scholarly journals When to Use Bioresorbable Vascular Scaffolds

2017 ◽  
Vol 11 (1) ◽  
pp. 25 ◽  
Author(s):  
Xiaoyu Yang ◽  
Mohamed Ahmed ◽  
Donald E Cutlip ◽  
◽  
◽  
...  
Keyword(s):  
Bare Metal Stents ◽  
Percutaneous Treatment ◽  
The United States ◽  
Lessons Learned ◽  
High Rate ◽  
Drug Eluting Stent ◽  
Metal Stents ◽  
Scaffold Thrombosis ◽  
Vascular Scaffolds ◽  
Bioresorbable Vascular Scaffolds

The development of the drug eluting stent (DES) was an important milestone in percutaneous treatment of coronary artery disease. The DES overcomes vessel recoil and restenosis to decrease the high rate of target lesion revascularization associated with balloon angioplasty and bare metal stents. Despite these benefits, the DES has an ongoing risk of stent-related complications because of permanent implantation of a foreign body and restriction of vascular vasomotion. Bioresorbable vascular scaffolds (BVS) are designed to provide mechanical support and drug delivery similar to the DES, followed by complete resorption over several years. Recent trials have demonstrated clinical non-inferiority of the BVS compared with contemporary DES, although certain clinical outcomes are concerning, particularly with regard to higher rates of scaffold thrombosis. The theoretical long-term benefits are promising, but remain unproven. Early adoption of this new technology in the United States should apply the lessons learned regarding rigorous strategies to decrease adverse events, including careful patient and lesion selection and meticulous implantation techniques.

Vollständig resorbierbare Stents – eine neue Ära in der Behandlung der koronaren Herzkrankheit?

Praxis ◽  
2017 ◽  
Vol 106 (2) ◽  
pp. 85-89
Author(s):  
Zaid Sabti ◽  
Raban Jeger
Keyword(s):  
Bare Metal Stents ◽  
Drug Eluting Stents ◽  
Metal Stents ◽  
Bare Metal ◽  
Vascular Scaffolds ◽  
Drug Eluting ◽  
Bioresorbable Vascular Scaffolds

Zusammenfassung. Die perkutane Ballonangioplastie revolutionierte die Behandlung der koronaren Herzkrankheit. Der Einsatz von Gefässstützen (Stents) setzte diese Revolution fort. Nach den reinen Metallstents (Bare metal stents, BMS) und den Medikamenten-beschichteten Stents (drug-eluting stents, DES) folgen nun bioresorbierbare Stents (bioresorbable vascular scaffolds, BVS). Im Gegensatz zu den ersten zwei Stent-Generationen werden die BVS nach einer bestimmten Zeit vollständig abgebaut und versprechen eine Antwort für bisher ungelöste Probleme von BMS und DES.

scholarly journals Hybrid Coronary Percutaneous Treatment with Metallic Stents and Everolimus-Eluting Bioresorbable Vascular Scaffolds: 2-Years Results from the GABI-R Registry

2019 ◽  
Vol 8 (6) ◽  
pp. 767
Author(s):  
Tommaso Gori ◽  
Stephan Achenbach ◽  
Thomas Riemer ◽  
Julinda Mehilli ◽  
Holger M. Nef ◽  
...  
Keyword(s):  
First Generation ◽  
Multivariable Analysis ◽  
Percutaneous Treatment ◽  
Cardiovascular Death ◽  
Hybrid Strategy ◽  
Scaffold Thrombosis ◽  
History Of ◽  
Vascular Scaffolds ◽  
Bioresorbable Vascular Scaffolds ◽  
Hybrid Group

The limitations of the first-generation everolimus-eluting coronary bioresorbable vascular scaffolds (BVS) have been demonstrated in several randomized controlled trials. Little data are available regarding the outcomes of patients receiving hybrid stenting with both BVS and drug-eluting stents (DES). Of 3144 patients prospectively enrolled in the GABI-Registry, 435 (age 62 ± 10, 19% females, 970 lesions) received at least one BVS and one metal stent (hybrid group). These patients were compared with the remaining 2709 (3308 lesions) who received BVS-only. Patients who had received hybrid stenting had more frequently a history of cardiovascular disease and revascularization (p < 0.05), had less frequently single-vessel disease (p < 0.0001), and the lesions treated in these patients were longer (p < 0.0001) and more frequently complex. Accordingly, the incidence of periprocedural myocardial infarction (p < 0.05) and that of cardiovascular death, target vessel and lesion failure and any PCI at 24 months was lower in the BVS-only group (all p < 0.05). The 24-months rate of definite and probable scaffold thrombosis was 2.7% in the hybrid group and 2.8% in the BVS-only group, that of stent thrombosis in the hybrid group was 1.86%. In multivariable analysis, only implantation in bifurcation lesions emerged as a predictor of device thrombosis, while the device type was not associated with this outcome (p = 0.21). The higher incidence of events in patients receiving hybrid stenting reflects the higher complexity of the lesions in these patients; in patients treated with a hybrid strategy, the type of device implanted did not influence patients´ outcomes.

Comparison of the Cost of Drug-Eluting Stents versus Bare Metal Stents in the Treatment of Critical Limb Ischemia in the United States

2019 ◽  
Vol 55 ◽  
pp. 55-62.e2 ◽  
Author(s):  
Satinderjit S. Locham ◽  
Nawar Paracha ◽  
Hanaa Dakour-Aridi ◽  
Besma Nejim ◽  
Muhammad Rizwan ◽  
...  
Keyword(s):  
United States ◽  
Critical Limb Ischemia ◽  
Bare Metal Stents ◽  
Limb Ischemia ◽  
The United States ◽  
Drug Eluting Stents ◽  
Metal Stents ◽  
Bare Metal ◽  
Drug Eluting ◽  
The Cost

Abstract 2567: Paclitaxel Eluting Stents are associated with a high rate of Stent Thrombosis compared to Bare Metal Stents in an Underserved Hispanic Population Presenting with Acute ST Segment Myocardial Infarction

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Atman P Shah ◽  
David M Shavelle ◽  
Kathleen Swenson ◽  
Sandra Jaquez ◽  
Michelle Martinez ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Tertiary Care ◽  
Bare Metal Stents ◽  
High Rate ◽  
Metal Stents ◽  
Care Hospital ◽  
Cardiac Events ◽  
St Segment Elevation ◽  
St Segment ◽  
Hispanic Patients

Background: Paclitaxel-eluting stents (PES) are shown to reduce restenosis and target lesion revascularization (TLR). The effectiveness of PES in Hispanic patients who present with acute myocardial infarction with ST segment elevation (STEMI) is not well established. Methods: A non-randomized, retrospective analysis was performed on 236 Hispanic patients presenting with STEMI between 8/2002 and 4/2006 at an academic tertiary care hospital serving a primarily indigent population. 150 patients received a PES and 86 received an uncoated stent (BMS). The incidence of cardiac death, myocardial infarction (MI), TLR, subacute thrombosis (SAT), and a composite of these major adverse cardiac events (MACE) was assessed at 1 year. Results: Baseline clinical characteristics in both groups revealed no statistically significant differences. All patients had clinical follow up at one year. There were statistically significant reductions in MI [2.0% (n=3 PES) vs. 10.5% (n=9 BMS), p=0.037] and TLR [6.0% (9) vs. 18.6% (16), p=0.04]. There was no difference in death [0.7% (1) vs. 1.1% (1), p=0.99]. SAT was increased in the PES group (6.0%, n=9) compared to the BMS group (1.1%, n=1, p=0.03). MACE was 14.7% in the PES group and 31.2% in the BMS group (p=0.017). Premature clopidogrel discontinuation (<6 months) was the etiology of SAT in 8 of the 9 patients. Conclusions: Use of DES is associated with lower rates of MI and TLR in Hispanics presenting with STEMI. There is an increased incidence of SAT in this population primarily due to premature clopidogrel discontinuation. The role of socioeconomic factors in premature antiplatelet discontinuation and its effects on SAT need further evaluation.

Abstract 1942: Drug-Eluting Stents for Cerebrovascular Disease: Feasibility, Safety and Intermediate-term Outcomes

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Nirav J Mehta ◽  
Srihari S Naidu
Keyword(s):  
High Risk ◽  
Cerebrovascular Disease ◽  
Cerebral Circulation ◽  
Bare Metal Stents ◽  
High Rate ◽  
Bleeding Complications ◽  
Minor Stroke ◽  
Metal Stents ◽  
Major Stroke

Background: Cerebral atherosclerosis poses risk of ischemic stroke by embolic or flow-related mechanism. Patients with cerebral vascular disease who are deemed high risk due to critical stenosis or medication failure may have annual risk of recurrent ischemic event in excess of 40%. Major concern with currently used bare metal stents (BMS) is very high rate of restenosis, reportedly > 30%. We analyzed current literature to assess feasibility, safety and short- and intermediate-term outcomes after DES implantation in cerebral circulation. Methods: We performed a systematic literature search for reports that evaluated DES in cerebrovascular disease. Data were extracted to analyze baseline characteristics, vessel selection, technical success, and peri-procedure and intermediate-term outcome. Results: Three studies totaling 88 patients, 94 vessels, and 88 stent placements met the inclusion criteria. Mean age of the patients was 61.5 ± 13.1 years. The success rate for DES delivery was 94% (88/94 vessels). 54 stents were paclitaxel-eluting and 34 were sirolimus-eluting. Peri-procedure complication rate was low with 2 disabling strokes (modified Rankin scale > 2), 1 minor stroke and 2 asymptomatic non-flow limiting dissections. No death or bleeding complications occurred. Stent thrombosis occurred in two cases despite double antiplatelet therapy, accounting for the disabling strokes. At intermediate follow-up (6.5 ± 3.15 months), 4 (5%) cases of restenosis of > 50% vessel diameter were detected, one of which was symptomatic. Major stroke-free survival by Kaplan-Meier analysis was 96% at 9 months. Conclusion: Elective DES delivery in cerebral circulation is technically feasible with low rate of procedural and intermediate-term major stroke or death in high-risk patients. Prospective studies with long term follow-up are required to assess efficacy of DES compared to BMS.

Risk reduction strategies: coronary revascularization before non-cardiac surgery

ESC CardioMed ◽  
2018 ◽  
pp. 2659-2663
Author(s):  
Fabio Rigamonti ◽  
Marco Roffi
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Cardiac Surgery ◽  
Myocardial Revascularization ◽  
Bare Metal Stents ◽  
Coronary Intervention ◽  
Drug Eluting Stent ◽  
Metal Stents ◽  
Percutaneous Coronary ◽  
Reduction Strategies ◽  
Drug Eluting

An individualized, stepwise patient evaluation based on the degree of urgency of non-cardiac surgery, functional capacity, clinical presentation, and estimated cardiovascular stress related to surgery is recommended in order to assess the perioperative cardiovascular risk and optimize management. Myocardial ischaemia in the context of non-cardiac surgery may be related to acute coronary syndromes secondary to coronary plaque rupture or prolonged myocardial oxygen supply–demand imbalance. Randomized controlled trials have failed to show a benefit of routine preoperative prophylactic myocardial revascularization. Preoperative coronary angiography and, if appropriate, myocardial revascularization may be considered before high-risk surgery depending on symptom status and extent of ischaemia on non-invasive imaging. In patients requiring percutaneous coronary intervention, guidelines recommend new-generation drug-eluting stents over bare-metal stents, though randomized data are absent. While the minimal delay for a safe surgery following drug-eluting stent implantation remains to be defined, a time window of 5–6 weeks between percutaneous coronary intervention and surgery appears to be adequate in patients who cannot wait longer.

In-stent restenosis in the drug-eluting stent era

2018 ◽  
pp. 453-472
Author(s):  
Jaya Chandrasekhar ◽  
Adriano Caixeta ◽  
Philippe Généreux ◽  
George Dangas ◽  
Roxana Mehran
Keyword(s):  
Low Frequency ◽  
Bare Metal Stents ◽  
Coronary Intervention ◽  
Drug Eluting Stent ◽  
Metal Stents ◽  
Pharmacological Agents ◽  
Stent Restenosis ◽  
Drug Eluting ◽  
In Stent Restenosis

Since the inception of percutaneous coronary intervention, restenosis has been considered a significant problem. Although drug-eluting stents (DES) have reduced rates of in-stent restenosis (ISR) compared with bare metal stents across all lesion subsets, ISR has not been abolished. DES efficacy has been limited by suboptimal polymer biocompatibility, efficacy of pharmacological agents, in vivo pharmacokinetic properties, and local drug resistance and toxicity. While the first two DES to be manufactured (sirolimus- and paclitaxel-eluting stents) have the longest clinical follow-up, extensive data are now also available on zotarolimus- and everolimus-eluting stents. The uptake of biolimus-eluting stents has recently increased in clinical practice. Although the low frequency of DES ISR makes it difficult to investigate this condition fully, many studies have examined the mechanism, incidence, predictors, and optimal treatment of DES restenosis. This review discusses the data relevant to DES restenosis and the perspective on the current treatment of this condition.

Fully bioresorbable vascular scaffolds: lessons learned and future directions

2018 ◽  
Vol 16 (5) ◽  
pp. 286-304 ◽  
Author(s):  
Hiroyuki Jinnouchi ◽  
Sho Torii ◽  
Atsushi Sakamoto ◽  
Frank D. Kolodgie ◽  
Renu Virmani ◽  
...  
Keyword(s):  
Lessons Learned ◽  
Future Directions ◽  
Vascular Scaffolds ◽  
Bioresorbable Vascular Scaffolds

scholarly journals Slender Percutaneous Coronary Intervention (“Slender PCI”) via Transradial approach by using 5Fr Guide Catheter- An Updated Single Center Experiences

2013 ◽  
Vol 5 (2) ◽  
pp. 160-164
Author(s):  
AHMW Islam ◽  
S Munwar ◽  
S Talukder ◽  
AQM Reza ◽  
T Ahmed ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Average Length ◽  
Bare Metal Stents ◽  
Fluoroscopy Time ◽  
Drug Eluting Stent ◽  
Metal Stents ◽  
Male Smoker ◽  
Transradial Approach ◽  
Guide Catheter ◽  
Procedural Complication

Background: Aim of the study was to evaluate the primary procedural success of slender PCI via transradial approach using either Bare-metal stents (BMS) or Drug Eluting Stent (DES). Methods: Total 10 patients were enrolled in this very preliminary study. Among them, Male: 8 and Female: 2. Clinical presentation were Ant MI: 4 (40%), Inf. MI: 2 (20%), Angina II-III: 3 (30%), and NSTEMI: 1 (10%). Total 10 stents were deployed. Mean age were for Male: 44yrs, for Female: 55yrs . Associated CAD risk factors were Dyslipidemia, High Blood pressure, Diabetes Mellitus, Positive FH for CAD and Smoking (all male). Results: Among the study group; 9 (90%) were Dyslipidemic, 5 (50%) were hypertensive; 6 (60%) patients were Diabetic, FH 6 (6%) and 8(63%) were all male smoker. Female patients were more obese (BMI M 24: F 27) and developed CAD in advance age. Common stented territory were LAD: 5 (50%) followed by RCA: 3 (30%) and LCX: 2 (20%). Average length and diameter of stent for LAD, RCA and LCX were 3.25, 3.16, 2.5 and 21.4, 20.3, 20 respectively. Stent used: BMS 3 (30%), Everolimus 5 (50%), Sirolimus 1(10%) and Zotarolimus 1(0.75%). Less contrast used (49.5ml), reduced radiation exposure (4727Gym2) and less fluoroscopy time (193 sec) with overall no procedural complication were observed. Conclusion: Our study has shown that the slender PCI via radial artery with a 5F guide catheter is safe with no procedural complication. It is also associated with less radiation exposure, less fluoroscopy time, good backup support and quick mobilization of patient. DOI: http://dx.doi.org/10.3329/cardio.v5i2.14320 Cardiovasc. j. 2013; 5(2): 160-164

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