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van Hemert ND, Voskuil M, Rozemeijer R, Kraaijeveld AO, Rittersma SZ, Leenders GEH, Stein M, Frambach P, van der Harst P, Agostoni P, Stella PR. Long-term follow-up of contemporary drug-eluting stent implantation in diabetic patients: Subanalysis of a randomized controlled trial. Catheter Cardiovasc Interv 2023; 101:505-510. [PMID: 36651339 DOI: 10.1002/ccd.30545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 12/04/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The elevated risk of adverse events following percutaneous coronary intervention in diabetic patients persists with newer-generation DES. The polymer-free amphilimus-eluting stent (PF-AES) possesses characteristics with a potentially enhanced performance in patients with diabetes. Data from the 1-year follow-up period has been previously published. The aim of this subanalysis was to assess long-term performance of two contemporary drug-eluting stents (DES) in a diabetic population. METHODS In the ReCre8 trial, patients were stratified for diabetes and troponin status, and randomized to implantation of a permanent polymer zotarolimus-eluting stent (PP-ZES) or PF-AES. The primary endpoint was target-lesion failure (TLF), a composite of cardiac death, target-vessel myocardial infarction and target-lesion revascularization. Clinical outcomes between discharge and 3 years follow-up were assessed. RESULTS A total of 302 patients with diabetes were included in this analysis. After 3 years, TLF occurred in 12.5% of PP-ZES patients versus 10.0% in PF-AES patients (p = 0.46). Similarly, the separate components of TLF were comparable between the two study arms. The secondary composite endpoint of NACE was higher in the PP-ZES arm with 45 cases (29.6%) versus 30 cases (20.0%) in the PF-AES arm (p = 0.036). In the insulin-dependent diabetic population, TLF occurred in 19.1% of PP-ZES patients versus 10.4% of PF-AES patients (p = 0.21). NACE occurred in 40.4% of PP-ZES patients versus 27.1% of PF-AES patients (p = 0.10). CONCLUSIONS This subanalysis shows that the use of PF-AES results in similar clinical outcomes as compared to PP-ZES, yet some benefits of use of PF-AES in diabetic patients may prevail. Future dedicated trials should confirm these findings.
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Affiliation(s)
- Nicole D van Hemert
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michiel Voskuil
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rik Rozemeijer
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Adriaan O Kraaijeveld
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Saskia Z Rittersma
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Geert E H Leenders
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mèra Stein
- Department of Cardiology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Peter Frambach
- National Institute of Cardiac Surgery and Interventional Cardiology, Luxembourg, Luxembourg
| | - Pim van der Harst
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Pieter R Stella
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
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2
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Steiner S, Honton B, Langhoff R, Chiesa R, Kahlberg A, Thieme M, Zeller T, Garot P, Commeau P, Cremonesi A, Marone EM, Sauguet A, Scheinert D. 2-Year Results With a Sirolimus-Eluting Self-Expanding Stent for Femoropopliteal Lesions: The First-in-Human ILLUMINA Study. JACC Cardiovasc Interv 2022; 15:618-626. [PMID: 35219622 DOI: 10.1016/j.jcin.2021.12.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/14/2021] [Accepted: 12/21/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVES The aim of the study was to assess 24-month efficacy and safety of a novel drug-eluting stent (DES) for femoropopliteal interventions with an innovative stent design and abluminal reservoir technology releasing the amphilimus formulation (sirolimus plus fatty acid) for efficient drug transfer and optimized release kinetics. BACKGROUND DES releasing paclitaxel exhibited good patency rates after femoropopliteal interventions. No benefit has been reported when sirolimus or everolimus were used for antiproliferative stent coating. METHODS Within a multicenter, first-in-man, single-arm study, 100 patients with symptomatic femoropopliteal disease (Rutherford category 2-4, mean lesion length 5.8 ± 3.9 cm, 35.0% total occlusions) were treated with the NiTiDES stent (Alvimedica). Two-year follow-up included assessment of primary patency (defined as absence of clinically driven target lesion revascularization or binary restenosis with a peak systolic velocity ratio >2.4 by duplex ultrasound), safety, functional, and clinical outcomes. RESULTS At 24 months, Kaplan-Meier estimates of primary patency and freedom from clinically driven target lesion revascularization were 83.4% (95% CI: 73.9%-89.6%) and 93.1% (95% CI: 85.3%-96.9%), respectively. Over the study period, 3 deaths were reported with no major limb amputation. Functional and clinical benefits were sustained, as 82.1% of patients fell into Rutherford category 0 or 1 at 24 months, which was associated with preserved improvements in all walking disability questionnaire scores. CONCLUSIONS The 2-year results of the ILLUMINA (Innovative siroLimus seLf expanding drUg-eluting stent for the treatMent of perIpheral disease: evaluation of safety aNd efficAcy) study demonstrate a sustained treatment benefit with a novel sirolimus-eluting stent that also compares favorably to other femoropopliteal intervention trials. Head-to-head comparisons of NiTiDES with a paclitaxel-based DES are warranted. (The ILLUMINA Study [ILLUMINA]; NCT03510676).
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Affiliation(s)
- Sabine Steiner
- Division of Angiology, Department of Internal Medicine, Neurology and Dermatology, University Hospital Leipzig, Leipzig, Germany; Helmholtz Institute for Metabolic, Obesity and Vascular Research, Helmholtz Zentrum München at the University of Leipzig and University Hospital Leipzig, Leipzig, Germany
| | | | - Ralf Langhoff
- Department of Angiology, Center for Internal Medicine I, Campus Clinic Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Roberto Chiesa
- Department of Vascular Surgery, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Kahlberg
- Department of Vascular Surgery, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | | | - Thomas Zeller
- Department of Angiology, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Philippe Garot
- Institut Cardio-vasculaire Paris Sud, Hôpital Privé Claude Galien, Ramsay-Générale de santé, Quincy-sous-Sénart, France
| | | | - Alberto Cremonesi
- Cardiovascular Department, Humanitas Gavazzeni Hospital, Bergamo, Italy
| | - Enrico Maria Marone
- Vascular Surgery, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Department of Vascular Surgery, Policlinico di Monza Group, Monza and Ivrea, Ollioules, Italy
| | | | - Dierk Scheinert
- Division of Angiology, Department of Internal Medicine, Neurology and Dermatology, University Hospital Leipzig, Leipzig, Germany.
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3
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Ng JCK, Toong DWY, Ow V, Chaw SY, Toh H, Wong PEH, Venkatraman S, Chong TT, Tan LP, Huang YY, Ang HY. Progress in drug-delivery systems in cardiovascular applications: stents, balloons and nanoencapsulation. Nanomedicine (Lond) 2022; 17:325-347. [PMID: 35060758 DOI: 10.2217/nnm-2021-0288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Drug-delivery systems in cardiovascular applications regularly include the use of drug-eluting stents and drug-coated balloons to ensure sufficient drug transfer and efficacy in the treatment of cardiovascular diseases. In addition to the delivery of antiproliferative drugs, the use of growth factors, genetic materials, hormones and signaling molecules has led to the development of different nanoencapsulation techniques for targeted drug delivery. The review will cover drug delivery and coating mechanisms in current drug-eluting stents and drug-coated balloons, novel innovations in drug-eluting stent technologies and drug encapsulation in nanocarriers for delivery in vascular diseases. Newer technologies and advances in nanoencapsulation techniques, such as the use of liposomes, nanogels and layer-by-layer coating to deliver therapeutics in the cardiovascular space, will be highlighted.
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Affiliation(s)
- Jaryl Chen Koon Ng
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.,Department of Biomedical Engineering, National University of Singapore, 4 Engineering Drive 3, Singapore, 117583, Singapore
| | - Daniel Wee Yee Toong
- Department of Materials Science and Engineering, Nanyang Technological University, Nanyang Avenue, Singapore, 639798, Singapore
| | - Valerie Ow
- Department of Biomedical Engineering, National University of Singapore, 4 Engineering Drive 3, Singapore, 117583, Singapore
| | - Su Yin Chaw
- Duke-National University of Singapore Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Hanwei Toh
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.,Department of Biomedical Engineering, National University of Singapore, 4 Engineering Drive 3, Singapore, 117583, Singapore
| | - Philip En Hou Wong
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.,Duke-National University of Singapore Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Subbu Venkatraman
- Department of Material Science Engineering, National University of Singapore, 9 Engineering Drive 1, Singapore, 117575, Singapore
| | - Tze Tec Chong
- Duke-National University of Singapore Medical School, 8 College Road, Singapore, 169857, Singapore.,Department of Vascular Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Lay Poh Tan
- Department of Materials Science and Engineering, Nanyang Technological University, Nanyang Avenue, Singapore, 639798, Singapore
| | - Ying Ying Huang
- Department of Materials Science and Engineering, Nanyang Technological University, Nanyang Avenue, Singapore, 639798, Singapore
| | - Hui Ying Ang
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.,Department of Biomedical Engineering, National University of Singapore, 4 Engineering Drive 3, Singapore, 117583, Singapore.,Duke-National University of Singapore Medical School, 8 College Road, Singapore, 169857, Singapore
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4
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van Hemert ND, Voskuil M, Rozemeijer R, Stein M, Frambach P, Pereira B, Rittersma SZ, Kraaijeveld AO, Leenders GEH, Timmers L, van der Harst P, Agostoni P, Stella PR. 3-Year Clinical Outcomes After Implantation of Permanent-Polymer Versus Polymer-Free Stent: ReCre8 Landmark Analysis. JACC Cardiovasc Interv 2021; 14:2477-2486. [PMID: 34794654 DOI: 10.1016/j.jcin.2021.08.078] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/16/2021] [Accepted: 08/24/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of this analysis was to assess long-term clinical outcomes of the polymer-free Amphilimus-eluting stent (PF-AES) compared with a latest generation permanent-polymer drug-eluting stent (DES) in an all-comers population. BACKGROUND PF-AES possess multiple properties improving targeted drug elution without the presence of polymers. Evaluation of long-term clinical performance of PF-AES versus latest generation permanent-polymer DES has not yet been performed in a large randomized trial introducing shortened dual-antiplatelet therapy. METHODS In this physician-initiated, multicenter, randomized, all-comers trial, patients undergoing percutaneous coronary intervention with implantation of DES were enrolled. Patients were stratified for diabetes and troponin status and randomized to implantation of a permanent-polymer zotarolimus-eluting stent (PP-ZES) or a PF-AES. Dual-antiplatelet therapy duration was 12 months in troponin-positive patients and 1 month in troponin-negative patients. A noninferiority analysis was conducted to compare the 2 arms regarding target lesion failure (TLF) between 1 and 3 years. RESULTS A total of 1,491 patients were randomized and treated. In this landmark analysis, between 1- and 3-year follow-up, TLF occurred in 35 patients (4.9%) in the PP-ZES arm and 37 PF-AES patients (5.1%). Clinical noninferiority of the PF-AES was confirmed, with a risk difference of 0.2% (upper limit 1-sided 95% CI: 2.2%; Pnoninferiority = 0.0031). CONCLUSIONS ReCre8 (Randomized "All-Comer" Evaluation of a Permanent Polymer Resolute Integrity Stent Versus a Polymer Free Cre8 Stent) is the first randomized, multicenter trial with a head-to-head comparison of PP-ZES compared with PF-AES to investigate clinical outcomes of these new-generation DES in an all-comers population with long-term follow-up. On the basis of the present results, PF-AES are clinically noninferior to PP-ZES regarding TLF between 1 and 3 years. (Randomized "All-Comer" Evaluation of a Permanent Polymer Resolute Integrity Stent Versus a Polymer Free Cre8 Stent; NCT02328898).
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Affiliation(s)
- Nicole D van Hemert
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Michiel Voskuil
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Rik Rozemeijer
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Mèra Stein
- Department of Cardiology, Zuyderland Medical Center, Heerlen, the Netherlands
| | - Peter Frambach
- National Institute of Cardiac Surgery and Interventional Cardiology, Luxembourg, Luxembourg
| | - Bruno Pereira
- National Institute of Cardiac Surgery and Interventional Cardiology, Luxembourg, Luxembourg
| | - Saskia Z Rittersma
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Adriaan O Kraaijeveld
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Geert E H Leenders
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Leo Timmers
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Pim van der Harst
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Pieter R Stella
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands.
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5
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Spione F, Brugaletta S. Second generation drug-eluting stents: a focus on safety and efficacy of current devices. Expert Rev Cardiovasc Ther 2021; 19:107-127. [PMID: 33417509 DOI: 10.1080/14779072.2021.1874352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Percutaneous coronary intervention (PCI) represents the most frequent procedure performed in medicine. Second generation drug eluting stents (DES) have been developed to reduce the rates of late and very late complications of first generation DES.Areas covered: To improve long-term efficacy and safety of patients undergoing PCI, second generation DES have been developed with novel stent platforms, biocompatible durable and biodegradable polymers and newer antiproliferative agents. In this review we provide an overview of second generation DES and their clinical trials, discussing safety and effectiveness of these devices, and outlining clinical indication for use.Expert commentary: Numerous clinical trials have demonstrated the safety and efficacy of second generation DES over the last decade. These devices represent the gold standard treatment in stable and acute coronary syndromes.
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Affiliation(s)
- Francesco Spione
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, Bari, Italy
| | - Salvatore Brugaletta
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
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6
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Gagliardi M. Numerical analysis of paclitaxel-eluting coronary stents: Mechanics and drug release properties. Med Eng Phys 2020; 82:78-85. [PMID: 32709268 DOI: 10.1016/j.medengphy.2020.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 04/14/2020] [Accepted: 06/15/2020] [Indexed: 10/23/2022]
Abstract
Since theoretical models provide data that cannot be otherwise gathered, numerical methods applied to medical devices analysis have emerged as fundamental tool in preclinical development. Large efforts were done to study mechanical and drug-eluting properties in stents but often the coating modelling is neglected. This work presents a finite element framework to calculate mechanical loads and drug distribution in three commercial drug-eluting stents (Palmaz-Schatz, Palmaz Genesis and Multi Link Vision), to check coatings strength and drug distribution maps in biological tissues. The promising copolymer poly(methylmethacrylate-co-n-butylmethacrylate), loaded with paclitaxel, is analyzed. Results demonstrated that the coating undergoes localized plastic phenomena, and calculated stresses are lower than the ultimate stress, ensuring coating integrity. Computed drug concentration depends on stent geometry and its values are in all cases lower than the toxicity level for this drug.
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7
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Romaguera R, Salinas P, Brugaletta S, Gomez-Lara J, Díaz JF, Romero MA, García-Blas S, Ocaranza R, Borde P, Jiménez Kockar M, Millan Segovia R, Íñiguez A, Alameda M, Trillo R, Lee DH, Martín P, López-Benito M, Frutos A, Moreu J, Hernández-Hernández F, García Del Blanco B, Roura G, Rossello X, Pocock SJ, Fernández-Ortiz A, Sabate M, Gómez-Hospital JA. Second-Generation Drug-Eluting Stents in Diabetes (SUGAR) trial: Rationale and study design. Am Heart J 2020; 222:174-182. [PMID: 32087418 DOI: 10.1016/j.ahj.2020.01.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 01/19/2020] [Indexed: 12/27/2022]
Affiliation(s)
- Rafael Romaguera
- Hospital de Bellvitge - IDIBELL, University of Barcelona, Barcelona, Spain.
| | - Pablo Salinas
- Hospital Clínico San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | | | - Josep Gomez-Lara
- Hospital de Bellvitge - IDIBELL, University of Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | | | | | - Mar Alameda
- Hospital Universitario Son Espases, Mallorca, Spain
| | | | - Dae Hyun Lee
- Hospital Marqués de Valdecilla, Santander, Spain
| | | | | | | | - José Moreu
- Hospital Virgen de la Salud, Toledo, Spain
| | | | | | - Gerard Roura
- Hospital de Bellvitge - IDIBELL, University of Barcelona, Barcelona, Spain
| | - Xavier Rossello
- Clinical Trials Coordination Unit, Centro Nacional de Investigaciones Cardiovaculares (CNIC), Madrid, Spain
| | - Stuart J Pocock
- Department of Biostatistics, London, School of Hygiene & Tropical Medicine, London, UK
| | - Antonio Fernández-Ortiz
- Hospital Clínico San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Manel Sabate
- Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - J A Gómez-Hospital
- Hospital de Bellvitge - IDIBELL, University of Barcelona, Barcelona, Spain
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8
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Rozemeijer R, van Muiden IG, Koudstaal S, Leenders GE, Timmers L, Rittersma SZ, Kraaijeveld AO, Doevendans PA, Voskuil M, Stella PR. One-year clinical outcomes of patients treated with polymer-free amphilimus-eluting stents or zotarolimus-eluting stents: A propensity-score adjusted analysis. Catheter Cardiovasc Interv 2019; 94:61-69. [PMID: 30604493 PMCID: PMC6619187 DOI: 10.1002/ccd.28041] [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: 03/14/2018] [Accepted: 12/01/2018] [Indexed: 11/26/2022]
Abstract
Background Polymer‐free amphilimus‐eluting stents (PF‐AES) represent a novel elution‐technology in coronary stenting. We aimed to assess 1‐year clinical outcomes of PF‐AES as compared to latest‐generation permanent polymer zotarolimus‐eluting stents (PP‐ZES) in a real‐world all‐comers setting. Methods A prospective registry of patients treated with either PF‐AES or PP‐ZES between 2014 and 2016 was conducted. The primary outcome was defined as major adverse cardiac and cerebrovascular events (MACCE), and the secondary outcome was defined as target‐lesion failure (TLF) at 1 year. To account for measured confounders, a propensity‐score adjusted Cox proportional‐hazard model was built to evaluate clinical outcomes. Results A total of 734 consecutive patients with 1,269 DES implantations were enrolled. The population was characterized by 28% diabetes, 24% ST‐segment elevation myocardial infarction, and a high number of complex lesions (69%). The rate of MACCE was 11.5% for PF‐AES and 13.6% for PP‐ZES, plog‐rank = 0.11. TLF was numerically lower in PF‐AES as compared to PP‐ZES (5.4 vs. 6.1%, plog‐rank = 0.68). After propensity‐score adjustment, PF‐AES showed a trend toward a lower rate of MACCE and a favorable rate of TLF as compared to PP‐ZES (HR 0.70; 95%CI 0.45 to 1.10, P = 0.12; and HR 0.88; 95%CI 0.47 to 1.65, P = 0.68, respectively). Rates of definite ST were low (0.8 vs. 0.3%, plog‐rank = 0.62). Conclusions Our study suggests that implantation of PF‐AES was safe and effective in real‐world patients, with low‐rates of MACCE and TLF at 1 year. Our data needs to be confirmed by a large trial to evaluate the clinical outcomes of this novel polymer‐free, eluting‐technology used in PF‐AES.
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Affiliation(s)
- Rik Rozemeijer
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Ivar G van Muiden
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Stefan Koudstaal
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands.,Farr Institute of Health Informatics, University College London
| | - Geert E Leenders
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Leo Timmers
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Saskia Z Rittersma
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Adriaan O Kraaijeveld
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Pieter A Doevendans
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands.,Netherlands Heart Institute, Utrecht, The Netherlands.,Central Military Hospital, Utrecht, The Netherlands
| | - Michiel Voskuil
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Pieter R Stella
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
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9
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Maeremans J, Cottens D, Azzalini L, Pereira B, Godino C, Carlino M, Colombo A, Frambach P, Bellini B, Candilio L, Briguori C, Pierri A, Lamers S, Roux L, Duponselle J, Vrolix M, Dens J. Outcomes of the amphilimus-eluting polymer-free stent for chronic total occlusion treatment: a multicentre experience. J Cardiovasc Med (Hagerstown) 2019; 19:564-570. [PMID: 30124545 DOI: 10.2459/jcm.0000000000000704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Late stent thrombosis and delayed vessel wall healing remain an important issue in coronary vessels treated with drug-eluting stents (DES), especially when long-vessel segments need to be covered, like in chronic total occlusions (CTO). Avoiding polymer use to avoid chronic inflammatory responses is a potential solution to reduce target vessel failure (TVF). We aimed to validate the clinical safety and efficacy at 1 year of the polymer-free Cre8 DES vs. nonpolymer-free DES for the percutaneous treatment of CTO. METHODS Between September 2011 and August 2016, patients were prospectively enrolled in three CTO centres. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE), including cardiac death, any myocardial infarction, stent thrombosis, TVF and target vessel revascularization. RESULTS A total of 102 Cre8 and 133 non-Cre8 patients were enrolled. At 1 year, a low cumulative MACCE was observed in the Cre8 group (6.9%, respectively). Moreover, a numerical trend towards better MACCE was observed in the Cre8 group vs. the non-Cre8 group (6.9 vs. 14.3%; P = 0.065). The clinically driven TVF rate was not statistically different between Cre8 and non-Cre8 patients (6.9 vs. 9.8%; P = 0.373). A borderline significant difference regarding mortality was observed in favour of Cre8 patients (0 vs. 3.8%; P = 0.049). CONCLUSION Low rates of MACCE and TVF up to 1 year were observed in the Cre8 group, supportive of the use of polymer-free DES for lesions with high complexity.
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Affiliation(s)
- Joren Maeremans
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk.,Faculty of Medicine and Life Sciences, Universiteit Hasselt, Hasselt, Belgium
| | - Daan Cottens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk
| | - Lorenzo Azzalini
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Bruno Pereira
- Department of Cardiology, Institut de Chirurgie Cardiaque et de Cardiologie Interventionelle, Luxembourg, Luxembourg
| | - Cosmo Godino
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Mauro Carlino
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Colombo
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Peter Frambach
- Department of Cardiology, Institut de Chirurgie Cardiaque et de Cardiologie Interventionelle, Luxembourg, Luxembourg
| | - Barbara Bellini
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Luciano Candilio
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Carlo Briguori
- Department of Cardiology, Clinica Mediterranea, Naples, Italy
| | - Adele Pierri
- Department of Cardiology, Clinica Mediterranea, Naples, Italy
| | - Scott Lamers
- Faculty of Medicine and Health Sciences - Universiteit Antwerpen, Antwerp, Belgium
| | - Lien Roux
- Faculty of Medicine and Life Sciences, Universiteit Hasselt, Hasselt, Belgium
| | - Jolien Duponselle
- Faculty of Medicine and Life Sciences, Universiteit Hasselt, Hasselt, Belgium
| | | | - Jo Dens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk.,Faculty of Medicine and Life Sciences, Universiteit Hasselt, Hasselt, Belgium
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10
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Chiarito M, Sardella G, Colombo A, Briguori C, Testa L, Bedogni F, Fabbiocchi F, Paggi A, Palloshi A, Tamburino C, Margonato A, Pivato CA, Baber U, Calcagno S, Giordano A, Godino C, Stefanini GG. Safety and Efficacy of Polymer-Free Drug-Eluting Stents. Circ Cardiovasc Interv 2019; 12:e007311. [DOI: 10.1161/circinterventions.118.007311] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Mauro Chiarito
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy (M.C., C.A.P., G.G.S.)
- Humanitas Clinical and Research Center IRCCS - Rozzano, Milan, Italy (M.C., C.A.P., G.G.S.)
| | - Gennaro Sardella
- Department of Cardiovascular Sciences, Policlinico Umberto I, Sapienza University of Rome, Italy (G.S., S.C.)
| | | | | | - Luca Testa
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese-Milan, Italy (L.T., F.B.)
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese-Milan, Italy (L.T., F.B.)
| | | | - Anita Paggi
- Department of Interventional Cardiology, Sant’Anna Hospital Como (A. Paggi.)
| | - Altin Palloshi
- Interventional Cardiovascular Unit, Cardiology Department, Istituto Clinico Città Studi, Milan, Italy (A. Palloshi)
| | - Corrado Tamburino
- U.O.C. Cardiologia, C.A.S.T. Centro Alte Specialità e Trapianti, P.O. G. Rodolico, A.O.U. Policlinico-V. Emanuele, Università di Catania, Italy (C.T.)
| | | | - Carlo Andrea Pivato
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy (M.C., C.A.P., G.G.S.)
- Humanitas Clinical and Research Center IRCCS - Rozzano, Milan, Italy (M.C., C.A.P., G.G.S.)
- San Raffaele Hospital, Milan, Italy (A.M., C.A.P., C.G.)
| | - Usman Baber
- Zena and Michael Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (U.B.)
| | - Simone Calcagno
- Department of Cardiovascular Sciences, Policlinico Umberto I, Sapienza University of Rome, Italy (G.S., S.C.)
| | | | - Cosmo Godino
- San Raffaele Hospital, Milan, Italy (A.M., C.A.P., C.G.)
| | - Giulio G. Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy (M.C., C.A.P., G.G.S.)
- Humanitas Clinical and Research Center IRCCS - Rozzano, Milan, Italy (M.C., C.A.P., G.G.S.)
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11
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Zhu Y, Zhang H, Zhang Y, Wu H, Wei L, Zhou G, Zhang Y, Deng L, Cheng Y, Li M, Santos HA, Cui W. Endovascular Metal Devices for the Treatment of Cerebrovascular Diseases. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2019; 31:e1805452. [PMID: 30589125 DOI: 10.1002/adma.201805452] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 09/20/2018] [Indexed: 06/09/2023]
Abstract
Cerebrovascular disease involves various medical disorders that obstruct brain blood vessels or deteriorate cerebral circulation, resulting in ischemic or hemorrhagic stroke. Nowadays, platinum coils with or without biological modification have become routine embolization devices to reduce the risk of cerebral aneurysm bleeding. Additionally, many intracranial stents, flow diverters, and stent retrievers have been invented with uniquely designed structures. To accelerate the translation of these devices into clinical usage, an in-depth understanding of the mechanical and material performance of these metal-based devices is critical. However, considering the more distal location and tortuous anatomic characteristics of cerebral arteries, present devices still risk failing to arrive at target lesions. Consequently, more flexible endovascular devices and novel designs are under urgent demand to overcome the deficiencies of existing devices. Herein, the pros and cons of the current structural designs are discussed when these devices are applied to the treatment of diseases ranging broadly from hemorrhages to ischemic strokes, in order to encourage further development of such kind of devices and investigation of their use in the clinic. Moreover, novel biodegradable materials and drug elution techniques, and the design, safety, and efficacy of personalized devices for further clinical applications in cerebral vasculature are discussed.
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Affiliation(s)
- Yueqi Zhu
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Road, Shanghai, 200233, P. R. China
| | - Hongbo Zhang
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, P. R. China
- Department of Pharmaceutical Sciences Laboratory, Åbo Akademi University, Turku, FI-20520, Finland
- Turku Center for Biotechnology, University of Turku and Åbo Akademi University, Turku, FI-20520, Finland
| | - Yiran Zhang
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Road, Shanghai, 200233, P. R. China
| | - Huayin Wu
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, 02138, USA
| | - Liming Wei
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Road, Shanghai, 200233, P. R. China
| | - Gen Zhou
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Road, Shanghai, 200233, P. R. China
| | - Yuezhou Zhang
- Department of Pharmaceutical Sciences Laboratory, Åbo Akademi University, Turku, FI-20520, Finland
- Turku Center for Biotechnology, University of Turku and Åbo Akademi University, Turku, FI-20520, Finland
| | - Lianfu Deng
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, P. R. China
| | - Yingsheng Cheng
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Road, Shanghai, 200233, P. R. China
| | - Minghua Li
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Road, Shanghai, 200233, P. R. China
| | - Hélder A Santos
- Drug Research Program, Division of Pharmaceutical Chemistry and Technology, Faculty of Pharmacy, University of Helsinki, FI-00014, Helsinki, Finland
- Helsinki Institute of Life Science, University of Helsinki, FI-00014, Helsinki, Finland
| | - Wenguo Cui
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, P. R. China
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12
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Randomized All-Comers Evaluation of a Permanent Polymer Zotarolimus-Eluting Stent Versus a Polymer-Free Amphilimus-Eluting Stent. Circulation 2019; 139:67-77. [DOI: 10.1161/circulationaha.118.037707] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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13
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Byrne RA, Banai S, Colleran R, Colombo A. Challenges in Patients with Diabetes: Improving Clinical Outcomes After Percutaneous Coronary Intervention Through EVOlving Stent Technology. Interv Cardiol 2018; 13:40-44. [PMID: 29593836 DOI: 10.15420/icr.2017:27:1] [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] [Indexed: 11/04/2022] Open
Abstract
Patients with diabetes have poorer outcomes after percutaneous coronary intervention than patients without diabetes. The Cre8™ EVO drug-eluting stent (DES) has design features that aim to improve clinical outcomes in patients with diabetes. These include Abluminal Reservoir Technology - a proprietary polymer-free drug-release system consisting of reservoirs on the abluminal surface of the stent that control drug release and direct the drug exclusively towards the vessel wall - and the Amphilimus™ drug formulation, which enables enhanced drug-tissue permeation utilising fatty acid transport pathways. The latter is particularly advantageous in patients with diabetes, whose cell metabolism favours increased cellular uptake of fatty acid. Furthermore, evidence suggests that mTOR inhibitors (-limus drugs) utilised in conventional DES are less effective in diabetic cells. The new stent architecture provides high device deliverability and conformability, facilitating clinical use in complex disease patterns and high-risk lesion morphologies. Clinical evidence for the efficacy and safety of the Cre8™ DES in patients with diabetes has been demonstrated in a number of clinical trials and observational registries. These data are reviewed herein, along with an overview of on-going randomised trials.
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Affiliation(s)
- Robert A Byrne
- German Heart Centre Munich, Technical University of MunichMunich, Germany
| | | | - Roisin Colleran
- German Heart Centre Munich, Technical University of MunichMunich, Germany
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14
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Rozemeijer R, Benedetto D, Kraaijeveld AO, Voskuil M, Stein M, Timmers L, Rittersma SZ, Agostoni P, Doevendans PA, Stella PR. Clinical outcomes of complex real-world diabetic patients treated with amphilimus sirolimus-eluting stents or zotarolimus-eluting stents: A single-center registry. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 19:521-525. [PMID: 29137966 DOI: 10.1016/j.carrev.2017.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 10/20/2017] [Accepted: 10/23/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess clinical outcomes of Amphilimus Sirolimus-Eluting Stents (A-SES) as compared to Zotarolimus-Eluting Stents (ZES) in complex real-world diabetic patients. BACKGROUND Patients with diabetes mellitus represent one of the most challenging scenarios with high rates of restenosis and stent thrombosis in the current era of drug-eluting stents. Hence, we assessed the safety of A-SES versus ZES in complex diabetic patients. METHODS In this observational study, we analyzed all consecutive patients with diabetes mellitus referred to our center from November 2012 to November 2014. The primary outcome was target-lesion failure at 1-year follow-up. RESULTS A total of 165 consecutive diabetic patients underwent percutaneous coronary intervention with A-SES or ZES for stable coronary artery disease in our tertiary center. Using the Kaplan Meier method the cumulative incidence of target-lesion failure was 6.7% (5.9% A-SES versus 7.5% ZES, p=0.19) at 1-year follow-up. Event-free survival at 1year follow-up was similar (89.4% A-SES vs. 83.3% ZES, p=0.29). Interestingly, we did not find any cases of definite-, and only one case of probable stent thrombosis in this high risk cohort. CONCLUSION In this real-world registry, A-SES and ZES seems to be associated with promising 1-year clinical safety outcomes following PCI in a contemporary cohort of high-risk diabetic patients. Our results should be considered hypothesis generating, as the clinical safety of A-SES has to be confirmed in a large trial.
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Affiliation(s)
- Rik Rozemeijer
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Daniela Benedetto
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Adriaan O Kraaijeveld
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Michiel Voskuil
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Mèra Stein
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Leo Timmers
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Saskia Z Rittersma
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Pierfrancesco Agostoni
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands; Department of Cardiology, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Pieter A Doevendans
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands; Netherlands Heart Institute, The Netherlands
| | - Pieter R Stella
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands.
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15
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Godino C, Pivato CA, Chiarito M, Donahue M, Testa L, Colantonio R, Cappelletti A, Milazzo D, Parisi R, Nicolino A, Moshiri S, Aprigliano G, Palloshi A, Zavalloni Parenti D, Rutigliano D, Locuratolo N, Melillo F, Scotti A, Arrigoni L, Montorfano M, Fattori R, Presbitero P, Sardella G, Bedogni F, Margonato A, Briguori C, Colombo A. Polymer-free amphilimus-eluting stent versus biodegradable polymer biolimus-eluting stent in patients with and without diabetes mellitus. Int J Cardiol 2017; 245:69-76. [DOI: 10.1016/j.ijcard.2017.06.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 05/22/2017] [Accepted: 06/07/2017] [Indexed: 11/28/2022]
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16
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Sardella G, Stella P, Chiarito M, Leone AM, Balian V, Prosperi F, Sorropago G, Mancone M, Calcagno S, Briguori C, Stefanini GG. Clinical outcomes with reservoir‐based polymer‐free amphilimus‐eluting stents in real‐world patients according to diabetes mellitus and complexity: The INVESTIG8 registry. Catheter Cardiovasc Interv 2017; 91:884-891. [DOI: 10.1002/ccd.27187] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 05/05/2017] [Accepted: 06/08/2017] [Indexed: 11/12/2022]
Affiliation(s)
- Gennaro Sardella
- Department of CardiovascularRespiratory, Nephrologic, Anesthesiologic and Geriatric Sciences, Policlinico Umberto I, “Sapienza” University of RomeRome Italy
| | - Pieter Stella
- University Medical Centre UtrechtUtrecht Netherlands
| | - Mauro Chiarito
- Department of Biomedical SciencesHumanitas UniversityRozzano Milan Italy
| | | | - Vruyr Balian
- Ospedale di Circolo di Busto ArsizioBusto Arsizio Italy
| | | | | | - Massimo Mancone
- Department of CardiovascularRespiratory, Nephrologic, Anesthesiologic and Geriatric Sciences, Policlinico Umberto I, “Sapienza” University of RomeRome Italy
| | - Simone Calcagno
- Department of CardiovascularRespiratory, Nephrologic, Anesthesiologic and Geriatric Sciences, Policlinico Umberto I, “Sapienza” University of RomeRome Italy
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17
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Rozemeijer R, Stein M, Frambach P, Voskuil M, Kraaijeveld AO, Rodríguez-Olivares R, Timmers L, Pereira B, Rittersma SZ, Agostoni P, Doevendans PA, Stella PR. Rationale and design of amphilimus sirolimus-eluting stents versus zotarolimus-eluting stents in all-comers requiring percutaneous coronary intervention (ReCre8): A multicenter randomized clinical trial. Catheter Cardiovasc Interv 2017; 91:410-416. [DOI: 10.1002/ccd.27142] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 03/28/2017] [Accepted: 05/03/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Rik Rozemeijer
- Department of Cardiology; University Medical Centre Utrecht; Utrecht The Netherlands
| | - Mèra Stein
- Department of Cardiology; University Medical Centre Utrecht; Utrecht The Netherlands
- Department of Cardiology; Zuyderland Medical Centre Heerlen; The Netherlands
| | - Peter Frambach
- Department of Cardiology; National Institute of Cardiac Surgery and Interventional Cardiology; Luxembourg Luxembourg
| | - Michiel Voskuil
- Department of Cardiology; University Medical Centre Utrecht; Utrecht The Netherlands
| | | | | | - Leo Timmers
- Department of Cardiology; University Medical Centre Utrecht; Utrecht The Netherlands
| | - Bruno Pereira
- Department of Cardiology; National Institute of Cardiac Surgery and Interventional Cardiology; Luxembourg Luxembourg
| | - Saskia Z. Rittersma
- Department of Cardiology; University Medical Centre Utrecht; Utrecht The Netherlands
| | - Pierfrancesco Agostoni
- Department of Cardiology; University Medical Centre Utrecht; Utrecht The Netherlands
- Department of Cardiology; St. Antonius Hospital; Nieuwegein The Netherlands
| | - Pieter A. Doevendans
- Department of Cardiology; University Medical Centre Utrecht; Utrecht The Netherlands
| | - Pieter R. Stella
- Department of Cardiology; University Medical Centre Utrecht; Utrecht The Netherlands
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18
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Byrne RA, Eeckhout E, Sardella G, Stella P, Verheye S. PCI in Patients with Diabetes: Role of the Cre8 Drug-eluting Stent. Interv Cardiol 2017; 12:13-17. [PMID: 29588724 PMCID: PMC5808482 DOI: 10.15420/icr.2016:28:2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 10/04/2016] [Indexed: 12/20/2022] Open
Abstract
Patients with diabetes have poor outcomes compared to the general patient population when undergoing percutaneous coronary intervention. The Cre8™ (Alvimedica) drug-eluting stent (DES) has unique features that may improve clinical outcomes in patients with diabetes. These include abluminal reservoir technology, a proprietary polymer-free drug-release system consisting of reservoirs on the stent's outer surface that control and direct drug release exclusively towards the vessel wall, and the Amphilimus™ formulation, which enables enhanced drug tissue permeation, utilising fatty acid transport pathways. This is particularly advantageous in diabetic patients, since increased uptake of fatty acid occurs in diabetic cells. Furthermore, mTOR inhibitors (-limus drugs), which are utilised in DESs, are relatively ineffective in diabetic cells. Clinical efficacy and safety of the Cre8™ in patients with diabetes has been demonstrated in a number of clinical trials and real-world studies, and further studies are on-going.
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Affiliation(s)
- Robert A Byrne
- Department of Cardiovascular Diseases, German Heart Centre, Technical University, Munich, Germany
| | - Eric Eeckhout
- Cardiology Department, Vaud University Hospital, Lausanne, Switzerland
| | - Gennaro Sardella
- Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences, Sapienza University of Rome, Rome, Italy
| | - Pieter Stella
- Department of Interventional Cardiology, University Medical Centre Utrecht, Utrecht, the Netherlands, and National University Singapore, Singapore
| | - Stefan Verheye
- Antwerp Cardiovascular Center, ZNA Middelheim, Antwerp, Belgium
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19
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Godino C, Chiarito M, Donahue M, Testa L, Colantonio R, Cappelletti A, Monello A, Magni V, Milazzo D, Parisi R, Nicolino A, Moshiri S, Fattori R, Aprigliano G, Palloshi A, Caramanno G, Montorfano M, Bedogni F, Briguori C, Margonato A, Colombo A. Midterm and one-year outcome of amphilimus polymer free drug eluting stent in patients needing short dual antiplatelet therapy. Insight from the ASTUTE registry (AmphilimuS iTalian mUlticenTer rEgistry). Int J Cardiol 2017; 231:54-60. [PMID: 28104306 DOI: 10.1016/j.ijcard.2017.01.023] [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: 09/18/2016] [Revised: 12/08/2016] [Accepted: 01/02/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND To assess clinical outcomes of patients needing short dual antiplatelet therapy (S-DAPT) after PCI with Cre8 polymer-free amphilimus eluting-stent (AES). The Cre8-AES with pure i-Carbofilm coating was supposed to induce faster stent endothelialization and reduce device thrombogenicity. METHODS We performed a sub-analysis of unrestricted consecutive patients treated with Cre8-AES between August 2011 and January 2015. Two groups were formed: 1) patients discharged with S-DAPT (≤3-month), because of high bleeding risk or attending urgent non-cardiac surgery; and 2) patients discharged with Recommended DAPT duration (R-DAPT; ≥6-month). The primary ischemic- and bleeding-safety endpoints were Target Vessel Failure (TVF, composite endpoint of cardiac-death, target vessel-myocardial infarction and target vessel-revascularization), and major-bleeding (BARC ≥type-3a) at 6-month and 1-year. RESULTS 106 patients (8.7%) were discharged with ≤3-month DAPT (83±19days; S-DAPT group) and 1102 patients (90.6%) with ≥6-month DAPT (342±62days; R-DAPT group). Between S-DAPT and R-DAPT groups no significant differences were observed in TVF at 1-year (5.7% vs 5.1%); 1-year BARC major bleeding rate was higher in S-DAPT group (3.4% vs 0.2%, p=0.007) with all bleeding events occurred within 3months. The landmark analysis (started at 90days, ended at 1year) showed no differences in BARC major bleedings between groups (0% vs. 0.3%). CONCLUSIONS The results of this multicenter registry show that the use of Cre8 AES in patients needing short DAPT (≤3-month) was safe regarding ischemic events and could favor a reduction of bleeding events related to the recommended DAPT. A large randomized trial is necessary to support these preliminary findings.
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Affiliation(s)
- Cosmo Godino
- San Raffaele Scientific Institute, Milan, Italy.
| | | | | | - Luca Testa
- IRCCS Policlinico San Donato, San Donato M.ne, Milan, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Antonio Colombo
- San Raffaele Scientific Institute, Milan, Italy; EMO-GVM Centro Cuore Columbus, Milan, Italy
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20
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Thakkar AS, Dave BA. Revolution of Drug-Eluting Coronary Stents: An Analysis of Market Leaders. EUROPEAN MEDICAL JOURNAL 2016. [DOI: 10.33590/emj/10314703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
Percutaneous coronary intervention with drug-eluting stents (DES) is a well-established and widely-accepted treatment approach in patients with coronary artery disease. Although the underlying principle of DES remains constant for different stents available on the market, certain factors may offer variations with respect to deliverability (ease of placement), efficacy (preventing restenosis), and safety (thrombosis rates). These factors may include the type of drug (sirolimus, everolimus, biolimus, zotarolimus, novolimus, paclitaxel, docetaxel), type of stent platforms (stainless steel, platinum, cobalt-chromium, cobalt-nickel, platinum-chromium), type of polymers (permanent, biodegradable, polymer-free), thickness of stent struts (thick, thin, ultra-thin), type of coating (abluminal, conformal), and type of stent design (open-cell, closed-cell, combination of open-closed cell). In this context, we present a review on characteristic features of several of the most widely used coronary stents worldwide. Furthermore, the advancements of completely biodegradable stents are discussed. In addition, the future directions for the development of creating an ideal or perfect DES are debated.
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Affiliation(s)
| | - Bhargav A. Dave
- Manish Therapy Services, Madison Heights, Texas, USA; Department of Physical Therapy, Srinivas University, Mangaluru, Karnataka, India
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21
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Romaguera R, Gómez-Hospital JA, Gomez-Lara J, Brugaletta S, Pinar E, Jiménez-Quevedo P, Gracida M, Roura G, Ferreiro JL, Teruel L, Montanya E, Fernandez-Ortiz A, Alfonso F, Valgimigli M, Sabate M, Cequier A. A Randomized Comparison of Reservoir-Based Polymer-Free Amphilimus-Eluting Stents Versus Everolimus-Eluting Stents With Durable Polymer in Patients With Diabetes Mellitus: The RESERVOIR Clinical Trial. JACC Cardiovasc Interv 2016; 9:42-50. [PMID: 26762910 DOI: 10.1016/j.jcin.2015.09.020] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 09/24/2015] [Indexed: 01/07/2023]
Abstract
OBJECTIVES The aim of this study was to compare the efficacy of amphilimus-eluting stents (AES) with that of everolimus-eluting stents (EES) in patients with diabetes mellitus (DM). BACKGROUND The AES is a polymer-free drug-eluting stent that elutes sirolimus formulated with an amphiphilic carrier from laser-dug wells. This technology could be associated with a high efficacy in patients with DM. METHODS This was a multicenter, randomized, noninferiority trial. Patients with DM medically treated with oral glucose-lowering agents or insulin and de novo coronary lesions were randomized in a 1:1 fashion to AES or EES. The primary endpoint was the neointimal (NI) volume obstruction assessed by optical coherence tomography at 9-month follow-up. RESULTS A total of 116 lesions in 112 patients were randomized. Overall, 40% were insulin-treated patients, with a median HbA1c of 7.3% (interquartile range: 6.7% to 8.0%). The primary endpoint, NI volume obstruction, was 11.97 ± 5.94% for AES versus 16.11 ± 18.18% for EES, meeting the noninferiority criteria (p = 0.0003). Pre-specified subgroup analyses showed a significant interaction between stent type and glycemic control (p = 0.02), with a significant reduction in NI hyperplasia in the AES group in patients with the higher HbA1c (p = 0.03). By quantitative coronary angiography, in-stent late loss was 0.14 ± 0.24 for AES versus 0.24 ± 0.57 mm for EES (p = 0.27), with a larger minimal lumen diameter at follow-up for AES (p = 0.02), mainly driven by 2 cases of occlusive restenosis in the EES group. CONCLUSIONS AES are noninferior to EES for the coronary revascularization of patients with DM. These results suggest a high efficacy of the AES and may support the potential benefit of this stent in patients with DM. (A Randomized Comparison of Reservoir-Based Polymer-Free Amphilimus-Eluting Stents Versus Everolimus-Eluting Stents With Durable Polymer in Patients With Diabetes Mellitus [RESERVOIR]; NCT01710748).
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Affiliation(s)
- Rafael Romaguera
- Heart Diseases Institute, Hospital de Bellvitge-IDIBELL, University of Barcelona, Barcelona, Spain.
| | - Joan A Gómez-Hospital
- Heart Diseases Institute, Hospital de Bellvitge-IDIBELL, University of Barcelona, Barcelona, Spain
| | - Josep Gomez-Lara
- Heart Diseases Institute, Hospital de Bellvitge-IDIBELL, University of Barcelona, Barcelona, Spain
| | | | - Eduardo Pinar
- Department of Cardiology, Hospital Virgen de la Arrixaca, Murcia, Spain
| | | | - Montserrat Gracida
- Heart Diseases Institute, Hospital de Bellvitge-IDIBELL, University of Barcelona, Barcelona, Spain
| | - Gerard Roura
- Heart Diseases Institute, Hospital de Bellvitge-IDIBELL, University of Barcelona, Barcelona, Spain
| | - Jose L Ferreiro
- Heart Diseases Institute, Hospital de Bellvitge-IDIBELL, University of Barcelona, Barcelona, Spain
| | - Luis Teruel
- Heart Diseases Institute, Hospital de Bellvitge-IDIBELL, University of Barcelona, Barcelona, Spain
| | - Eduard Montanya
- Endocrine Unit, Hospital de Bellvitge-IDIBELL, CIBERDEM, University of Barcelona, Barcelona, Spain
| | | | | | | | - Manel Sabate
- Thorax Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Angel Cequier
- Heart Diseases Institute, Hospital de Bellvitge-IDIBELL, University of Barcelona, Barcelona, Spain
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Colombo A, Godino C, Donahue M, Testa L, Chiarito M, Pavon AG, Colantonio R, Cappelletti A, Monello A, Magni V, Milazzo D, Parisi R, Nicolino A, Moshiri S, Fattori R, Aprigliano G, Palloshi A, Caramanno G, Montorfano M, Bedogni F, Margonato A, Briguori C. One-year clinical outcome of amphilimus polymer-free drug-eluting stent in diabetes mellitus patients. Int J Cardiol 2016; 214:113-20. [DOI: 10.1016/j.ijcard.2016.03.088] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 03/17/2016] [Accepted: 03/19/2016] [Indexed: 01/04/2023]
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23
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Saito N, Mori Y, Uchiyama S. Drug diffusion and biological responses of arteries using a drug-eluting stent with nonuniform coating. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2016; 9:33-43. [PMID: 27051322 PMCID: PMC4803265 DOI: 10.2147/mder.s102094] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The purpose of this study was to determine the effect of a nonuniform coating, abluminal-gradient coating (AGC), which leaves the abluminal surface of the curves and links parts of the stent free from the drug coating, on the diffusion direction of the drug and the biological responses of the artery to drug-eluting stent (DES) by comparing the AGC-sirolimus stent and the conventional full-surface coating (CFC) sirolimus stent. The study aimed to verify whether the AGC approach was appropriate for the development of a safer DES, minimizing the risks of stent thrombosis due to delayed endothelialization by the drug and distal embolization due to cracking of the coating layer on the hinge parts of the DES on stent expansion. In the in vitro local drug diffusion study, we used rhodamine B as a model drug, and rhodamine B released from the AGC stent diffused predominantly into the abluminal side of the alginate artery model. Conversely, rhodamine B released from the CFC stent quickly spread to the luminal side of the artery model, where endothelial cell regeneration is required. In the biological responses study, the luminal surface of the iliac artery implanted with the AGC-sirolimus stent in a rabbit iliac artery for 2 weeks was completely covered with endothelial-like cells. On the other hand, the luminal surface of the iliac artery implanted with the CFC-sirolimus stent for 2 weeks only showed partial coverage with endothelial-like cells. While thrombosis was observed in two of the three CFC-sirolimus stents, it was observed in only one of the three AGC-sirolimus stents. Taken together, these findings indicate that the designed nonuniform coating (AGC) is an appropriate approach to ensure a safer DES. However, the number of studies is limited and a larger study should be conducted to reach a statistically significant conclusion.
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Affiliation(s)
- Noboru Saito
- Terumo Corporation R&D Center, Inokuchi, Nakai-machi, Ashigarakami-gun, Kanagawa, Japan
| | - Yuhei Mori
- Terumo Corporation R&D Center, Inokuchi, Nakai-machi, Ashigarakami-gun, Kanagawa, Japan
| | - Sayaka Uchiyama
- Terumo Corporation R&D Center, Inokuchi, Nakai-machi, Ashigarakami-gun, Kanagawa, Japan
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24
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Tenekecioglu E, Bourantas C, Abdelghani M, Zeng Y, Silva RC, Tateishi H, Sotomi Y, Onuma Y, Yılmaz M, Serruys PW. From drug eluting stents to bioresorbable scaffolds; to new horizons in PCI. Expert Rev Med Devices 2016; 13:271-86. [DOI: 10.1586/17434440.2016.1143356] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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25
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Panoulas VF, Latib A, Naim C, Sato K, Ielasi A, Tespili M, Godino C, Testa L, Bedogni F, Colombo A. Clinical outcomes of real-world patients treated with an amphilimus polymer-free stent versus new generation everolimus-eluting stents. Catheter Cardiovasc Interv 2015; 86:1168-76. [DOI: 10.1002/ccd.25931] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 03/14/2015] [Indexed: 12/31/2022]
Affiliation(s)
- Vasileios F. Panoulas
- Cardiovascular science division, Faculty of Medicine, National Heart and Lung Institute; Imperial College London; London Greater London United Kingdom
- Interventional Cardiology Department, EMO GVM Centro Cuore Columbus; Milan Italy
- Interventional Cardiology Department; San Raffaele Scientific Institute; Milan Italy
| | - Azeem Latib
- Interventional Cardiology Department, EMO GVM Centro Cuore Columbus; Milan Italy
- Interventional Cardiology Department; San Raffaele Scientific Institute; Milan Italy
| | - Charbel Naim
- Interventional Cardiology Department; San Raffaele Scientific Institute; Milan Italy
| | - Katsumasa Sato
- Interventional Cardiology Department; San Raffaele Scientific Institute; Milan Italy
| | - Alfonso Ielasi
- Interventional Cardiology Department, Azienda Ospedaliera Bolognini; Seriate Bergamo Italy
| | - Maurizio Tespili
- Interventional Cardiology Department, Istituto Clinico San Ambrogio; Milan Italy
| | - Cosmo Godino
- Interventional Cardiology Department; San Raffaele Scientific Institute; Milan Italy
| | - Luca Testa
- Interventional Cardiology Department, Istituto Clinico San Ambrogio; Milan Italy
| | - Francesco Bedogni
- Interventional Cardiology Department, Istituto Clinico San Ambrogio; Milan Italy
| | - Antonio Colombo
- Interventional Cardiology Department, EMO GVM Centro Cuore Columbus; Milan Italy
- Interventional Cardiology Department; San Raffaele Scientific Institute; Milan Italy
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26
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Walters DL, Christopher Raffel O, Jang IK. Are the findings of optical coherence tomography sufficient for the evaluation of the safety and efficacy of the next generation of drug eluting stents? Int J Cardiol 2015; 179:127-8. [PMID: 25464431 DOI: 10.1016/j.ijcard.2014.10.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 10/20/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Darren L Walters
- The Prince Charles Hospital, Rode Rd, Brisbane, Australia; The University of Queensland, St Lucia, Brisbane, Australia.
| | - O Christopher Raffel
- The Prince Charles Hospital, Rode Rd, Brisbane, Australia; The University of Queensland, St Lucia, Brisbane, Australia
| | - Ik-Kyung Jang
- Massachusetts General Hospital, 55 Fruit St, Boston, United States; Harvard Medical School Boston, United States
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27
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Romaguera R, Brugaletta S, Gomez-Lara J, Pinar E, Jiménez-Quevedo P, Gracida M, Roura G, Ferreiro J, Teruel L, Gómez-Hospital J, Montanya E, Alfonso F, Valgimigli M, Sabate M, Cequier A. Rationale and study design of the RESERVOIR trial: A randomized trial comparing reservoir-based polymer-free amphilimus-eluting stents versus everolimus-eluting stents with durable polymer in patients with diabetes mellitus. Catheter Cardiovasc Interv 2014; 85:E116-22. [DOI: 10.1002/ccd.25728] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 11/03/2014] [Indexed: 11/06/2022]
Affiliation(s)
- R. Romaguera
- Department of Cardiology, Heart Diseases Institute, Hospital de Bellvitge; IDIBELL, University of Barcelona; Barcelona Spain
| | - S. Brugaletta
- Department of Cardiology, Thorax Institute; Hospital Clinic, University of Barcelona; Barcelona Spain
| | - J. Gomez-Lara
- Department of Cardiology, Heart Diseases Institute, Hospital de Bellvitge; IDIBELL, University of Barcelona; Barcelona Spain
| | - E. Pinar
- Department of Cardiology; Hospital Virgen de la Arrixaca; Murcia Spain
| | - P. Jiménez-Quevedo
- Department of Cardiology, Cardiovascular Institute; Hospital Clínico San Carlos; Madrid Spain
| | - M. Gracida
- Department of Cardiology, Heart Diseases Institute, Hospital de Bellvitge; IDIBELL, University of Barcelona; Barcelona Spain
| | - G. Roura
- Department of Cardiology, Heart Diseases Institute, Hospital de Bellvitge; IDIBELL, University of Barcelona; Barcelona Spain
| | - J.L. Ferreiro
- Department of Cardiology, Heart Diseases Institute, Hospital de Bellvitge; IDIBELL, University of Barcelona; Barcelona Spain
| | - L. Teruel
- Department of Cardiology, Heart Diseases Institute, Hospital de Bellvitge; IDIBELL, University of Barcelona; Barcelona Spain
| | - J.A. Gómez-Hospital
- Department of Cardiology, Heart Diseases Institute, Hospital de Bellvitge; IDIBELL, University of Barcelona; Barcelona Spain
| | - E. Montanya
- Endocrine Unit, Hospital de Bellvitge; IDIBELL, CIBERDEM, University of Barcelona; Barcelona Spain
| | - F. Alfonso
- Department of Cardiology; Hospital la Princesa; Madrid Spain
| | - M. Valgimigli
- Department of Cardiology, Erasmus MC; Thoraxcenter; Rotterdam the Netherlands
| | - M. Sabate
- Department of Cardiology, Thorax Institute; Hospital Clinic, University of Barcelona; Barcelona Spain
| | - A. Cequier
- Department of Cardiology, Heart Diseases Institute, Hospital de Bellvitge; IDIBELL, University of Barcelona; Barcelona Spain
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28
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Prati F, Romagnoli E, Valgimigli M, Burzotta F, De Benedictis M, Ramondo A, Mehran R, Stella PR. Randomized comparison between 3-month Cre8 DES vs. 1-month Vision/Multilink8 BMS neointimal coverage assessed by OCT evaluation: The DEMONSTRATE study. Int J Cardiol 2014; 176:904-9. [DOI: 10.1016/j.ijcard.2014.08.031] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 06/07/2014] [Accepted: 08/05/2014] [Indexed: 01/27/2023]
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29
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Polymer-free drug-eluting stent in unselected patient population: A single center experience. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2014; 15:350-3. [DOI: 10.1016/j.carrev.2014.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 08/24/2014] [Accepted: 08/29/2014] [Indexed: 11/18/2022]
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30
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Mountfort K, Carrié D, Valgimigli M, Sardella G, Banai S, Romaguera R, Stella P. Meeting the Unmet - The Cre8 Polymer-free Drug-eluting Stents Technology: Proceedings of a satellite symposium held at EuroPCR on May 20th - 23rd 2014 in Paris. Interv Cardiol 2014; 9:184-189. [PMID: 29588800 DOI: 10.15420/icr.2014.9.3.184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The use of first-generation drug-eluting stents (DES) has been associated with safety concerns such as very late stent thrombosis. Today, with the release of newer DES, there is a need for comparative studies of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) to demonstrate their value in patients with high risk of restenosis such as diabetic patients. In a satellite symposium presented at EuroPCR 2014, the Cre8™ DES was discussed. The Cre8 device has a number of unique clinical features, including polymer-free technology, abluminal reservoir technology and bio-inducer surface that ensure effective neointima suppression and rapid endothelialisation. The efficacy of the Cre8 DES has been demonstrated in the International randomised comparison between DES Limus Carbostent and Taxus drug-eluting stents in the treatment of de novo coronary lesions (NEXT) randomised clinical study, with equivalent efficacy in the diabetic and general populations, a unique finding. Ongoing clinical studies such as Investig8 and the Tel Aviv Medical Center (TLVMC) Cre8 study have confirmed the efficacy of the device in patient populations with a high proportion of diabetic patients. The Demonstr8 randomised trial has shown almost complete Cre8 strut coverage at three months with a numerical advantage versus bare metal stent (bare metal stents [BMS] - comparator device) at one month. In addition, use of the Cre8 DES may enable a shorter duration of dual antiplatelet therapy (DAPT) following PCI. The Cre8 DES therefore represents a significant advance in stent technology and may be particularly useful in challenging clinical settings.
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Affiliation(s)
- Katrina Mountfort
- Centre Hospitalier Universitaire Rangueil, Toulouse, France.,The University Hospital of Ferrara, Ferrara, Italy.,Policlinico "Umberto I," "Sapienza" University, Rome, Italy.,Tel Aviv Medical Center, Tel Aviv, Israel.,Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,University Medical Centre Utrecht, The Netherlands
| | - Didier Carrié
- Centre Hospitalier Universitaire Rangueil, Toulouse, France
| | | | | | | | - Rafael Romaguera
- Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
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31
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Sangiorgi G, Biondi-Zoccai G, Modena MG. Repetita iuvant (repeating helps): why another paper on a new stent is important. EUROINTERVENTION 2011; 7:1014-7. [PMID: 22207225 DOI: 10.4244/eijv7i9a162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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