Bioresorbable vascular scaffold versus metallic stent in percutaneous coronary intervention: results of the AIDA trial

Abstract

Drug-eluting stents have significantly improved the long-term outcomes of percutaneous coronary intervention (PCI) by decreasing the excessive growth of neointima. However, conventional stents have some limitations. PCI with a bioresorbable vascular scaffold (BVS) has emerged as an alternative since the presence of the prosthesis in the coronary artery is transient. A US Food and Drug Administration advisory panel of experts recommended approval of BVS based on the analysis of its risks and rewards in July 2016. In June 2017, the preliminary results of the Amsterdam Investigator-initiateD Absorb Strategy All-comers (AIDA) trial were released. This randomized controlled trial compared an everolimus-eluting BVS with an everolimus-eluting metallic stent in the context of routine clinical practice. The preliminary results revealed no significant difference in target-vessel failure when BVS was compared with metallic stenting. However, during the 2 years of follow-up, BVS was associated with a higher rate of device thrombosis. This is seen as an important development in the trial. There are some concerns regarding stent thrombosis and the restoration of real vessel functionality in the long term. For these reasons, for now, metallic stents remain the treatment of choice for PCI.

Gigantic arteriovenous fistula between left coronary cusp and coronary sinus draining into the right atrium

“…The clinical presentation is generally dependent on the degree of the shunt and the size of the fistula. Literature has shown potential complications, which include myocardial ischemia secondary to embolization or steal phenomenon and sudden cardiac death [6,7]. The closure of the fistula is recommended when it is symptomatic, while the treatment in asymptomatic patients remains controversial.…”

“…The closure of the fistula is recommended when it is symptomatic, while the treatment in asymptomatic patients remains controversial. Large coronary fistulas should be closed by transcatheter or surgical treatment, regardless of symptoms, while small to moderate size fistulas should be treated only if they cause symptoms [6][7][8][9]. Treatment for clinically significant CAF have focused on surgical management.…”

Sex-Based Differences in Coronary and Structural Percutaneous Interventions

“…These are composed of a temporary scaffold designed to provide a platform for drug elution but then degrade over time with no material left behind. Studies have shown that these scaffolds fully resorb after 3 years, leaving the vessel in its native state [ 33 ]. However, the enthusiasm for these new stents has been tempered by concerns over increase in stent thrombosis, leading to limitations in use in Europe and the United States [ 34 ].…”

Right ventricular dysplasia: management and treatment in light of current evidence

“…ICD placement is the only proven mortality benefit treatment for ARVC [11,23,24,27,29,52–54]. ICD placement can also be used for primary or secondary prevention [23,24,54].…”