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Azzalini L, Ellis S, Kereiakes D, Kimura T, Gao R, Onuma Y, Chevalier B, Dressler O, Crowley A, Zhou Z, Redfors B, Serruys P, Stone G. Optimal dual antiplatelet therapy duration for bioresorbable scaffolds: an individual patient data pooled analysis of the ABSORB trials. EUROINTERVENTION 2021; 17:e981-e988. [PMID: 34105515 PMCID: PMC9724910 DOI: 10.4244/eij-d-21-00263] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Compared with everolimus-eluting metallic stents, the Absorb bioresorbable scaffold (BRS) results in increased rates of myocardial infarction (MI) and scaffold thrombosis (ST) during its three-year bioresorption phase. It is unknown whether prolonged dual antiplatelet therapy (DAPT) duration might decrease the risk of ischaemic events. AIMS We sought to evaluate the impact of DAPT duration on ischaemic and bleeding outcomes following BRS implantation. METHODS We conducted an individual patient data pooled analysis from four ABSORB randomised trials and one prospective ABSORB registry. Study endpoints were MI, ST, bleeding, and death up to three-year follow-up. Propensity score-adjusted Cox regression analysis was used to account for baseline differences related to DAPT duration. RESULTS The five ABSORB studies included 2,973 patients. DAPT use was 91.7%, 53.2%, and 48.0% at 1, 2, and 3 years, respectively. DAPT use within the first year after BRS implantation was associated with markedly lower risks of MI (adjusted hazard ratio [aHR] 0.17, 95% CI: 0.10-0.32; p<0.0001) and ST (aHR 0.08, 95% CI: 0.03-0.19; p<0.0001). Conversely, DAPT use between 1 and 3 years did not significantly affect the risk of MI (aHR 1.04, 95% CI: 0.70-1.55; p=0.84) or ST (aHR 0.86, 95% CI: 0.42-1.75; p=0.67). DAPT did not have major effects upon bleeding or death in either period. CONCLUSIONS DAPT use during the first year after BRS implantation was strongly associated with lower risks of ST and MI. However, a benefit of ongoing DAPT use between 1 and 3 years after BRS implantation was not apparent.
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Affiliation(s)
- Lorenzo Azzalini
- Division of Cardiology, VCU Health Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Dean Kereiakes
- The Christ Hospital, Heart and Vascular Center, Lindner Research Center, Cincinnati, OH, USA
| | - Takeshi Kimura
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Runlin Gao
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | | | | | - Ovidiu Dressler
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Aaron Crowley
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Zhipeng Zhou
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Björn Redfors
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA,NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA,Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Patrick Serruys
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland,Department of Cardiology, Imperial College of London, London, United Kingdom
| | - Gregg Stone
- Mount Sinai Hospital, Cardiovascular Research Foundation, 1700 Broadway, 8th Floor, New York, NY 10019, USA. E-mail:
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Peng X, Qu W, Jia Y, Wang Y, Yu B, Tian J. Bioresorbable Scaffolds: Contemporary Status and Future Directions. Front Cardiovasc Med 2020; 7:589571. [PMID: 33330651 PMCID: PMC7733966 DOI: 10.3389/fcvm.2020.589571] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/20/2020] [Indexed: 12/13/2022] Open
Abstract
Percutaneous coronary intervention, which is safe, effective, and timely, has become an important treatment for coronary artery diseases and has been widely used in clinical practice. However, there are still some problems that urgently need to be solved. Permanent vessel caging through metallic implants not only prevents the process of positive vessel remodeling and the restoration of vascular physiology but also makes the future revascularization of target vessels more difficult. Bioresorbable scaffolds (BRSs) have been developed as a potential solution to avoid the above adverse reactions caused by permanent metallic devices. BRSs provide temporary support to the vessel wall in the short term and then gradually degrade over time to restore the natural state of coronary arteries. Nonetheless, long-term follow-up of large-scale trials has drawn considerable attention to the safety of BRSs, and the significantly increased risk of late scaffold thrombosis (ScT) limits its clinical application. In this review, we summarize the current status and clinical experiences of BRSs to understand the application prospects and limitations of these devices. In addition, we focus on ScT after implantation, as it is currently the primary drawback of BRS. We also analyze the causes of ScT and discuss improvements required to overcome this serious drawback and to move the field forward.
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Affiliation(s)
- Xiang Peng
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry of Education, Harbin, China
| | - Wenbo Qu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry of Education, Harbin, China
| | - Ying Jia
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry of Education, Harbin, China
| | - Yani Wang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry of Education, Harbin, China
| | - Bo Yu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry of Education, Harbin, China
| | - Jinwei Tian
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry of Education, Harbin, China.,Guangxi Key Laboratory of Diabetic Systems Medicine, Guilin Medical University, Guilin, China
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3
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Buono A, Ielasi A, Colombo A. Latest generation stents: is it time to revive the bioresorbable scaffold? Minerva Cardioangiol 2020; 68:415-435. [DOI: 10.23736/s0026-4725.20.05188-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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4
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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.
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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
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5
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Caixeta A, Campos CM, Felix C, Chieffo A, Capranzano P, Kawamoto H, Tamburino C, Diletti R, de Ribamar Costa J, Onuma Y, van Geuns RJ, Bartorelli AL, Colombo A, Tamburino C, Serruys PW, Abizaid A. Predictors of long-term adverse events after Absorb bioresorbable vascular scaffold implantation: a 1,933-patient pooled analysis from international registries. EUROINTERVENTION 2019; 15:623-630. [DOI: 10.4244/eij-d-16-00796] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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6
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Colombo A, Azzalini L. Bioresorbable Scaffolds: A Complex Journey to the "Promised Land". JACC Cardiovasc Interv 2019; 10:2360-2362. [PMID: 29216998 DOI: 10.1016/j.jcin.2017.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 10/17/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Antonio Colombo
- Division of Interventional Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy.
| | - Lorenzo Azzalini
- Division of Interventional Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
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7
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Costa JR, Abizaid A, Whitbourn R, Serruys PW, Jepson N, Steinwender C, Stuteville M, Ediebah D, Sudhir K, Bartorelli AL. Three-year clinical outcomes of patients treated with everolimus-eluting bioresorbable vascular scaffolds: Final results of the ABSORB EXTEND trial. Catheter Cardiovasc Interv 2018; 93:E1-E7. [PMID: 30286520 DOI: 10.1002/ccd.27715] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 05/21/2018] [Accepted: 06/10/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND There is still limited data on the very long term clinical outcomes after ABSORB BRS in daily practice. We sought to evaluate the 3 year-performance of the Absorb bioresorbable vascular scaffolds for the treatment of low/moderate complexity patients enrolled in the ABSORB EXTEND trial. METHODS ABSORB EXTEND is a prospective, single-arm, open-label clinical study in which 812 patients were enrolled at 56 sites. This study allowed the treatment of lesions ≤28 mm in length and reference vessel diameter of 2.0-3.8 mm (as assessed by on-line QCA). To determine the independent predictors of MACE, a multivariable logistic regression model was built using a stepwise (forward/backward) procedure. RESULTS Average population age was 61 years and 26.5% had diabetes. Most patients had single target lesion (92.4%). Adequate scaffold deployment (PSP) was achieved in 14.2% of the cases. At three years, the composite endpoints of MACE and ischemia-driven target vessel failure were 9.2% and 10.6%, respectively. The cumulative rate of ARC definite/probable thrombosis was 2.2%, with 1.2% of the cases occurring after the 1st year. Independent predictors of MACE were hypertension and the need for "bail out" stent. CONCLUSION At three-year follow-up, the use of ABSORB in low/moderate complex PCI was associated with low and acceptable rates of major adverse clinical events, despite the infrequent use of the recommended contemporary scaffold deployment technique. However, scaffold thrombosis rate was higher than reported with current generation of metallic DES. The study is registered on clinicaltrials.gov (unique identifier NCT01023789).
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Affiliation(s)
| | | | | | - Patrick W Serruys
- Thoraxcenter Erasmus University Medical Center, Rotterdam, The Netherlands
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8
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Ielasi A, Cortese B, Moscarella E, Loi B, Tarantini G, Varricchio A, Pisano F, Durante A, Pasquetto G, Colombo A, Tumminello G, Moretti L, Calabrò P, Mazzarotto P, Tespili M, Orrego PS, Corrado D, Steffenino G. One-year clinical outcomes after unrestricted implantation of the Absorb bioresorbable scaffold (RAI registry). EUROINTERVENTION 2018; 14:e546-e553. [PMID: 28966155 DOI: 10.4244/eij-d-17-00443] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this study was to assess outcomes following Absorb bioresorbable scaffold (BVS) implantation in an unrestricted clinical practice according to an "on-label" versus "off-label" indication. METHODS AND RESULTS RAI is a prospective registry, investigating BVS performance in different lesion subsets. No specific exclusion criteria were applied. Co-primary endpoints were target lesion revascularisation (TLR) and definite/probable scaffold thrombosis (ScT) at one year. A total of 1,505 patients (1,969 lesions) were enrolled. In 58% of patients, BVS was implanted in at least one off-label subset according to the manufacturer's instructions for use. Predilatation was performed in 98.5% of the cases, and post-dilatation in 96.8%. At one-year follow-up, TLR and ScT rates were 3.3% and 1.3%, respectively. TLR was significantly higher in the off-label group (4.0% vs. 2.2%, HR 1.8, 95% CI: 1.0-3.4; p=0.05) while a trend towards a higher ScT rate was observed in the off-label group (1.7% vs. 0.6%, HR 2.7, 95% CI: 0.9-8.2; p=0.06). At multivariate analysis, treatment of in-stent restenosis, chronic total occlusion and BVS diameter were independent predictors of TLR. CONCLUSIONS Our data from a real-world population suggest that BVS could be associated with acceptable one-year clinical outcomes when meticulously implanted. However, a higher rate of adverse events was observed when this device was used in off-label lesions.
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Affiliation(s)
- Alfonso Ielasi
- Division of Cardiology, ASST Bergamo Est, "Bolognini" Hospital, Seriate, Italy
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9
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Bangalore S, Bezerra HG, Rizik DG, Armstrong EJ, Samuels B, Naidu SS, Grines CL, Foster MT, Choi JW, Bertolet BD, Shah AP, Torguson R, Avula SB, Wang JC, Zidar JP, Maksoud A, Kalyanasundaram A, Yakubov SJ, Chehab BM, Spaedy AJ, Potluri SP, Caputo RP, Kondur A, Merritt RF, Kaki A, Quesada R, Parikh MA, Toma C, Matar F, DeGregorio J, Nicholson W, Batchelor W, Gollapudi R, Korngold E, Sumar R, Chrysant GS, Li J, Gordon JB, Dave RM, Attizzani GF, Stys TP, Gigliotti OS, Murphy BE, Ellis SG, Waksman R. The State of the Absorb Bioresorbable Scaffold: Consensus From an Expert Panel. JACC Cardiovasc Interv 2018; 10:2349-2359. [PMID: 29216997 DOI: 10.1016/j.jcin.2017.09.041] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 08/31/2017] [Accepted: 09/21/2017] [Indexed: 12/26/2022]
Abstract
Significant progress has been made in the percutaneous coronary intervention technique from the days of balloon angioplasty to modern-day metallic drug-eluting stents (DES). Although metallic stents solve a temporary problem of acute recoil following balloon angioplasty, they leave behind a permanent problem implicated in very late events (in addition to neoatherosclerosis). BRS were developed as a potential solution to this permanent problem, but the promise of these devices has been tempered by clinical trials showing increased risk of safety outcomes, both early and late. This is not too dissimilar to the challenges seen with first-generation DES in which refinement of deployment technique, prolongation of dual antiplatelet therapy, and technical iteration mitigated excess risk of very late stent thrombosis, making DES the treatment of choice for coronary artery disease. This white paper discusses the factors potentially implicated in the excess risks, including the scaffold consideration and deployment technique, and outlines patient and lesion selection, implantation technique, and dual antiplatelet therapy considerations to potentially mitigate this excess risk with the first-generation thick strut Absorb scaffold (Abbott Vascular, Abbott Park, Illinois). It remains to be seen whether these considerations together with technical iterations will ultimately close the gap between scaffolds and metal stents for short-term events while at the same time preserving options for future revascularization once the scaffold bioresorbs.
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Affiliation(s)
- Sripal Bangalore
- Department of Medicine, New York University School of Medicine, New York, New York.
| | - Hiram G Bezerra
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - David G Rizik
- Department of Medicine, HonorHealth and the HonorHealth Heart Group, Scottsdale, Arizona
| | | | - Bruce Samuels
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Srihari S Naidu
- Department of Medicine, Westchester Medical Center, Valhalla, New York
| | - Cindy L Grines
- Department of Medicine, North Shore University Hospital, Manhasset, New York
| | - Malcolm T Foster
- Department of Medicine, Tennova Healthcare, Knoxville, Tennessee
| | - James W Choi
- Department of Medicine, Baylor Heart and Vascular Hospital, Dallas, Texas
| | - Barry D Bertolet
- Department of Medicine, North Mississippi Medical Center, Tupelo, Mississippi
| | - Atman P Shah
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Rebecca Torguson
- Department of Medicine, MedStar Washington Hospital Center, Washington, DC
| | - Surendra B Avula
- Department of Medicine, Advocate Christ Hospital and Medical Center, Oak Lawn, Illinois
| | - John C Wang
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, Maryland
| | - James P Zidar
- Department of Medicine, UNC/Rex Healthcare, Raleigh, North Carolina
| | - Aziz Maksoud
- Department of Medicine, Cardiovascular Research Institute of Kansas, Kansas City, Kansas
| | - Arun Kalyanasundaram
- Department of Medicine, Seattle Heart and Vascular Institute, Seattle, Washington
| | | | - Bassem M Chehab
- Department of Medicine, University of Kansas, Kansas City, Kansas
| | - Anthony J Spaedy
- Department of Medicine, Missouri Heart Center, Columbia, Missouri
| | - Srini P Potluri
- Department of Medicine, The Heart Hospital Baylor Plano, Plano, Texas
| | - Ronald P Caputo
- Department of Medicine, St. Joseph's/Trinity Hospital, Syracuse, New York
| | - Ashok Kondur
- Department of Medicine, DMC Heart Hospital/Wayne State University, Detroit, Michigan
| | - Robert F Merritt
- Department of Medicine, Mercy Hospital and Clinic, Springfield, Missouri
| | - Amir Kaki
- Department of Medicine, Heart & Vascular Institute, Detroit, Michigan
| | - Ramon Quesada
- Department of Medicine, Miami Cardiac & Vascular Institute, Baptist Health, Miami, Florida
| | - Manish A Parikh
- Department of Medicine, Columbia University Medical Center, New York, New York
| | - Catalin Toma
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Fadi Matar
- Department of Medicine, University of South Florida, Tampa, Florida
| | - Joseph DeGregorio
- Department of Medicine, Englewood Hospital and Medical Center, Englewood, New Jersey
| | | | - Wayne Batchelor
- Department of Medicine, Tallahassee Memorial Hospital/Florida State University, Tallahassee, Florida
| | - Raghava Gollapudi
- Department of Medicine, San Diego Cardiac Center, San Diego, California
| | - Ethan Korngold
- Department of Medicine, Providence St. Vincent Medical Center, Portland, Oregon
| | - Riyaz Sumar
- Department of Medicine, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - George S Chrysant
- Department of Medicine, INTEGRIS Baptist Medical Center, Oklahoma City, Oklahoma
| | - Jun Li
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - John B Gordon
- Department of Medicine, San Diego Cardiac Center, San Diego, California
| | - Rajesh M Dave
- Department of Medicine, Geisinger Holy Spirit, Harrisburg, Pennsylvania
| | - Guilherme F Attizzani
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Tom P Stys
- Department of Medicine, Sanford Health, Sioux Falls, South Dakota
| | | | - Bruce E Murphy
- Department of Medicine, Arkansas Heart Hospital, Little Rock, Arkansas
| | | | - Ron Waksman
- Department of Medicine, MedStar Washington Hospital Center, Washington, DC
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Haddad K, Tanguay JF, Potter BJ, Matteau A, Gobeil F, Mansour S. Longer Inflation Duration and Predilation-Sizing-Postdilation Improve Bioresorbable Scaffold Outcomes in a Long-term All-Comers Canadian Registry. Can J Cardiol 2018; 34:752-758. [PMID: 29801740 DOI: 10.1016/j.cjca.2018.02.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 02/15/2018] [Accepted: 02/23/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Real-world long-term safety and efficacy of the ABSORB (Abbott Vascular, Santa Clara, CA) bioresorbable vascular scaffold has not been well characterized in the literature, particularly in the setting of acute coronary syndromes (ACS). Herein, we report outcomes up to 4 years in such a high-risk cohort, with identification of parameters associated with better outcomes. METHODS ReABSORB is a Canadian dual-centre, prospective, nonrandomized, all-comers registry consisting of 125 consecutively enrolled nontrial patients between October 2012 and December 2016. Angiographic and clinical follow-up is now available up to 4 years. RESULTS Average age was 59 ± 11 years and 69% were male. Most (70.4%) presented with ACS and the median available follow-up was 1330 days (interquartile range, 1035-1483). Treated lesions (n = 163) were type A in 23%, type B (1 or 2) in 64%, and type C in 13%. Procedural success and device success were 98.2% and 98.8%, respectively. Using Kaplan-Meier methods, major adverse cardiac event-free survival (EFS) up to 4 years of clinical follow-up was 90.7% overall. However, use of a predilation-sizing-postdilation (PSP) technique was associated with an EFS rate of 95.8% vs 74.0% without PSP (P = 0.001). No significant differences in major adverse cardiac EFS rates were found between patients with or without ACS (92.7% vs 86.0%, respectively, P = 0.239). Use of PSP as well as inflation time ≥ 60 seconds were independent predictors of EFS at 2 years. CONCLUSIONS In this prospective, real-world registry with mostly ACS patients, use of the recommended PSP implantation technique and longer inflations times were associated with significantly higher EFS.
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Affiliation(s)
- Kevin Haddad
- Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada; Centre Hospitalier de l'Université de Montréal, Research Center, Montréal, Québec, Canada
| | - Jean-François Tanguay
- Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada; Institut de Cardiologie de Montréal, Montréal, Québec, Canada
| | - Brian J Potter
- Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada; Centre Hospitalier de l'Université de Montréal, Research Center, Montréal, Québec, Canada
| | - Alexis Matteau
- Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada; Centre Hospitalier de l'Université de Montréal, Research Center, Montréal, Québec, Canada
| | - François Gobeil
- Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada; Centre Hospitalier de l'Université de Montréal, Research Center, Montréal, Québec, Canada
| | - Samer Mansour
- Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada; Centre Hospitalier de l'Université de Montréal, Research Center, Montréal, Québec, Canada.
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Bioresorbable vascular scaffolds: Time to absorb past lessons or fade away? Arch Cardiovasc Dis 2018; 111:229-232. [DOI: 10.1016/j.acvd.2018.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 04/05/2018] [Indexed: 11/23/2022]
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12
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Ferenț I, Benedek I, Corduneanu A, Mester A, Benedek T, Benedek I. In-stent Flow Hemodynamics and the Risk of STent Failure Following Bioresorbable Vascular ScAFFolds Implantation – the STAFF Study. JOURNAL OF INTERDISCIPLINARY MEDICINE 2018. [DOI: 10.1515/jim-2017-0091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background: Myocardial revascularization procedures have undergone important developments over the last decades, which led to a major shift in current clinical practice and therapeutic guidelines across the world. Bare metal and drug-eluting stents present several limitations, all centered on the concept of disturbed coronary hemodynamics after implantation, which can be surpassed by bioresorbable vascular scaffolds (BVS). BVSs are fourth-generation stents used in coronary revascularization procedures, but despite all the promising initial results published on their efficiency, several clinical trials have reported unsatisfactory results, and the main explanation was accredited to improper implantation method. Shear stress is a central element of intravascular homeostasis; it controls vascular remodeling, as well as the development, progression, and destabilization of atheromatous plaques. This study aims to assess the role of in-stent flow hemodynamics (evaluated by computational determination of shear stress via coronary CT imaging) in predicting the clinical evolution following BVS implantation.
Material and methods: This case-control observational study will include patients with BVSs implanted at least 12 months prior to randomization. Each patient will undergo a complete evaluation of the demographic and clinical characteristics, cardiovascular risk factors, and imaging acquisitions via coronary CT angiography, based on which the endothelial shear stress will be calculated before and after BVS implantation. Post-processing of CT imaging data will evaluate the shear stress and the composition of the coronary plaques along the entire coronary tree. The primary endpoint will be the major adverse cardiovascular events (MACE) in patients with altered vs. non-altered BVS-related shear stress, and the secondary endpoints will comprise evaluating the rate of progression of stent resorption and progression of shear stress alteration.
Conclusions: The findings of the STAFF study can be extremely useful in clinical practice for providing an answer to a key question that is still under debate: why do BVSs fail and how can we prevent this?.
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Affiliation(s)
- Ionuț Ferenț
- University of Medicine and Pharmacy , Tîrgu Mureș , Romania
- Center of Advanced Research in Multimodality Cardiac Imaging, Cardio Med Medical Center , Tîrgu Mureș , Romania
| | - István Benedek
- University of Medicine and Pharmacy , Tîrgu Mureș , Romania
| | | | - András Mester
- University of Medicine and Pharmacy , Tîrgu Mureș , Romania
- Center of Advanced Research in Multimodality Cardiac Imaging, Cardio Med Medical Center , Tîrgu Mureș , Romania
| | - Theodora Benedek
- University of Medicine and Pharmacy , Tîrgu Mureș , Romania
- Center of Advanced Research in Multimodality Cardiac Imaging, Cardio Med Medical Center , Tîrgu Mureș , Romania
| | - Imre Benedek
- University of Medicine and Pharmacy , Tîrgu Mureș , Romania
- Center of Advanced Research in Multimodality Cardiac Imaging, Cardio Med Medical Center , Tîrgu Mureș , Romania
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13
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Tarantini G, Masiero G, Barioli A, Paradies V, Vlachojannis G, Tellaroli P, Cortese B, di Palma G, Varricchio A, Ielasi A, Loi B, Steffenino G, Ueshima D, Mojoli M, Smits P. Absorb bioresorbable vascular scaffold vs. everolimus-eluting metallic stent in small vessel disease: A propensity matched analysis of COMPARE II, RAI, and MAASSTAD-ABSORB studies. Catheter Cardiovasc Interv 2018. [DOI: 10.1002/ccd.27522] [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] [Indexed: 11/06/2022]
Affiliation(s)
- Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences; University of Padua Medical School; Padua Italy
| | - Giulia Masiero
- Department of Cardiac, Thoracic and Vascular Sciences; University of Padua Medical School; Padua Italy
| | - Alberto Barioli
- Department of Cardiac, Thoracic and Vascular Sciences; University of Padua Medical School; Padua Italy
| | | | | | - Paola Tellaroli
- Biostatistics, Epidemiology and Public Health Unit of Department of Cardiac, Thoracic and Vascular Sciences; University of Padua Medical School; Padua Italy
| | - Bernardo Cortese
- Unità Operativa di Cardiologia, ASST Fatebenefratelli-Sacco; P.O. Fatebenefratelli Italy
| | - Gaetano di Palma
- Unità Operativa di Cardiologia, ASST Fatebenefratelli-Sacco; P.O. Fatebenefratelli Italy
| | - Attilio Varricchio
- Cardiology Division; Santa Maria della Pietà Hospital; Nola Naples Italy
| | - Alfonso Ielasi
- Cardiology Division; A.O. Bolognini; Seriate Bergamo Italy
| | - Bruno Loi
- Cardiology Division; A.O. Brotzu; Cagliari Italy
| | | | - Daisuke Ueshima
- Department of Cardiac, Thoracic and Vascular Sciences; University of Padua Medical School; Padua Italy
| | - Marco Mojoli
- Department of Cardiac, Thoracic and Vascular Sciences; University of Padua Medical School; Padua Italy
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Impact of PSP Technique on Clinical Outcomes Following Bioresorbable Scaffolds Implantation. J Clin Med 2018; 7:jcm7020027. [PMID: 29415486 PMCID: PMC5852443 DOI: 10.3390/jcm7020027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 01/26/2018] [Accepted: 01/26/2018] [Indexed: 01/18/2023] Open
Abstract
Bioresorbable scaffolds (BRS) were introduced in clinical practice to overcome the long-term limitations of newer-generation drug-eluting stents. Despite some initial promising results of the Absorb BRS, safety concerns have led to the discontinuation of the commercialization of this device. Several retrospective studies have assessed the impact of the so-called Pre-dilation, Sizing and Post-dilation (PSP) technique concluding that an optimal PSP technique can improve clinical outcomes following BRS implantation. In this article, the definition of the PSP technique, and the current evidence of its impact on clinical outcomes are put in perspective. Additionality, the relationship between the PSP technique and the dual-antiplatelet therapy to prevent scaffold thrombosis is addressed. Finally, the future perspectives of BRS technology in clinical practice are commented.
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15
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Byrne R, Stefanini G, Capodanno D, Onuma Y, Baumbach A, Escaned J, Haude M, James S, Joner M, Jüni P, Kastrati A, Oktay S, Wijns W, Serruys P, Windecker S. Report of an ESC-EAPCI Task Force on the evaluation and use of bioresorbable scaffolds for percutaneous coronary intervention: executive summary. EUROINTERVENTION 2018; 13:1574-1586. [DOI: 10.4244/eij20170912-01] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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16
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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.
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17
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Colombo A, Azzalini L. Bioresorbable scaffolds: reflections after a setback - losing a battle does not mean losing the war! EUROINTERVENTION 2017; 13:785-786. [PMID: 28930075 DOI: 10.4244/eijv13i7a115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Antonio Colombo
- Division of Interventional Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
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18
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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.
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19
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Byrne RA, Stefanini GG, Capodanno D, Onuma Y, Baumbach A, Escaned J, Haude M, James S, Joner M, Jüni P, Kastrati A, Oktay S, Wijns W, Serruys PW, Windecker S. Report of an ESC-EAPCI Task Force on the evaluation and use of bioresorbable scaffolds for percutaneous coronary intervention: executive summary. Eur Heart J 2017; 39:1591-1601. [DOI: 10.1093/eurheartj/ehx488] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 08/06/2017] [Indexed: 01/05/2023] Open
Affiliation(s)
- Robert A Byrne
- Deutsches Herzzentrum München, Technische Universität München, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Giulio G Stefanini
- Division of Cardiology, Cardio Center, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Davide Capodanno
- Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Italy
| | - Yoshinobu Onuma
- Department of Interventional Cardiology Erasmus Medical Center Rotterdam, The Netherlands
| | - Andreas Baumbach
- Department of Cardiology, St Bartholomew’s Hospital, William Harvey Research Institute, and Queen Mary University of London, London, UK
| | - Javier Escaned
- Interventional Cardiology, Hospital San Carlos, Madrid, Spain
| | - Michael Haude
- Medical Clinic I, Städtische Kliniken Neuss, Lukaskrankenhaus GmbH, Neuss, Germany
| | - Stefan James
- Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Michael Joner
- Deutsches Herzzentrum München, Technische Universität München, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Peter Jüni
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität München, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Semih Oktay
- Cardio Med Device Consultants, Baltimore, USA
| | - William Wijns
- Saolta University Healthcare Group, Galway, Ireland
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland, Galway, Ireland
| | - Patrick W Serruys
- Erasmus University, Rotterdam, the Netherlands
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, UK
| | - Stephan Windecker
- Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland
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20
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Collet JP, Roffi M, Byrne RA, Costa F, Valgimigli M, Valgimigli M, Bueno H, Byrne RA, Collet JP, Costa F, Jeppsson A, Jüni P, Kastrati A, Kolh P, Mauri L, Montalescot G, Neumann FJ, Petricevic M, Roffi M, Steg PG, Windecker S, Zamorano JL, Badimon L, Vranckx P, Agewall S, De Luca L, Desmet W, James S, Lettino M, McFadden EP, Storey R, Ten Berg JM, Aboyans V, Jofresa AB, Biščević A, Calabrò P, Constantinides S, Damrina E, Diakite M, Dzudovic B, Ruiz VG, Yáñez IK, Lacalzada-Almeida J, Leite L, Maskon O, Myat LL, Ricottini E, Saporito F, Wong PSC, Yamaji K, Zeitouni M. Case-based implementation of the 2017 ESC Focused Update on Dual Antiplatelet Therapy in Coronary Artery Disease. Eur Heart J 2017; 39:e1-e33. [DOI: 10.1093/eurheartj/ehx503] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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21
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Affiliation(s)
- Gregg W Stone
- The New York Presbyterian Hospital, Columbia University Medical Center, and the Cardiovascular Research Foundation, New York, NY, USA
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22
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Colombo A, Azzalini L. Optimal implantation is the way to prevent scaffold thrombosis: a hypothesis to be tested. EUROINTERVENTION 2017; 13:e142-e144. [DOI: 10.4244/eijv13i2a19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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