Bioresorbable Vascular Scaffold Korean Expert Panel Report

Abstract

Bioresorbable vascular scaffold (BRS) is an innovative device that provides structural support and drug release to prevent early recoil or restenosis, and then degrades into nontoxic compounds to avoid late complications related with metallic drug-eluting stents (DESs). BRS has several putative advantages. However, recent randomized trials and registry studies raised clinical concerns about the safety and efficacy of first generation BRS. In addition, the general guidance for the optimal practice with BRS has not been suggested due to limited long-term clinical data in Korea. To address the safety and efficacy of BRS, we reviewed the clinical evidence of BRS implantation, and suggested the appropriate criteria for patient and lesion selection, scaffold implantation technique, and management.

2018 update of expert consensus statement on antiplatelet therapy in East Asian patients with ACS or undergoing PCI

“…208) was 0% with ticagrelor and 16.7% with clopidogrel. These findings support the hypothesis that 90 mg twice daily ticagrelor in East Asians would achieve more than the optimal antiplatelet effect and that the platelet inhibition achieved by low-dose ticagrelor would be more optimal in East Asians [2,9].…”

“…There has been an emerging concern about the safety of bioresorbable vascular scaffold (BRS) after implantation. Recent Korean experience provided the low risk of scaffold thrombosis in ACS patients: 9 scaffold thrombosis (0.32%) from 2833 BRSs [9]. Taken together, numerous clinical studies consistently have shown lower atherothrombotic events following ACS or PCI in East Asians compared with Caucasians during clopidogrel treatment.…”

“…Standard-dose potent P2Y 12 receptor inhibitors vs. clopidogrel have been found to be associated with a higher risk of significant bleeding in East Asian patients, raising concern over potential bleeding complications in this population. This may be partly due to a lower atherothrombotic events and a higher tendency for bleeding in East Asian individuals over Caucasian individuals, which may be partly associated with the different therapeutic window of antiplatelet effect (''East Asian Paradox") [1,2,9]. In addition, the recent pharmacokinetic and pharmacodynamic studies showed the higher exposure of the major active metabolites and enhanced platelet inhibition by potent P2Y 12 receptor inhibitors in East Asian individuals compared with Caucasian individuals [2].…”

“…Likewise, East Asian patients have a similar or lower rate of ischemic events after PCI compared with Caucasian patients despite a lower response to clopidogrel in East Asians [6][7][8]. This phenomenon was first noted in 2011 by Jeong and coinvestigators who developed the concept of ''East Asian Paradox" [2,9], suggesting a different therapeutic targeting of antiplatelet effect in East Asian patients.…”

Structural Design of Mechanical Property for Biodegradable Polymeric Stent

“…Biodegradable vascular stents are hailed as the fourth revolution in coronary intervention [1]. ey provide temporary support to diseased blood vessels and disappears gradually, which overcome the core complications induced by the permanent retention of traditional metallic stents including vasomotor dysfunction, late in-stent restenosis and revascularization of advanced target lesions [2][3][4]. Based on the superior biocompatibility, biodegradability, and processability of biodegradable polymers, BPS has become a subject of current interest [5,6].…”