ScT. Secondary endpoints included myocardial infarction, target-lesion and target-vessel revascularization. RESULTS The registry enrolled a high complexity subset of lesions (69.4% of type B2 or C lesions; 10.3% of severe calcific lesions; 26.1% of bifurcations). Predilatation was performed in almost all cases (99.2%); intracoronary imaging was liberally adopted (37.3%). Mean scaffold length was 42.9 ± 27.4 mm per patient, and post-dilation with a 1:1 high-pressure (22 ± 3.5 atm) balloon was performed in 99.9% of lesions. Median follow-up (available for 98.6% of patients) was 981 days (IQR 802-1133). Overall incidence of ScT was reassuringly low: three thrombotic events occurred during the first year (0.5%), while only one event ensued in the second year of follow-up, and ScT rate remained stable thereafter up to the fourth year (0.7%). Cumulative TLF rates at 1, 2, 3 and 4 years were 3.0%, 6.0%, 7.8% and 12.2%. CONCLUSIONS These long-term results from a complex "real-world" population appear to be reassuring as regards to the incidence of ScT and TLF when BVS are implanted by experienced operators with a dedicated implantation technique.
Collapse
Affiliation(s)
- Damiano Regazzoli
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Azeem Latib
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Unit of Cardiovascular Interventions, EMO-GVM Centro Cuore Columbus, Milan, Italy.
| | - Babu Ezhumalai
- Unit of Cardiovascular Interventions, Fortis Escorts Heart Institute, New Delhi, India
| | - Akihito Tanaka
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Pier Pasquale Leone
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sara Khan
- Unit of Cardiovascular Interventions, Fortis Escorts Heart Institute, New Delhi, India
| | - Vijay Kumar
- Unit of Cardiovascular Interventions, Fortis Escorts Heart Institute, New Delhi, India
| | - Vishal Rastogi
- Unit of Cardiovascular Interventions, Fortis Escorts Heart Institute, New Delhi, India
| | - Marco Bruno Ancona
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Mangieri
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Giannini
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Unit of Cardiovascular Interventions, EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Satoru Mitomo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ashok Seth
- Unit of Cardiovascular Interventions, Fortis Escorts Heart Institute, New Delhi, India
| | - Antonio Colombo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Unit of Cardiovascular Interventions, EMO-GVM Centro Cuore Columbus, Milan, Italy
| |
Collapse
|
18
|
Appropriate use criteria for optical coherence tomography guidance in percutaneous coronary interventions : Recommendations of the working group of interventional cardiology of the Netherlands Society of Cardiology. Neth Heart J 2018; 26:473-483. [PMID: 30171434 PMCID: PMC6150879 DOI: 10.1007/s12471-018-1143-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Introduction Optical coherence tomography (OCT) enables detailed imaging of the coronary wall, lumen and intracoronary implanted devices. Responding to the lack of specific appropriate use criteria (AUC) for this technique, we conducted a literature review and a procedure for appropriate use criteria. Methods Twenty-one of all 184 members of the Dutch Working Group on Interventional Cardiology agreed to evaluate 49 pre-specified cases. During a meeting, factual indications were established whereupon members individually rated indications on a 9-point scale, with the opportunity to substantiate their scoring. Results Twenty-six indications were rated ‘Appropriate’, eighteen indications ‘May be appropriate’, and five ‘Rarely appropriate’. Use of OCT was unanimously considered ‘Appropriate’ in stent thrombosis, and ‘Appropriate’ for guidance in PCI, especially in distal left main coronary artery and proximal left anterior descending coronary artery, unexplained angiographic abnormalities, and use of bioresorbable vascular scaffold (BVS). OCT was considered ‘Rarely Appropriate’ on top of fractional flow reserve (FFR) for treatment indication, assessment of strut coverage, bypass anastomoses or assessment of proximal left main coronary artery. Conclusions The use of OCT in stent thrombosis is unanimously considered ‘Appropriate’ by these experts. Varying degrees of consensus exists on the appropriate use of OCT in other settings. Electronic supplementary material The online version of this article (10.1007/s12471-018-1143-z) contains supplementary material, which is available to authorized users.
Collapse
|
19
|
Feng C, Zhang P, Han B, Li X, Liu Y, Niu D, Shi Y. Optical coherence tomographic analysis of drug-eluting in-stent restenosis at different times: A STROBE compliant study. Medicine (Baltimore) 2018; 97:e12117. [PMID: 30142870 PMCID: PMC6372013 DOI: 10.1097/md.0000000000012117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The imaging characteristics of drug-eluting in-stent restenosis (ISR) at different times varied; however, the mechanism had not yet been elucidated.To analyze the imaging characteristics of drug-eluting ISR at different time points by optical coherence tomography (OCT) and investigate the cause of the stent treatment failure.A total of 70 patients with drug-eluting ISR undergoing OCT were enrolled (intimal hyperplasia ≥50% of stent area) and implanted with drug-eluting stents. According to stent implantation time, the patients were divided into 2 groups: early in-stent restenosis group (E-ISR group) (group A, n = 35, stent age ≤12 months) and late in-stent restenosis group (L-ISR group) (group B, n = 35, stent age ≥24 months). A qualitative analysis of the restenosis tissue included the nature of restenosis tissue (homogeneous and heterogeneous), neoatherosclerosis, thin-cap fibroatheroma (TCFA), and microvessels.The ratio of ≥75% cross-sectional area stenosis between the L-ISR and E-ISR groups was (60.00% vs 34.28%, P < .05). The heterogeneous intima, neoatherosclerosis, TCFA, and microvessels were more prevalent in the L-ISR group as compared to the E-ISR group (71.43% vs 45.71%, P < .05; 48.57% vs 22.86%, P < .05; 25.71% vs 5.71%, P < .05; 22.86% vs 2.86%, P < .05, respectively).The morphological characteristics of L-ISR were significantly different from those in the E-ISR; the former was closer to the atherosclerotic plaque, which provided a new approach for the treatment of drug-eluting ISR.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Yibing Shi
- Department of Imaging, Xuzhou Central Hospital in Jiangsu,
Institute of Cardiovascular Disease, Xuzhou, China
| |
Collapse
|
20
|
Räber L, Mintz GS, Koskinas KC, Johnson TW, Holm NR, Onuma Y, Radu MD, Joner M, Yu B, Jia H, Meneveau N, de la Torre Hernandez JM, Escaned J, Hill J, Prati F, Colombo A, Di Mario C, Regar E, Capodanno D, Wijns W, Byrne RA, Guagliumi G. Clinical use of intracoronary imaging. Part 1: guidance and optimization of coronary interventions. An expert consensus document of the European Association of Percutaneous Cardiovascular Interventions. EUROINTERVENTION 2018; 14:656-677. [DOI: 10.4244/eijy18m06_01] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
21
|
Räber L, Mintz GS, Koskinas KC, Johnson TW, Holm NR, Onuma Y, Radu MD, Joner M, Yu B, Jia H, Meneveau N, de la Torre Hernandez JM, Escaned J, Hill J, Prati F, Colombo A, di Mario C, Regar E, Capodanno D, Wijns W, Byrne RA, Guagliumi G, Alfonso F, Bhindi R, Ali Z, Carter R. Clinical use of intracoronary imaging. Part 1: guidance and optimization of coronary interventions. An expert consensus document of the European Association of Percutaneous Cardiovascular Interventions. Eur Heart J 2018; 39:3281-3300. [DOI: 10.1093/eurheartj/ehy285] [Citation(s) in RCA: 271] [Impact Index Per Article: 45.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 05/16/2018] [Indexed: 12/22/2022] Open
Affiliation(s)
- Lorenz Räber
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Gary S Mintz
- Cardiovascular Research Foundation, New York, NY, USA
| | | | - Thomas W Johnson
- Bristol Heart Institute, University Hospitals Bristol NHSFT, Bristol, UK
| | - Niels R Holm
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Yoshinubo Onuma
- Department of Interventional Cardiology, Cardialysis, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Maria D Radu
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Michael Joner
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Bo Yu
- Department of Cardiology, 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Haibo Jia
- Department of Cardiology, 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Nicolas Meneveau
- Department of Cardiology, University Hospital Jean Minjoz, Besancon, France
- EA3920, University of Burgundy Franche-Comté, Besancon, France
| | | | - Javier Escaned
- Hospital Clinico San Carlos IDISSC and Universidad Complutense, Madrid, Spain
| | - Jonathan Hill
- Department of Cardiology, King’s College Hospital, London, UK
| | - Francesco Prati
- Department of Cardiology, San Giovanni Hospital, Rome, Italy & CLI Foundation, Rome, Italy
| | - Antonio Colombo
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele, Scientific Institute, Milan, Italy
| | - Carlo di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Evelyn Regar
- Department of Cardiovacular Surgery, Zürich University Hospita, Zürich, Switzerland
| | - Davide Capodanno
- Division of Cardiology, Cardio-Thoraco-Vascular and Transplant Department, CAST, Rodolico Hospital, AOU “Policlinico-Vittorio Emanuele”, University of Catania, Catania, Italy
| | - William Wijns
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland Galway, Saolta University Healthcare Group, Galway, Ireland
| | - Robert A Byrne
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Giulio Guagliumi
- Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Fernando Alfonso
- Department of Cardiology Hospital Universitario de la Princesa, Madrid, Spain
| | - Ravinay Bhindi
- Royal North Shore Hospital, The University of Sydney, Sydney, Australia
| | - Ziad Ali
- Columbia University Medical Center, New York, USA
| | - Rickey Carter
- Department of Health Sciences Research, Mayo Clinic, Rochester, USA
| | | |
Collapse
|
22
|
Li Y, Li Z, Holck EN, Xu B, Karanasos A, Fei Z, Chang Y, Chu M, Dijkstra J, Christiansen EH, Reiber JHC, Holm NR, Tu S. Local Flow Patterns After Implantation of Bioresorbable Vascular Scaffold in Coronary Bifurcations - Novel Findings by Computational Fluid Dynamics. Circ J 2018; 82:1575-1583. [PMID: 29576586 DOI: 10.1253/circj.cj-17-1332] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Development of methods for accurate reconstruction of bioresorbable scaffolds (BRS) and assessing local hemodynamics is crucial for investigation of vascular healing after BRS implantation.Methods and Results:Patients with BRS that crossed over in a coronary bifurcation were included for analysis. Reconstructions of the coronary lumen and BRS were performed by fusion of optical coherence tomography and coronary angiography generating a tree model (TM) and a hybrid model with BRS (TM-BRS). A virtual BRS model with thinner struts was created and all 3 models were analyzed using computational fluid dynamics to derive: (1) time-average shear stress (TASS), (2) TASS gradient (TASSG), which represents SS heterogeneity, and (3) fractional flow reserve (FFR). Reconstruction of the BRS was successful in all 10 patients. TASS and TASSG were both higher by TM-BRS than by TM in main vessels (difference 0.27±4.30 Pa and 10.18±27.28 Pa/mm, P<0.001), with a remarkable difference at side branch ostia (difference 13.51±17.40 Pa and 81.65±105.19 Pa/mm, P<0.001). With thinner struts, TASS was lower on the strut surface but higher at the inter-strut zones, whereas TASSG was lower in both regions (P<0.001 for all). Computational FFR was lower by TM-BRS than by TM for both main vessels and side branches (P<0.001). CONCLUSIONS Neglecting BRS reconstruction leads to significantly lower SS and SS heterogeneity, which is most pronounced at side branch ostia. Thinner struts can marginally reduce SS heterogeneity.
Collapse
Affiliation(s)
- Yingguang Li
- Division of Image Processing, Department of Radiology, Leiden University Medical Center
| | - Zehang Li
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University
| | - Emil N Holck
- Department of Cardiology, Aarhus University Hospital
| | - Bo Xu
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital
| | | | - Zhenyu Fei
- Department of Biomedical Engineering, University of Michigan
| | - Yunxiao Chang
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University
| | - Miao Chu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University
| | - Jouke Dijkstra
- Division of Image Processing, Department of Radiology, Leiden University Medical Center
| | | | - Johan H C Reiber
- Division of Image Processing, Department of Radiology, Leiden University Medical Center
| | - Niels R Holm
- Department of Cardiology, Aarhus University Hospital
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University
| |
Collapse
|
23
|
Nef H, Wiebe J, Boeder N, Dörr O, Bauer T, Hauptmann KE, Latib A, Colombo A, Fischer D, Rudolph T, Foin N, Richardt G, Hamm C. A multicenter post-marketing evaluation of the Elixir DESolve®
Novolimus-eluting bioresorbable coronary scaffold system: First results from the DESolve PMCF study. Catheter Cardiovasc Interv 2018; 92:1021-1027. [DOI: 10.1002/ccd.27550] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 12/25/2017] [Accepted: 01/28/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Holger Nef
- Department of Cardiology and Angiology; University of Giessen, Medizinische Klinik I; Giessen Germany
| | - Jens Wiebe
- Department of Cardiology; Deutsches Herzzentrum Muenchen; Munich Germany
| | - Niklas Boeder
- Department of Cardiology and Angiology; University of Giessen, Medizinische Klinik I; Giessen Germany
| | - Oliver Dörr
- Department of Cardiology and Angiology; University of Giessen, Medizinische Klinik I; Giessen Germany
| | - Timm Bauer
- Department of Cardiology and Angiology; University of Giessen, Medizinische Klinik I; Giessen Germany
| | | | | | | | - Dieter Fischer
- Department of Cardiology and Angiology; University of Münster; Münster Germany
| | - Tanja Rudolph
- Department of Cardiology; University of Cologne; Cologne Germany
| | - Nicolas Foin
- National Heart Centre Singapore, Duke-NUS Medical School; Singapore, Singapore
| | - Gert Richardt
- Department of Cardiology; Segeberger Kliniken; Bad Segeberg Germany
| | - Christian Hamm
- Department of Cardiology and Angiology; University of Giessen, Medizinische Klinik I; Giessen Germany
| |
Collapse
|
24
|
Zhang BC, Tu SX, Karanasos A, van Geuns RJ, de Jaegere P, Zijlstra F, Regar E. Association of stent-induced changes in coronary geometry with late stent failure: Insights from three-dimensional quantitative coronary angiographic analysis. Catheter Cardiovasc Interv 2018; 92:1040-1048. [PMID: 29399998 DOI: 10.1002/ccd.27520] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 12/31/2017] [Accepted: 01/06/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND The relationship between vessel angulation and large changes in vessel geometry after stent implantation and the occurrence of stent failure still remains unclear. We sought to investigate the association of the change in the coronary bending angle after stenting and the risk for late stent failure by three-dimensional quantitative coronary angiography (3D QCA). METHODS The bending angle in coronary lesions that presented with late stent failure and those without stent failure was computed during the cardiac cycle, before and after stenting using a recently developed 3D QCA software. RESULTS A total of 40 lesions with stent failure (cases) were successfully matched to 47 lesions without stent failure (controls).The mean duration to follow-up coronary angiography was 1,011 days in cases and 1,109 days in the control group (P = 0.14). In stent failure, the systolic bending angle after stenting was smaller (14.45° [12.18, 17.68] versus 18.20° [14.00, 20.30], P = 0.01), while the stent-induced change in systolic bending angle was significantly larger (4.15° [1.13, 7.20] versus 1.80° [-1.90, 4.40], P = 0.004). Multivariable logistic regression analysis suggested that systolic bending angle after stenting (odds ratio: 0.88; 95% CI: 0.79-0.99; P = 0.03), and decrease in systolic bending angle after stenting (odds ratio: 1.13; 95% CI: 1.02-1.26; P = 0.03) were predictors of stent failure. CONCLUSIONS Our study suggests that a change in the natural tortuous course of the coronaries by stent implantation with the decrease in coronary bending angle is a potentially major contributor in stent failure.
Collapse
Affiliation(s)
- Bu Chun Zhang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People's Republic of China.,Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Sheng Xian Tu
- Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Antonios Karanasos
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Cardiology, Hippokration Hospital, Athens, Greece
| | - Robert-Jan van Geuns
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Peter de Jaegere
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Felix Zijlstra
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Evelyn Regar
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.,University Hospital of Zurich, Heart Center, Zurich, Switzerland
| |
Collapse
|
25
|
Scaffold thrombosis following implantation of the ABSORB BVS in routine clinical practice: Insight into possible mechanisms from optical coherence tomography. Catheter Cardiovasc Interv 2018; 92:E106-E114. [DOI: 10.1002/ccd.27475] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/28/2017] [Accepted: 11/25/2017] [Indexed: 11/07/2022]
|
26
|
Vogiatzi G, Toutouzas K, Karanasos A, Synetos A, Latsios G, Tsiamis E, Tousoulis D. Everolimus-eluting bioresorbable vascular scaffold implantation in Kawasaki disease: serial OCT observation. Hellenic J Cardiol 2018; 59:358-359. [PMID: 29307692 DOI: 10.1016/j.hjc.2017.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 12/27/2017] [Accepted: 12/28/2017] [Indexed: 11/28/2022] Open
Affiliation(s)
- Georgia Vogiatzi
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece.
| | - Konstantinos Toutouzas
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - Antonis Karanasos
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - Andreas Synetos
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - Georgios Latsios
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - Eleftherios Tsiamis
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - Dimitris Tousoulis
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| |
Collapse
|
27
|
Impact of calcium on procedural and clinical outcomes in lesions treated with bioresorbable vascular scaffolds - A prospective BRS registry study. Int J Cardiol 2017; 249:119-126. [PMID: 28943146 DOI: 10.1016/j.ijcard.2017.08.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 07/11/2017] [Accepted: 08/14/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND There is limited data on the impact of calcium (Ca) on acute procedural and clinical outcomes in patients with lesions treated with bioresorbable vascular scaffolds (BRS). We sought to evaluate the effect of calcium on procedural and clinical outcomes in a 'real world' population. METHODS Clinical outcomes were compared between patients with at least 1 moderately or heavily calcified lesion (Ca) and patients with no/mild calcified lesions (non-Ca) enrolled in our institutional BRS registry. RESULTS 455 patients (N) with 548 lesions (L) treated with 735 BRS were studied. Patients in the Ca group (N=160, L=200) had more complex (AHA B2/C lesion: 69.0% in Ca vs 14.9% in non-Ca, p<0.001) and significantly longer lesions (27.80±15.27 vs 19.48±9.92mm, p<0.001). Overall device success rate was 99.1% with no significant differences between the groups. Despite more aggressive lesion preparation and postdilation compared to non Ca, acute lumen gain was significantly less in Ca lesions (1.50±0.66 vs 1.62±0.69mm, p=0.040) with lower final MLD (2.28±0.41 vs 2.36±0.43, p=0.046). There were no significant differences in all-cause mortality, total definite scaffold thrombosis (ST), target lesion revascularization and myocardial infarction between the 2 groups. Late ST was more frequent in the Ca group compared to non Ca group (late ST: 2.1 vs 0%, p=0.02). CONCLUSIONS Clinical outcomes after BRS implantation in calcified and non-calcified lesions were similar. A remarkable difference in timing of thrombosis was observed, with an increased rate of late thrombosis in calcified lesions.
Collapse
|
28
|
Iliescu CA, Cilingiroglu M, Giza DE, Rosales O, Lebeau J, Guerrero-Mantilla I, Lopez-Mattei J, Song J, Silva G, Loyalka P, Paixao ARM, Yusuf SW, Perin E, Anderson VH, Marmagkiolis K. "Bringing on the light" in a complex clinical scenario: Optical coherence tomography-guided discontinuation of antiplatelet therapy in cancer patients with coronary artery disease (PROTECT-OCT registry). Am Heart J 2017; 194:83-91. [PMID: 29223438 DOI: 10.1016/j.ahj.2017.08.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 08/17/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cancer patients with recently placed drug-eluting stents (DESs) often require premature dual antiplatelet therapy (DAPT) discontinuation for cancer-related procedures. Optical coherence tomography (OCT) can identify risk factors for stent thrombosis such as stent malapposition, incomplete strut coverage and in-stent restenosis and may help guide discontinuation of DAPT. METHODS We conducted a single-center prospective study in cancer patients with recently placed (1-12 months) DES who required premature DAPT discontinuation. Patients were evaluated with diagnostic coronary angiogram and OCT. Individuals with appropriate stent strut coverage, expansion, apposition, and absence of in-stent restenosis or intraluminal masses were considered low risk and transiently discontinued DAPT to allow optimal cancer therapy. Patients who did not meet all these criteria were considered high risk and underwent further endovascular treatment when appropriate and bridging with low-molecular weight heparin. The incidence of adverse cardiovascular events was assessed after the procedure and at 12 months. RESULTS A total of 40 patients were included. Twenty-seven patients (68%) were considered low risk by OCT criteria and DAPT was transiently discontinued. Thirteen patients (32%) were considered high risk with one or more OCT findings: uncovered stent struts (4 patients, 10%); stent underexpansion (3 patients, 8%); malapposition (8 patients, 20%); in-stent restenosis (2 patients, 5%). The high-risk patients with uncovered stent struts and malapposition underwent additional stent dilatation. There were no cardiovascular events in the low-risk group. One myocardial infarction occurred in the high-risk group. Fourteen non-cardiac deaths were registered before 12 months due to cancer progression or cancer therapy. CONCLUSION OCT imaging allows identification of low-risk cancer patients with DES placed who may safely discontinue DAPT and proceed with cancer-related surgery or procedures.
Collapse
Affiliation(s)
- Cezar A Iliescu
- The University of Texas MD Anderson Cancer Center, Houston, TX.
| | | | - Dana E Giza
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | - Juhee Song
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Pranav Loyalka
- University of Texas Health Science Center, Memorial Hermann Hospital, Houston, TX
| | | | | | | | | | | |
Collapse
|
29
|
Lee WC, Wu CJ, Chen CJ, Yang CH, Hsueh SK, Yip HK, Hang CL, Fang CY, Fang HY. Thirty-Day and One-Year Clinical Outcomes of Bioresorbable Vascular Scaffold Implantation: A Single-Center Experience. ACTA CARDIOLOGICA SINICA 2017; 33:614-623. [PMID: 29167614 DOI: 10.6515/acs20170714a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Available data on the use of the Bioresorbable vascular scaffold (BVS) (Abbott Vascular, Santa Clara, CA) in real-world patients is limited, particularly in Asian populations. The aim of this study was to assess clinical outcomes of patients treated with a BVS in real-world practice in Taiwan. Methods This study focused on 156 patients with coronary artery disease and a total of 249 lesions who received BVS implantation from October 2012 to October 2015. The study's primary endpoint was major adverse cardiac event (MACE), such as a myocardial infarction (MI), target vessel revascularization (TVR), target lesion revascularization (TLR), definite or possible scaffold thrombosis, cardiovascular death, and all-cause mortality during the thirty-day follow-up period. The secondary endpoint was MACE during the one-year follow-up period. Additionally, the composite clinical secondary endpoint was target lesion failure (TLF), which was called device-oriented composite endpoint. Results The average age of the patients was 60.34 ± 10.15 years, and 81.4% were male. The average of Syntax score was 12.42 ± 8.77 points. 44.2 % lesions were type B2 or C. At 31 days, one patient experienced a MACE (1/156) the composite of two TLF (2/249) with ST elevation MI, which was related to scaffold thrombosis. At one-year, 5.1 % (8/156) of the patients experienced a MACE and 3.6% (9/249) of the lesions experienced a TLF. There was no cardiovascular or all-cause mortality in the 30-day follow-up. The one-year cardiovascular and all-cause mortality rates were each 1.3%, respectively. Diabetes, ostial lesion, bifurcation lesion, and non-standard dual anti-platelet therapy (DAPT) were the strong associations of one-year TLF. Conclusions Even with difficult and complex lesions of patients in this study, acceptable outcomes were achieved with low definite or possible scaffold thrombosis rates after BVS implantation. And despite anatomical issues, it is important to complete standard DAPT.
Collapse
Affiliation(s)
- Wei-Chieh Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chiung-Jen Wu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chien-Jen Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Hsu Yang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shu-Kai Hsueh
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hon-Kan Yip
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chi-Ling Hang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Yuan Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsiu-Yu Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| |
Collapse
|
30
|
Anwar S, Vachharajani TJ. Stent use for hemodialysis access: What a general nephrologist needs to know. Hemodial Int 2017; 22:143-149. [DOI: 10.1111/hdi.12608] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Siddiq Anwar
- Nephrology Section; King Faisal Specialist Hospital and Research Center; Riyadh Saudi Arabia
| | | |
Collapse
|
31
|
Yamaji K, Ueki Y, Souteyrand G, Daemen J, Wiebe J, Nef H, Adriaenssens T, Loh JP, Lattuca B, Wykrzykowska JJ, Gomez-Lara J, Timmers L, Motreff P, Hoppmann P, Abdel-Wahab M, Byrne RA, Meincke F, Boeder N, Honton B, O’Sullivan CJ, Ielasi A, Delarche N, Christ G, Lee JK, Lee M, Amabile N, Karagiannis A, Windecker S, Räber L. Mechanisms of Very Late Bioresorbable Scaffold Thrombosis. J Am Coll Cardiol 2017; 70:2330-2344. [DOI: 10.1016/j.jacc.2017.09.014] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 09/06/2017] [Accepted: 09/06/2017] [Indexed: 10/18/2022]
|
32
|
Maeremans J, Verhaert D, Pereira B, Frambach P, Van Mieghem C, Barbato E, Willems E, Vrolix M, Dens J. One-year clinical and computed tomography follow-up after implantation of bioresorbable vascular scaffolds in patients with coronary chronic total occlusions. Catheter Cardiovasc Interv 2017; 92:488-496. [DOI: 10.1002/ccd.27390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 09/18/2017] [Accepted: 10/09/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Joren Maeremans
- Faculty of Medicine and Life Sciences; Universiteit Hasselt; Hasselt Belgium
- Department of Cardiology; Ziekenhuis Oost-Limburg; Genk Belgium
| | - David Verhaert
- Department of Cardiology; Ziekenhuis Oost-Limburg; Genk Belgium
| | - Bruno Pereira
- Department of Cardiology; Institut de Chirurgie Cardiaque et de Cardiologie Interventionelle; Luxembourg Luxembourg
| | - Peter Frambach
- Department of Cardiology; Institut de Chirurgie Cardiaque et de Cardiologie Interventionelle; Luxembourg Luxembourg
| | | | - Emanuele Barbato
- Department of Cardiology; Onze-Lieve-Vrouw-Ziekenhuis; Aalst Belgium
- Department of Advanced Biomedical Medicine; University of Naples Federico II; Naples Italy
| | - Endry Willems
- Department of Radiology; Ziekenhuis Oost-Limburg; Genk Belgium
| | - Mathias Vrolix
- Department of Cardiology; Ziekenhuis Oost-Limburg; Genk Belgium
| | - Jo Dens
- Faculty of Medicine and Life Sciences; Universiteit Hasselt; Hasselt Belgium
- Department of Cardiology; Ziekenhuis Oost-Limburg; Genk Belgium
| |
Collapse
|
33
|
Amrute JM, Athanasiou L, Rikhtegar F, de la Torre Hernández JM, Camarero TG, Edelman ER. Automated Segmentation of Bioresorbable Vascular Scaffold Struts in Intracoronary Optical Coherence Tomography Images. INTERNATIONAL CONFERENCE ON BIOINFORMATICS AND BIOMEDICAL ENGINEERING : [PROCEEDINGS]. INTERNATIONAL CONFERENCE ON BIOINFORMATICS AND BIOMEDICAL ENGINEERING 2017; 2017:297-302. [PMID: 30147989 PMCID: PMC6104816 DOI: 10.1109/bibe.2017.00-38] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Bioresorbable vascular scaffolds (BVS), the next step in the continuum of minimally invasive vascular interventions present new opportunities for patients and clinicians but challenges as well. As they are comprised of polymeric materials standard imaging is challenging. This is especially problematic as modalities like optical coherence tomography (OCT) become more prevalent in cardiology. OCT, a light-based intracoronary imaging technique, provides cross-sectional images of plaque and luminal morphology. Until recently segmentation of OCT images for BVS struts was performed manually by experts. However, this process is time consuming and not tractable for large amounts of patient data. Several automated methods exist to segment metallic stents, which do not apply to the newer BVS. Given this current limitation coupled with the emerging popularity of the BVS technology, it is crucial to develop an automated methodology to segment BVS struts in OCT images. The objective of this paper is to develop a novel BVS strut detection method in intracoronary OCT images. First, we preprocess the image to remove imaging artifacts. Then, we use a K-means clustering algorithm to automatically segment the image. Finally, we isolate the stent struts from the rest of the image. The accuracy of the proposed method was evaluated using expert estimations on 658 annotated images acquired from 7 patients at the time of coronary arterial interventions. Our proposed methodology has a positive predictive value of 0.93, a Pearson Correlation coefficient of 0.94, and a F1 score of 0.92. The proposed methodology allows for rapid, accurate, and fully automated segmentation of BVS struts in OCT images.
Collapse
Affiliation(s)
- Junedh M Amrute
- Division of Biology and Biological Engineering California Institute of Technology Pasadena, CA, USA
| | - Lambros Athanasiou
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge, MA, USA
| | - Farhad Rikhtegar
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge, MA, USA
| | | | | | - Elazer R Edelman
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge, MA, USA
| |
Collapse
|
34
|
Chan KH, Seow SC, Tan HC. Very late bioresorbable vascular scaffold thrombosis at 25 months post implantation. Singapore Med J 2017; 58:571-572. [PMID: 28948291 DOI: 10.11622/smedj.2017089] [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]
Affiliation(s)
- Koo Hui Chan
- Cardiac Department, National University Heart Centre, Singapore
| | - Swee-Chong Seow
- Cardiac Department, National University Heart Centre, Singapore
| | - Huay Cheem Tan
- Cardiac Department, National University Heart Centre, Singapore
| |
Collapse
|
35
|
Tanaka A, Jabbour RJ, Mitomo S, Latib A, Colombo A. Hybrid Percutaneous Coronary Intervention With Bioresorbable Vascular Scaffolds in Combination With Drug-Eluting Stents or Drug-Coated Balloons for Complex Coronary Lesions. JACC Cardiovasc Interv 2017; 10:539-547. [PMID: 28335892 DOI: 10.1016/j.jcin.2016.12.285] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 12/05/2016] [Accepted: 12/29/2016] [Indexed: 12/26/2022]
Abstract
Bioresorbable vascular scaffolds (BVS) have become an attractive option in the percutaneous coronary intervention field due to the potential advantages associated with the complete resorption process that occurs within a few years. However, current-generation BVS have several limitations including thicker struts, reduced radial strength, and limited expansion capability when compared with drug-eluting stents (DES). As a result, complex coronary disease often contains BVS-inappropriate/unfavorable segments. This does not necessarily mean that BVS use must be completely avoided, and minimizing the length of permanent metallic caging may still be advantageous. Operators should fully understand the limitations of current BVS, and when to consider a hybrid strategy of BVS in combination with DES or drug-coated balloons.
Collapse
Affiliation(s)
- Akihito Tanaka
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy; Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Richard J Jabbour
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy; Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Department of Cardiology, Imperial College London, London, United Kingdom
| | - Satoru Mitomo
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy; Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Azeem Latib
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy; Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Colombo
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy; Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.
| |
Collapse
|
36
|
Capodanno D, Angiolillo DJ. Antiplatelet Therapy After Implantation of Bioresorbable Vascular Scaffolds: A Review of the Published Data, Practical Recommendations, and Future Directions. JACC Cardiovasc Interv 2017; 10:425-437. [PMID: 28279311 DOI: 10.1016/j.jcin.2016.12.279] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 11/15/2016] [Accepted: 12/15/2016] [Indexed: 12/24/2022]
Abstract
The introduction of bioresorbable vascular scaffolds (BVS) for clinical use has raised a number of questions on whether current dual-antiplatelet therapy (DAPT) recommendations after drug-eluting stent (DES) implantation, mostly deriving from data on second-generation DES, are also applicable to this completely different technology. This article aims to review the technical shortcomings of BVS-the most extensively studied fully bioresorbable coronary stent-and its contemporary rates of scaffold thrombosis, with a focus on recommendations for DAPT duration.
Collapse
|
37
|
Evaluation of potential substrates for restenosis and thrombosis in overlapped versus edge-to-edge juxtaposed bioabsorbable scaffolds: Insights from a computed fluid dynamic study. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 19:273-278. [PMID: 28918876 DOI: 10.1016/j.carrev.2017.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 08/08/2017] [Accepted: 08/14/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND/PURPOSE Multiple BRSs and specifically the Absorb scaffold (BVS) (Abbott Vascular, Santa Clara, CA USA) have been often used to treat long diffuse coronary artery lesions. We evaluate by a computational fluid dynamic(CFD) study the impact on the intravascular fluid rheology on multiple bioabsorbable scaffolds (BRS) by standard overlapping versus edge-to-edge technique. METHODS/MATERIALS We simulated the treatment of a real long significant coronary lesion (>70% luminal narrowing) involving the left anterior descending artery (LAD) treated with a standard or edge-to-edge technique, respectively. Simulations were performed after BVS implantations in two different conditions: 1) Edge-to-edge technique, where the scaffolds are kissed but not overlapped resulting in a luminal encroachment of 0.015cm (150μm); 2) Standard overlapping, where the scaffolds are overlapped resulting in a luminal encroachment of 0.030cm (300μm). After positioning the BVS across the long lesion, the implantation procedure was performed in-silico following all the usual procedural steps. RESULTS Analysis of the wall shear stress (WSS) suggested that at the vessel wall level the WSS were lower in the overlapping zones overlapping compared to the edge-to-edge zone (∆=0.061Pa, p=0.01). At the struts level the difference between the two WSS was more striking (∆=1.065e-004 p=0.01) favouring the edge-to-edge zone. CONCLUSIONS Our study suggested that at both vessel wall and scaffold struts levels, there was lowering WSS when multiple BVS were implanted with the standard overlapping technique compared to the "edge-to-edge" technique. This lower WSS might represent a substrate for restenosis, early and late BVS thrombosis, potentially explaining at least in part the recent evidences of devices poor performance.
Collapse
|
38
|
Remkes WS, Hermanides RS, Kennedy MW, Fabris E, Kaplan E, Ottervanger JP, van 't Hof AWJ, Kedhi E. Everolimus-eluting bioresorbable vascular scaffold in daily clinical practice: A single-centre experience. Neth Heart J 2017; 25:611-617. [PMID: 28913627 PMCID: PMC5653537 DOI: 10.1007/s12471-017-1038-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Recent evidence has raised concerns regarding the safety of the everolimus-eluting bioresorbable vascular scaffold (E-BVS) (Absorb, Abbott Vascular, Santa Clara, CA, USA). Following these data, the use of this device has diminished in the Netherlands; however, daily practice data are limited. Therefore we studied the incidence of safety and efficacy outcomes with this device in daily clinical practice in a single large tertiary centre in the Netherlands. Methods All E‑BVS treated patients were included in this analysis. The primary endpoint was target lesion failure (TLF), a composite of cardiac death, target vessel non-fatal myocardial infarction (TV-MI) and clinically-driven target lesion revascularisation (TLR). The secondary endpoint was the incidence of definite scaffold thrombosis. Results Between October 2013 and January 2017, 105 patients were treated with 147 E‑BVS. This population contained 42 (40%) patients with diabetes mellitus and 43 (40.9%) undergoing treatment for acute coronary syndrome, and thus represents a high-risk patient cohort. Mean follow-up was 19.8 months. Intravascular imaging guidance during scaffold implantation was used in 64/105 (43.5%) patients. The primary endpoint (TLF) occurred in 3 (2.9%) patients. All-cause mortality and cardiac mortality occurred in 2 (2%) and 0 (0%) patients respectively. TV-MI occurred in 2 patients (1.9%): both were periprocedural and not related to the BVS implantation. TLR occurred in 1 patient (1.0%) during follow-up. No definite scaffold thrombosis occurred during follow-up. Conclusion This single-centre study examining the real-world experience of E‑BVS implantation in a high-risk population shows excellent procedural safety and long-term clinical outcomes.
Collapse
Affiliation(s)
- W S Remkes
- Isala Hartcentrum, Zwolle, The Netherlands
| | | | | | - E Fabris
- Isala Hartcentrum, Zwolle, The Netherlands
| | - E Kaplan
- Isala Hartcentrum, Zwolle, The Netherlands
| | | | | | - E Kedhi
- Isala Hartcentrum, Zwolle, The Netherlands.
| |
Collapse
|
39
|
van Ditzhuijzen NS, Kurata M, van den Heuvel M, Sorop O, van Duin RWB, Krabbendam-Peters I, Ligthart J, Witberg K, Murawska M, Bouma B, Villiger M, Garcia-Garcia HM, Serruys PW, Zijlstra F, van Soest G, Duncker DJ, Regar E, van Beusekom HMM. Neoatherosclerosis development following bioresorbable vascular scaffold implantation in diabetic and non-diabetic swine. PLoS One 2017; 12:e0183419. [PMID: 28898243 PMCID: PMC5595285 DOI: 10.1371/journal.pone.0183419] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 08/03/2017] [Indexed: 11/19/2022] Open
Abstract
Background DM remains a risk factor for poor outcome after stent-implantation, but little is known if and how DM affects the vascular response to BVS. Aim The aim of our study was to examine coronary responses to bioresorbable vascular scaffolds (BVS) in swine with and without diabetes mellitus fed a ‘fast-food’ diet (FF-DM and FF-NDM, respectively) by sequential optical coherence tomography (OCT)-imaging and histology. Methods Fifteen male swine were evaluated. Eight received streptozotocin-injection to induce DM. After 9 months (M), 32 single BVS were implanted in epicardial arteries with a stent to artery (S/A)-ratio of 1.1:1 under quantitative coronary angiography (QCA) and OCT guidance. Lumen, scaffold, neointimal coverage and composition were assessed by QCA, OCT and near-infrared spectroscopy (NIRS) pre- and/or post-procedure, at 3M and 6M. Additionally, polarization-sensitive (PS)-OCT was performed in 7 swine at 6M. After sacrifice at 3M and 6M, histology and polymer degradation analysis were performed. Results Late lumen loss was high (~60%) within the first 3M after BVS-implantation (P<0.01 FF-DM vs. FF-NDM) and stabilized between 3M and 6M (<5% change in FF-DM, ~10% in FF-NDM; P>0.20). Neointimal coverage was highly heterogeneous in all swine (DM vs. NDM P>0.05), with focal lipid accumulation, irregular collagen distribution and neointimal calcification. Likewise, polymer mass loss was low (~2% at 3M, ~5% at 6M;P>0.20) and not associated with DM or inflammation. Conclusion Scaffold coverage showed signs of neo-atherosclerosis in all FF-DM and FF-NDM swine, scaffold polymer was preserved and the vascular response to BVS was not influenced by diabetes.
Collapse
Affiliation(s)
- Nienke S. van Ditzhuijzen
- Department of Cardiology, Thoraxcenter, Cardiovascular Research school COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mie Kurata
- Department of Cardiology, Thoraxcenter, Cardiovascular Research school COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mieke van den Heuvel
- Department of Cardiology, Thoraxcenter, Cardiovascular Research school COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Oana Sorop
- Department of Cardiology, Thoraxcenter, Cardiovascular Research school COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Richard W. B. van Duin
- Department of Cardiology, Thoraxcenter, Cardiovascular Research school COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ilona Krabbendam-Peters
- Department of Cardiology, Thoraxcenter, Cardiovascular Research school COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jurgen Ligthart
- Department of Cardiology, Thoraxcenter, Cardiovascular Research school COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Karen Witberg
- Department of Cardiology, Thoraxcenter, Cardiovascular Research school COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Magdalena Murawska
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Brett Bouma
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Martin Villiger
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | | | | | - Felix Zijlstra
- Department of Cardiology, Thoraxcenter, Cardiovascular Research school COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Gijs van Soest
- Department of Cardiology, Thoraxcenter, Cardiovascular Research school COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Dirk-Jan Duncker
- Department of Cardiology, Thoraxcenter, Cardiovascular Research school COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Evelyn Regar
- Department of Cardiology, Thoraxcenter, Cardiovascular Research school COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
- Dept. of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Heleen M. M. van Beusekom
- Department of Cardiology, Thoraxcenter, Cardiovascular Research school COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
- * E-mail:
| |
Collapse
|
40
|
Mintz GS, Guagliumi G. Intravascular imaging in coronary artery disease. Lancet 2017; 390:793-809. [PMID: 28831995 DOI: 10.1016/s0140-6736(17)31957-8] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 06/27/2017] [Accepted: 07/05/2017] [Indexed: 12/15/2022]
Abstract
Although it is the method used by most interventional cardiologists to assess the severity of coronary artery disease and guide treatment, coronary angiography has many known limitations, particularly the fact that it is a lumenogram depicting foreshortened, shadowgraph, planar projections of the contrast-filled lumen rather than imaging the diseased vessel itself. Intravascular imaging-intravascular ultrasound and more recently optical coherence tomography-provide a tomographical or cross-sectional image of the coronary arteries. These techniques are clinically useful to answer questions such as whether the stenosis is clinically relevant; the identification of the culprit lesion; or whether the plaque (or patient) is at high risk of future adverse events. They can also be used to optimise stent implantation to minimise stent-related adverse events, provide answers to the likelihood of distal embolisation or peri-procedural myocardial infarction during stent implantation, and provide reasons for stent thrombosis or restenosis. This review considers the usefulness of intravascular imaging in day-to-day practice.
Collapse
Affiliation(s)
- Gary S Mintz
- Cardiovascular Research Foundation, New York, NY, USA.
| | | |
Collapse
|
41
|
Chevalier B, Onuma Y, van Boven AJ, Piek JJ, Sabaté M, Helqvist S, Baumbach A, Smits PC, Kumar R, Wasungu L, Serruys PW. Randomised comparison of a bioresorbable everolimus-eluting scaffold with a metallic everolimus-eluting stent for ischaemic heart disease caused by de novo native coronary artery lesions: the 2-year clinical outcomes of the ABSORB II trial. EUROINTERVENTION 2017; 12:1102-1107. [PMID: 27564310 DOI: 10.4244/eijy16m08_01] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The one-year randomised data of the ABSORB II trial showed that the everolimus-eluting bioresorbable scaffold and the everolimus-eluting metallic stent were comparable for the composite secondary clinical outcomes of patient-oriented composite endpoint (PoCE) and device-oriented composite endpoint (DoCE)/target lesion failure (TLF), MACE and TVF. This report describes the two-year clinical outcomes of the ABSORB II trial. METHODS AND RESULTS Patients were randomly assigned in a 2:1 ratio to receive treatment with an everolimus-eluting bioresorbable scaffold (Absorb; Abbott Vascular, Santa Clara, CA, USA) or treatment with an everolimus-eluting metallic stent (XIENCE; Abbott Vascular). The trial enrolled 501 patients. Clinical follow-up at two years was available in 320 patients in the Absorb BVS arm and 160 patients in the XIENCE arm. At two years, the PoCE for the Absorb and XIENCE arms was 11.6% and 12.8% (p=0.70) and the DoCE/TLF was 7.0% and 3.0% (p=0.07), respectively. The hierarchical ID-MACE rate was 7.6% vs. 4.3% (p=0.16) and the rate of TVF was 8.5% vs. 6.7% (p=0.48). The definite/probable thrombosis rate was 1.5% in the Absorb arm vs. 0% in the XIENCE arm (p=0.17). Thirty-six percent and 34% of patients remained on DAPT at two years, respectively. Ninety-two percent of patients in both arms remained on aspirin. CONCLUSIONS Two-year clinical results demonstrate sustained low rates of PoCE, MACE, DoCE and TVF with the Absorb BVS as compared to the XIENCE stent.
Collapse
Affiliation(s)
- Bernard Chevalier
- Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Elias J, van Dongen IM, Kraak RP, Tijssen RYG, Claessen BEPM, Tijssen JGP, de Winter RJ, Piek JJ, Wykrzykowska JJ, Henriques JPS. Mid-term and long-term safety and efficacy of bioresorbable vascular scaffolds versus metallic everolimus-eluting stents in coronary artery disease: A weighted meta-analysis of seven randomised controlled trials including 5577 patients. Neth Heart J 2017; 25:429-438. [PMID: 28612280 PMCID: PMC5513992 DOI: 10.1007/s12471-017-1008-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Mid- and long-term safety and efficacy of the Absorb bioresorbable vascular scaffold (BVS) have been studied in randomised trials; however, most were not individually powered for clinical endpoints. We performed a weighted meta-analysis comparing mid- and long-term outcomes in patients treated with the BVS compared with the Xience metallic stent. METHODS AND RESULTS Randomised trials comparing the BVS and Xience were identified by searching MEDLINE, EMBASE and conference abstracts. Seven trials were included (BVS n = 3258, Xience n = 2319) with follow-up between 1-3 years. The primary outcome of target lesion failure occurred more frequently in BVS compared with Xience [OR 1.34; 95% CI 1.11-1.62, p = 0.003]. Overall definite or probable device thrombosis occurred more frequently with the BVS [OR 2.86; 95% CI 1.88-4.36, p < 0.001] and this extended beyond 1 year of follow-up [OR 4.13; 95% CI 1.99-8.57, p < 0.001]. Clinically indicated or ischaemia driven target lesion revascularisation [OR 1.43; 95% CI 1.11-1.83, p = 0.005] and myocardial infarction (all MI) [OR 1.64; 95% CI 1.20-2.23, p = 0.002] were more frequently seen in the BVS compared with Xience. Rates of target vessel failure [OR 1.15; 95% CI 0.91-1.46, p = 0.25] and cardiac death [OR 0.91; 95% CI 0.57-1.46, p = 0.71] were not significantly different between BVS and Xience. CONCLUSION This meta-analysis shows a higher rate of target lesion failure and an almost threefold higher rate of device thrombosis in BVS compared with Xience, which extends beyond the first year. Device thrombosis did not lead to an overall increased (cardiac) mortality.
Collapse
Affiliation(s)
- J Elias
- AMC Heartcenter, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - I M van Dongen
- AMC Heartcenter, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - R P Kraak
- AMC Heartcenter, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - R Y G Tijssen
- AMC Heartcenter, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - B E P M Claessen
- AMC Heartcenter, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - J G P Tijssen
- AMC Heartcenter, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - R J de Winter
- AMC Heartcenter, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - J J Piek
- AMC Heartcenter, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - J J Wykrzykowska
- AMC Heartcenter, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - J P S Henriques
- AMC Heartcenter, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
43
|
Mitomo S, Naganuma T, Fujino Y, Kawamoto H, Basavarajaiah S, Pitt M, Yin WH, Tresukosol D, Colombo A, Nakamura S. Response by Mitomo et al to Letter Regarding Article, "Bioresorbable Vascular Scaffolds for the Treatment of Chronic Total Occlusions: An International Multicenter Registry". Circ Cardiovasc Interv 2017. [PMID: 28625966 DOI: 10.1161/circinterventions.117.005299] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Satoru Mitomo
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Toru Naganuma
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Yusuke Fujino
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Hiroyoshi Kawamoto
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan.,Vita-Salute San Raffaele University, Milan, Italy.,Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sandeep Basavarajaiah
- Department of Interventional Cardiology, Heart of England NHS Trust, Birmingham, United Kingdom
| | - Michael Pitt
- Department of Interventional Cardiology, Heart of England NHS Trust, Birmingham, United Kingdom
| | - Wei-Hsian Yin
- Division of Cardiology, Cheng Hsin General Hospital, Taipei, Taiwan
| | | | - Antonio Colombo
- Vita-Salute San Raffaele University, Milan, Italy.,Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sunao Nakamura
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| |
Collapse
|
44
|
Wykrzykowska JJ, Kraak RP, Hofma SH, van der Schaaf RJ, Arkenbout EK, IJsselmuiden AJ, Elias J, van Dongen IM, Tijssen RYG, Koch KT, Baan J, Vis MM, de Winter RJ, Piek JJ, Tijssen JGP, Henriques JPS. Bioresorbable Scaffolds versus Metallic Stents in Routine PCI. N Engl J Med 2017; 376:2319-2328. [PMID: 28402237 DOI: 10.1056/nejmoa1614954] [Citation(s) in RCA: 326] [Impact Index Per Article: 46.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Bioresorbable vascular scaffolds were developed to overcome the shortcomings of drug-eluting stents in percutaneous coronary intervention (PCI). We performed an investigator-initiated, randomized trial to compare an everolimus-eluting bioresorbable scaffold with an everolimus-eluting metallic stent in the context of routine clinical practice. METHODS We randomly assigned 1845 patients undergoing PCI to receive either a bioresorbable vascular scaffold (924 patients) or a metallic stent (921 patients). The primary end point was target-vessel failure (a composite of cardiac death, target-vessel myocardial infarction, or target-vessel revascularization). The data and safety monitoring board recommended early reporting of the study results because of safety concerns. This report provides descriptive information on end-point events. RESULTS The median follow-up was 707 days. Target-vessel failure occurred in 105 patients in the scaffold group and in 94 patients in the stent group (2-year cumulative event rates, 11.7% and 10.7%, respectively; hazard ratio, 1.12; 95% confidence interval [CI], 0.85 to 1.48; P=0.43); event rates were based on Kaplan-Meier estimates in time-to-event analyses. Cardiac death occurred in 18 patients in the scaffold group and in 23 patients in the stent group (2-year cumulative event rates, 2.0% and 2.7%, respectively), target-vessel myocardial infarction occurred in 48 patients in the scaffold group and in 30 patients in the stent group (2-year cumulative event rates, 5.5% and 3.2%), and target-vessel revascularization occurred in 76 patients in the scaffold group and in 65 patients in the stent group (2-year cumulative event rates, 8.7% and 7.5%). Definite or probable device thrombosis occurred in 31 patients in the scaffold group as compared with 8 patients in the stent group (2-year cumulative event rates, 3.5% vs. 0.9%; hazard ratio, 3.87; 95% CI, 1.78 to 8.42; P<0.001). CONCLUSIONS In this preliminary report of a trial involving patients undergoing PCI, there was no significant difference in the rate of target-vessel failure between the patients who received a bioresorbable scaffold and the patients who received a metallic stent. The bioresorbable scaffold was associated with a higher incidence of device thrombosis than the metallic stent through 2 years of follow-up. (Funded by Abbott Vascular; AIDA ClinicalTrials.gov number, NCT01858077 .).
Collapse
Affiliation(s)
- Joanna J Wykrzykowska
- From the AMC Heartcenter, Academic Medical Center-University of Amsterdam (J.J.W., R.P.K., J.E., I.M.D., R.Y.G.T., K.T.K., J.B., M.M.V., R.J.W., J.J.P., J.G.P.T., J.P.S.H.), and the Department of Cardiology, Onze Lieve Vrouwe Gasthuis (R.J.S.), Amsterdam, the Department of Cardiology, Medical Center Leeuwarden, Leeuwarden (S.H.H.), the Department of Cardiology, Tergooi Hospital, Blaricum (E.K.A.), and the Department of Cardiology, Albert Schweitzer Hospital, Dordrecht (A.J.IJ.) - all in the Netherlands
| | - Robin P Kraak
- From the AMC Heartcenter, Academic Medical Center-University of Amsterdam (J.J.W., R.P.K., J.E., I.M.D., R.Y.G.T., K.T.K., J.B., M.M.V., R.J.W., J.J.P., J.G.P.T., J.P.S.H.), and the Department of Cardiology, Onze Lieve Vrouwe Gasthuis (R.J.S.), Amsterdam, the Department of Cardiology, Medical Center Leeuwarden, Leeuwarden (S.H.H.), the Department of Cardiology, Tergooi Hospital, Blaricum (E.K.A.), and the Department of Cardiology, Albert Schweitzer Hospital, Dordrecht (A.J.IJ.) - all in the Netherlands
| | - Sjoerd H Hofma
- From the AMC Heartcenter, Academic Medical Center-University of Amsterdam (J.J.W., R.P.K., J.E., I.M.D., R.Y.G.T., K.T.K., J.B., M.M.V., R.J.W., J.J.P., J.G.P.T., J.P.S.H.), and the Department of Cardiology, Onze Lieve Vrouwe Gasthuis (R.J.S.), Amsterdam, the Department of Cardiology, Medical Center Leeuwarden, Leeuwarden (S.H.H.), the Department of Cardiology, Tergooi Hospital, Blaricum (E.K.A.), and the Department of Cardiology, Albert Schweitzer Hospital, Dordrecht (A.J.IJ.) - all in the Netherlands
| | - Rene J van der Schaaf
- From the AMC Heartcenter, Academic Medical Center-University of Amsterdam (J.J.W., R.P.K., J.E., I.M.D., R.Y.G.T., K.T.K., J.B., M.M.V., R.J.W., J.J.P., J.G.P.T., J.P.S.H.), and the Department of Cardiology, Onze Lieve Vrouwe Gasthuis (R.J.S.), Amsterdam, the Department of Cardiology, Medical Center Leeuwarden, Leeuwarden (S.H.H.), the Department of Cardiology, Tergooi Hospital, Blaricum (E.K.A.), and the Department of Cardiology, Albert Schweitzer Hospital, Dordrecht (A.J.IJ.) - all in the Netherlands
| | - E Karin Arkenbout
- From the AMC Heartcenter, Academic Medical Center-University of Amsterdam (J.J.W., R.P.K., J.E., I.M.D., R.Y.G.T., K.T.K., J.B., M.M.V., R.J.W., J.J.P., J.G.P.T., J.P.S.H.), and the Department of Cardiology, Onze Lieve Vrouwe Gasthuis (R.J.S.), Amsterdam, the Department of Cardiology, Medical Center Leeuwarden, Leeuwarden (S.H.H.), the Department of Cardiology, Tergooi Hospital, Blaricum (E.K.A.), and the Department of Cardiology, Albert Schweitzer Hospital, Dordrecht (A.J.IJ.) - all in the Netherlands
| | - Alexander J IJsselmuiden
- From the AMC Heartcenter, Academic Medical Center-University of Amsterdam (J.J.W., R.P.K., J.E., I.M.D., R.Y.G.T., K.T.K., J.B., M.M.V., R.J.W., J.J.P., J.G.P.T., J.P.S.H.), and the Department of Cardiology, Onze Lieve Vrouwe Gasthuis (R.J.S.), Amsterdam, the Department of Cardiology, Medical Center Leeuwarden, Leeuwarden (S.H.H.), the Department of Cardiology, Tergooi Hospital, Blaricum (E.K.A.), and the Department of Cardiology, Albert Schweitzer Hospital, Dordrecht (A.J.IJ.) - all in the Netherlands
| | - Joëlle Elias
- From the AMC Heartcenter, Academic Medical Center-University of Amsterdam (J.J.W., R.P.K., J.E., I.M.D., R.Y.G.T., K.T.K., J.B., M.M.V., R.J.W., J.J.P., J.G.P.T., J.P.S.H.), and the Department of Cardiology, Onze Lieve Vrouwe Gasthuis (R.J.S.), Amsterdam, the Department of Cardiology, Medical Center Leeuwarden, Leeuwarden (S.H.H.), the Department of Cardiology, Tergooi Hospital, Blaricum (E.K.A.), and the Department of Cardiology, Albert Schweitzer Hospital, Dordrecht (A.J.IJ.) - all in the Netherlands
| | - Ivo M van Dongen
- From the AMC Heartcenter, Academic Medical Center-University of Amsterdam (J.J.W., R.P.K., J.E., I.M.D., R.Y.G.T., K.T.K., J.B., M.M.V., R.J.W., J.J.P., J.G.P.T., J.P.S.H.), and the Department of Cardiology, Onze Lieve Vrouwe Gasthuis (R.J.S.), Amsterdam, the Department of Cardiology, Medical Center Leeuwarden, Leeuwarden (S.H.H.), the Department of Cardiology, Tergooi Hospital, Blaricum (E.K.A.), and the Department of Cardiology, Albert Schweitzer Hospital, Dordrecht (A.J.IJ.) - all in the Netherlands
| | - Ruben Y G Tijssen
- From the AMC Heartcenter, Academic Medical Center-University of Amsterdam (J.J.W., R.P.K., J.E., I.M.D., R.Y.G.T., K.T.K., J.B., M.M.V., R.J.W., J.J.P., J.G.P.T., J.P.S.H.), and the Department of Cardiology, Onze Lieve Vrouwe Gasthuis (R.J.S.), Amsterdam, the Department of Cardiology, Medical Center Leeuwarden, Leeuwarden (S.H.H.), the Department of Cardiology, Tergooi Hospital, Blaricum (E.K.A.), and the Department of Cardiology, Albert Schweitzer Hospital, Dordrecht (A.J.IJ.) - all in the Netherlands
| | - Karel T Koch
- From the AMC Heartcenter, Academic Medical Center-University of Amsterdam (J.J.W., R.P.K., J.E., I.M.D., R.Y.G.T., K.T.K., J.B., M.M.V., R.J.W., J.J.P., J.G.P.T., J.P.S.H.), and the Department of Cardiology, Onze Lieve Vrouwe Gasthuis (R.J.S.), Amsterdam, the Department of Cardiology, Medical Center Leeuwarden, Leeuwarden (S.H.H.), the Department of Cardiology, Tergooi Hospital, Blaricum (E.K.A.), and the Department of Cardiology, Albert Schweitzer Hospital, Dordrecht (A.J.IJ.) - all in the Netherlands
| | - Jan Baan
- From the AMC Heartcenter, Academic Medical Center-University of Amsterdam (J.J.W., R.P.K., J.E., I.M.D., R.Y.G.T., K.T.K., J.B., M.M.V., R.J.W., J.J.P., J.G.P.T., J.P.S.H.), and the Department of Cardiology, Onze Lieve Vrouwe Gasthuis (R.J.S.), Amsterdam, the Department of Cardiology, Medical Center Leeuwarden, Leeuwarden (S.H.H.), the Department of Cardiology, Tergooi Hospital, Blaricum (E.K.A.), and the Department of Cardiology, Albert Schweitzer Hospital, Dordrecht (A.J.IJ.) - all in the Netherlands
| | - M Marije Vis
- From the AMC Heartcenter, Academic Medical Center-University of Amsterdam (J.J.W., R.P.K., J.E., I.M.D., R.Y.G.T., K.T.K., J.B., M.M.V., R.J.W., J.J.P., J.G.P.T., J.P.S.H.), and the Department of Cardiology, Onze Lieve Vrouwe Gasthuis (R.J.S.), Amsterdam, the Department of Cardiology, Medical Center Leeuwarden, Leeuwarden (S.H.H.), the Department of Cardiology, Tergooi Hospital, Blaricum (E.K.A.), and the Department of Cardiology, Albert Schweitzer Hospital, Dordrecht (A.J.IJ.) - all in the Netherlands
| | - Robbert J de Winter
- From the AMC Heartcenter, Academic Medical Center-University of Amsterdam (J.J.W., R.P.K., J.E., I.M.D., R.Y.G.T., K.T.K., J.B., M.M.V., R.J.W., J.J.P., J.G.P.T., J.P.S.H.), and the Department of Cardiology, Onze Lieve Vrouwe Gasthuis (R.J.S.), Amsterdam, the Department of Cardiology, Medical Center Leeuwarden, Leeuwarden (S.H.H.), the Department of Cardiology, Tergooi Hospital, Blaricum (E.K.A.), and the Department of Cardiology, Albert Schweitzer Hospital, Dordrecht (A.J.IJ.) - all in the Netherlands
| | - Jan J Piek
- From the AMC Heartcenter, Academic Medical Center-University of Amsterdam (J.J.W., R.P.K., J.E., I.M.D., R.Y.G.T., K.T.K., J.B., M.M.V., R.J.W., J.J.P., J.G.P.T., J.P.S.H.), and the Department of Cardiology, Onze Lieve Vrouwe Gasthuis (R.J.S.), Amsterdam, the Department of Cardiology, Medical Center Leeuwarden, Leeuwarden (S.H.H.), the Department of Cardiology, Tergooi Hospital, Blaricum (E.K.A.), and the Department of Cardiology, Albert Schweitzer Hospital, Dordrecht (A.J.IJ.) - all in the Netherlands
| | - Jan G P Tijssen
- From the AMC Heartcenter, Academic Medical Center-University of Amsterdam (J.J.W., R.P.K., J.E., I.M.D., R.Y.G.T., K.T.K., J.B., M.M.V., R.J.W., J.J.P., J.G.P.T., J.P.S.H.), and the Department of Cardiology, Onze Lieve Vrouwe Gasthuis (R.J.S.), Amsterdam, the Department of Cardiology, Medical Center Leeuwarden, Leeuwarden (S.H.H.), the Department of Cardiology, Tergooi Hospital, Blaricum (E.K.A.), and the Department of Cardiology, Albert Schweitzer Hospital, Dordrecht (A.J.IJ.) - all in the Netherlands
| | - Jose P S Henriques
- From the AMC Heartcenter, Academic Medical Center-University of Amsterdam (J.J.W., R.P.K., J.E., I.M.D., R.Y.G.T., K.T.K., J.B., M.M.V., R.J.W., J.J.P., J.G.P.T., J.P.S.H.), and the Department of Cardiology, Onze Lieve Vrouwe Gasthuis (R.J.S.), Amsterdam, the Department of Cardiology, Medical Center Leeuwarden, Leeuwarden (S.H.H.), the Department of Cardiology, Tergooi Hospital, Blaricum (E.K.A.), and the Department of Cardiology, Albert Schweitzer Hospital, Dordrecht (A.J.IJ.) - all in the Netherlands
| |
Collapse
|
45
|
Yahagi K, Yang Y, Torii S, Mensah J, White RM, Mathieu M, Pacheco E, Nakano M, Barakat A, Sharkawi T, Vert M, Joner M, Finn AV, Virmani R, Lafont A. Comparison of a Drug-Free Early Programmed Dismantling PDLLA Bioresorbable Scaffold and a Metallic Stent in a Porcine Coronary Artery Model at 3-Year Follow-Up. J Am Heart Assoc 2017; 6:e005693. [PMID: 28600401 PMCID: PMC5669179 DOI: 10.1161/jaha.117.005693] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 04/19/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Arterial Remodeling Technologies bioresorbable scaffold (ART-BRS), composed of l- and d-lactyl units without drug, has shown its safety in a porcine coronary model at 6 months. However, long-term performance remains unknown. The aim of this study was to evaluate the ART-BRS compared to a bare metal stent (BMS) in a healthy porcine coronary model for up to 3 years. METHODS AND RESULTS Eighty-two ART-BRS and 66 BMS were implanted in 64 Yucatan swine, and animals were euthanatized at intervals of 1, 3, 6, 9, 12, 18, 24, and 36 months to determine the vascular response using quantitative coronary angiography, optical coherence tomography, light and scanning electron microscopy, and molecular weight analysis. Lumen enlargement was observed in ART-BRS as early as 3 months, which progressively increased up to 18 months, whereas BMS showed no significant difference over time. Percentage area stenosis by optical coherence tomography was greater in ART-BRS than in BMS at 1 and 3 months, but this relationship reversed beyond 3 months. Inflammation peaked at 6 months and thereafter continued to decrease up to 36 months. Complete re-endothelialization was observed at 1 month following implantation in both ART-BRS and BMS. Scaffold dismantling started at 3 months, which allowed early vessel enlargement, and bioresorption was complete by 24 months. CONCLUSIONS ART-BRS has the unique quality of early programmed dismantling accompanied by vessel lumen enlargement with mild to moderate inflammation. The main distinguishing feature of the ART-BRS from other scaffolds made from poly-l-lactic acid may result in early and long-term vascular restoration.
Collapse
Affiliation(s)
| | - Yi Yang
- Université Paris-Descartes, Paris, France
- Cardiology Department, European Georges Pompidou Hospital, APHP, Paris, France
- PARCC INSERM U970, Paris, France
| | | | - Johanne Mensah
- Hydrodynamics Laboratory (LadHyX), CNRS UMR7646, Ecole Polytechnique, Palaiseau, France
| | | | | | | | | | - Abdul Barakat
- Hydrodynamics Laboratory (LadHyX), CNRS UMR7646, Ecole Polytechnique, Palaiseau, France
| | - Tahmer Sharkawi
- Faculty of Pharmacy, Institut des Biomolécules Max Mousseron, UMR CNRS 5247, University Montpellier 1-CNRS, Montpellier, France
| | - Michel Vert
- Faculty of Pharmacy, Institut des Biomolécules Max Mousseron, UMR CNRS 5247, University Montpellier 1-CNRS, Montpellier, France
| | | | | | | | - Antoine Lafont
- Université Paris-Descartes, Paris, France
- Cardiology Department, European Georges Pompidou Hospital, APHP, Paris, France
- PARCC INSERM U970, Paris, France
- Hydrodynamics Laboratory (LadHyX), CNRS UMR7646, Ecole Polytechnique, Palaiseau, France
| |
Collapse
|
46
|
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.
Collapse
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
| |
Collapse
|
47
|
Sethi A, Singbal Y, Rastogi U, Prasad VS. Late Incomplete stent apposition is associated with late/very late stent thrombosis: A meta-analysis. Catheter Cardiovasc Interv 2017; 91:365-375. [DOI: 10.1002/ccd.27102] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 03/02/2017] [Accepted: 03/29/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Ankur Sethi
- Department of Interventional Cardiology; Icahn School of Medicine at Mount Sinai; New York
| | - Yash Singbal
- Department of Cardiology; University of Queensland; Brisbane Australia
| | - Ujjwal Rastogi
- Department of Interventional Cardiology; Icahn School of Medicine at Mount Sinai; New York
| | | |
Collapse
|
48
|
Barillà F, Pelliccia F, Borzi M, Camici P, Cas LD, Di Biase M, Indolfi C, Mercuro G, Montemurro V, Padeletti L, Filardi PP, Vizza CD, Romeo F. Optimal duration of dual anti-platelet therapy after percutaneous coronary intervention: 2016 consensus position of the Italian Society of Cardiology. J Cardiovasc Med (Hagerstown) 2017; 18:1-9. [PMID: 27635937 DOI: 10.2459/jcm.0000000000000434] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Definition of the optimal duration of dual anti-platelet therapy (DAPT) is an important clinical issue, given the large number of patients having percutaneous coronary intervention (PCI), the costs and risks of pharmacologic therapy, the consequences of stent thrombosis, and the potential benefits of DAPT in preventing ischaemic outcomes beyond stent thrombosis. Nowadays, the rationale for a prolonged duration of DAPT should be not only the prevention of stent thrombosis, but also the prevention of ischaemic events unrelated to the coronary stenosis treated with index PCI. A higher predisposition to athero-thrombosis may persist for years after an acute myocardial infarction, and even stable patients with a history of prior myocardial infarction are at high risk for major adverse cardiovascular events. Recently, results of pre-specified post-hoc analyses of randomized clinical trials, including the PEGASUS-TIMI 54 trial, have shed light on strategies of DAPT in various clinical situations, and should impact the next rounds of international guidelines, and also routine practice. Accordingly, the 2015 to 2016 the Board of the Italian Society of Cardiology addressed newer recommendations on duration of DAPT based on most recent scientific information. The document states that physicians should decide duration of DAPT on an individual basis, taking into account ischaemic and bleeding risks of any given patient. Indeed, current controversy surrounding optimal duration of DAPT clearly reflects the fact that, nowadays, a one size fits all strategy cannot be reliably applied to patients treated with PCI. Indeed, patients usually have factors for both increased ischaemic and bleeding risks that must be carefully evaluated to assess the benefit/risk ratio of prolonged DAPT. Personalized management of DAPT must be seen as a dynamic prescription with regular re-evaluations of the risk/benefit to the patient according to changes in his/her clinical profile. Also, in order to derive more benefit than harm from new treatments, a multi-parametric approach using several risk scores of the ischaemic and bleeding risks might improve the process of risk factor characterization. In patients with high ischaemic risk, particularly those with a history of myocardial infarction, the benefits of extended DAPT (particularly with ticagrelor up to 3 years) are likely to outweigh the risks.
Collapse
Affiliation(s)
- Francesco Barillà
- aDepartment of Cardiovascular Sciences, Sapienza University bDepartment of Cardiovascular Disease, Tor Vergata University of Rome, Rome cCardiothoracic and Vascular Department, Vita-Salute University, Milan dDepartment of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia eDepartment of Medical & Surgical Sciences, University of Foggia, Foggia fDivision of Cardiology, Department of Medical and Surgical Sciences, 'Magna Graecia' University, Catanzaro gDepartment of Medical Sciences 'Mario Aresu', University of Cagliari, Cagliari hHeart and Vessels Department, University of Florence, Florence iDepartment of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Balloon postdilatation is a mandatory step in the deployment of bioresorbable vascular scaffold. Anatol J Cardiol 2017; 17:75. [PMID: 28144008 PMCID: PMC5324868 DOI: 10.14744/anatoljcardiol.2017.7551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
50
|
Tanaka A, Latib A, Kawamoto H, Jabbour R, Sato K, Miyazaki T, Naganuma T, Mangieri A, Pagnesi M, Montalto C, Chieffo A, Carlino M, Montorfano M, Colombo A. Clinical outcomes of a real-world cohort following bioresorbable vascular scaffold implantation utilising an optimised implantation strategy. EUROINTERVENTION 2017; 12:1730-1737. [DOI: 10.4244/eij-d-16-00247] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|