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Schmidt W, Behrens P, Brandt-Wunderlich C, Siewert S, Grabow N, Schmitz KP. In vitro performance investigation of bioresorbable scaffolds - Standard tests for vascular stents and beyond. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2016; 17:375-83. [PMID: 27266902 DOI: 10.1016/j.carrev.2016.05.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 05/04/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND/PURPOSE Biodegradable polymers are the main materials for coronary scaffolds. Magnesium has been investigated as a potential alternative and was successfully tested in human clinical trials. However, it is still challenging to achieve mechanical parameters comparative to permanent bare metal (BMS) and drug-eluting stents (DES). As such, in vitro tests are required to assess mechanical parameters correlated to the safety and efficacy of the device. METHODS/MATERIALS In vitro bench tests evaluate scaffold profiles, length, deliverability, expansion behavior including acute elastic and time-dependent recoil, bending stiffness and radial strength. The Absorb GT1 (Abbott Vascular, Temecula, CA), DESolve (Elixir Medical Corporation, Sunnyvale, CA) and the Magmaris (BIOTRONIK AG, Bülach, Switzerland) that was previously tested in the BIOSOLVE II study, were tested. RESULTS Crimped profiles were 1.38±0.01mm (Absorb GT1), 1.39±0.01mm (DESolve) and 1.44±0.00mm (Magmaris) enabling 6F compatibility. Trackability was measured depending on stiffness and force transmission (pushability). Acute elastic recoil was measured at free expansion and within a mock vessel, respectively, yielding results of 5.86±0.76 and 5.22±0.38% (Absorb), 7.85±3.45 and 9.42±0.21% (DESolve) and 5.57±0.72 and 4.94±0.31% (Magmaris). Time-dependent recoil (after 1h) was observed for the Absorb and DESolve scaffolds but not for the Magmaris. The self-correcting wall apposition behavior of the DESolve did not prevent time-dependent recoil under vessel loading. CONCLUSIONS The results of the suggested test methods allow assessment of technical feasibility based on objective mechanical data and highlight the main differences between polymeric and metallic bioresorbable scaffolds.
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Affiliation(s)
- Wolfram Schmidt
- Institute for Biomedical Engineering, University Medicine Rostock, Friedrich-Barnewitz-Strasse 4, D-18119 Rostock-Warnemünde, Germany.
| | - Peter Behrens
- Institute for Biomedical Engineering, University Medicine Rostock, Friedrich-Barnewitz-Strasse 4, D-18119 Rostock-Warnemünde, Germany.
| | - Christoph Brandt-Wunderlich
- Institute for ImplantTechnology and Biomaterials - IIB e.V., Associated Institute of the University of Rostock, Friedrich-Barnewitz-Strasse 4, D-18119 Rostock-Warnemünde, Germany.
| | - Stefan Siewert
- Institute for ImplantTechnology and Biomaterials - IIB e.V., Associated Institute of the University of Rostock, Friedrich-Barnewitz-Strasse 4, D-18119 Rostock-Warnemünde, Germany.
| | - Niels Grabow
- Institute for Biomedical Engineering, University Medicine Rostock, Friedrich-Barnewitz-Strasse 4, D-18119 Rostock-Warnemünde, Germany.
| | - Klaus-Peter Schmitz
- Institute for ImplantTechnology and Biomaterials - IIB e.V., Associated Institute of the University of Rostock, Friedrich-Barnewitz-Strasse 4, D-18119 Rostock-Warnemünde, Germany.
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Widimsky P, Petr R, Tousek P, Maly M, Linkova H, Vrana J, Hajsl M, Budesinsky T, Lisa L, Kocka V. One-Year Clinical and Computed Tomography Angiographic Outcomes After Bioresorbable Vascular Scaffold Implantation During Primary Percutaneous Coronary Intervention for ST-Segment-Elevation Myocardial Infarction: The PRAGUE-19 Study. Circ Cardiovasc Interv 2015; 8:e002933. [PMID: 26628591 DOI: 10.1161/circinterventions.115.002933] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Bioresorbable vascular scaffolds (BVS) represent promising new technology, but data on their long-term outcomes in ST-segment-elevation myocardial infarction (STEMI) setting are missing. The aim was to analyze 1-year clinical and computed tomographic angiographic outcomes after BVS implantation in STEMI. METHODS AND RESULTS PRAGUE-19 is a prospective multicenter single-arm study enrolling consecutive STEMI patients undergoing primary percutaneous coronary intervention (pPCI) with intention-to-implant BVS. A total of 343 STEMI patients were screened during 15 months enrollment period, and 70 patients (mean age 58.6±10.3 and 74% males) fulfilled entry criteria and BVS was successfully implanted in 96% of them. All patients were invited for clinical and computed tomographic angiographic control 1 year after BVS implantation. Restenosis was defined as ≥75% area stenosis within the scaffolded segment. Three events were potentially related to BVS: 1 in-stent restenosis (treated 7 months after pPCI with drug-eluting balloon), 1 stent thrombosis (treated 2 weeks after pPCI by balloon dilatation-this patient stopped all medications after pPCI), and 1 sudden death at home 9 months after pPCI. Four other patients had events definitely unrelated to BVS. Overall, 1-year mortality was 2.9%. Computed tomographic angiography after 1 year was performed in 59 patients. All BVS were widely patent, and binary restenosis rate was 2% (the only restenosis mentioned above). Mean in-scaffold minimal luminal area was 7.8±2.6 mm(2), area stenosis was 20.1±16.3%, minimal luminal diameter was 3.0±0.6 mm, and diameter stenosis was 12.8±11.1%. CONCLUSIONS BVS implantation in STEMI is feasible and safe and offers excellent 1-year clinical and angiographic outcomes.
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Affiliation(s)
- Petr Widimsky
- From the Third Faculty of Medicine, Charles University, Prague, Czech Republic (P.W., R.P., P.T., H.L., T.B., L.L., V.K.); Department of Cardiology, University Hospital Kralovske Vinohrady, Prague (P.W., R.P., P.T., H.L., T.B., L.L., V.K.); and Department of Cardiology, Central Military Hospital, Prague, Czech Republic (M.M., J.V., M.H.).
| | - Robert Petr
- From the Third Faculty of Medicine, Charles University, Prague, Czech Republic (P.W., R.P., P.T., H.L., T.B., L.L., V.K.); Department of Cardiology, University Hospital Kralovske Vinohrady, Prague (P.W., R.P., P.T., H.L., T.B., L.L., V.K.); and Department of Cardiology, Central Military Hospital, Prague, Czech Republic (M.M., J.V., M.H.)
| | - Petr Tousek
- From the Third Faculty of Medicine, Charles University, Prague, Czech Republic (P.W., R.P., P.T., H.L., T.B., L.L., V.K.); Department of Cardiology, University Hospital Kralovske Vinohrady, Prague (P.W., R.P., P.T., H.L., T.B., L.L., V.K.); and Department of Cardiology, Central Military Hospital, Prague, Czech Republic (M.M., J.V., M.H.)
| | - Martin Maly
- From the Third Faculty of Medicine, Charles University, Prague, Czech Republic (P.W., R.P., P.T., H.L., T.B., L.L., V.K.); Department of Cardiology, University Hospital Kralovske Vinohrady, Prague (P.W., R.P., P.T., H.L., T.B., L.L., V.K.); and Department of Cardiology, Central Military Hospital, Prague, Czech Republic (M.M., J.V., M.H.)
| | - Hana Linkova
- From the Third Faculty of Medicine, Charles University, Prague, Czech Republic (P.W., R.P., P.T., H.L., T.B., L.L., V.K.); Department of Cardiology, University Hospital Kralovske Vinohrady, Prague (P.W., R.P., P.T., H.L., T.B., L.L., V.K.); and Department of Cardiology, Central Military Hospital, Prague, Czech Republic (M.M., J.V., M.H.)
| | - Jiri Vrana
- From the Third Faculty of Medicine, Charles University, Prague, Czech Republic (P.W., R.P., P.T., H.L., T.B., L.L., V.K.); Department of Cardiology, University Hospital Kralovske Vinohrady, Prague (P.W., R.P., P.T., H.L., T.B., L.L., V.K.); and Department of Cardiology, Central Military Hospital, Prague, Czech Republic (M.M., J.V., M.H.)
| | - Martin Hajsl
- From the Third Faculty of Medicine, Charles University, Prague, Czech Republic (P.W., R.P., P.T., H.L., T.B., L.L., V.K.); Department of Cardiology, University Hospital Kralovske Vinohrady, Prague (P.W., R.P., P.T., H.L., T.B., L.L., V.K.); and Department of Cardiology, Central Military Hospital, Prague, Czech Republic (M.M., J.V., M.H.)
| | - Tomas Budesinsky
- From the Third Faculty of Medicine, Charles University, Prague, Czech Republic (P.W., R.P., P.T., H.L., T.B., L.L., V.K.); Department of Cardiology, University Hospital Kralovske Vinohrady, Prague (P.W., R.P., P.T., H.L., T.B., L.L., V.K.); and Department of Cardiology, Central Military Hospital, Prague, Czech Republic (M.M., J.V., M.H.)
| | - Libor Lisa
- From the Third Faculty of Medicine, Charles University, Prague, Czech Republic (P.W., R.P., P.T., H.L., T.B., L.L., V.K.); Department of Cardiology, University Hospital Kralovske Vinohrady, Prague (P.W., R.P., P.T., H.L., T.B., L.L., V.K.); and Department of Cardiology, Central Military Hospital, Prague, Czech Republic (M.M., J.V., M.H.)
| | - Viktor Kocka
- From the Third Faculty of Medicine, Charles University, Prague, Czech Republic (P.W., R.P., P.T., H.L., T.B., L.L., V.K.); Department of Cardiology, University Hospital Kralovske Vinohrady, Prague (P.W., R.P., P.T., H.L., T.B., L.L., V.K.); and Department of Cardiology, Central Military Hospital, Prague, Czech Republic (M.M., J.V., M.H.)
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