Feasibility of everolimus-eluting bioresorbable vascular scaffolds in patients with chronic total occlusion

Wiebe, Jens; Liebetrau, Christoph; Dörr, Oliver; Most, Astrid; Weipert, Kay; Rixe, Johannes; Bauer, Timm; Möllmann, Helge; Elsässer, Albrecht; Hamm, Christian W.; Nef, Holger

doi:10.1016/j.ijcard.2014.10.032

Cited by 29 publications

(25 citation statements)

References 31 publications

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“…However, CTO lesions were excluded in all BRS trials, and available evidence derives from small single-center, single-arm studies of Absorb. [5][6][7][8] Our study aim was to compare the procedural and long-term clinical outcomes of Absorb versus second-generation drug-eluting stents (DES) in a multicenter registry of CTO patients.…”

Section: Azzalini Et Al Brs Vs Des For Cto Pcimentioning

confidence: 99%

Procedural and Long-Term Outcomes of Bioresorbable Scaffolds Versus Drug-Eluting Stents in Chronic Total Occlusions

Azzalini

Giustino

Ojeda

et al. 2016

Circ: Cardiovascular Interventions

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Bioresorbable scaffolds (BRS) have been one of the latest revolutions in interventional cardiology. Because of their reabsorptive properties, they provide temporary scaffolding that promotes vessel healing and then disappear, thus restoring a functional endothelium and vasomotion. Although several BRS platforms have been developed, real-world experience is mostly limited to Absorb (Abbott Vascular, Santa Clara, CA), which has demonstrated comparable 1-year outcomes with a metallic everolimus-eluting stent (Xience; Abbott Vascular) in 4 large randomized trials. [1][2][3][4] The reabsorptive properties of BRS make them particularly appealing when long segments of coronary arteries Background-There is little evidence regarding the efficacy and safety of bioresorbable scaffolds (BRS) for the percutaneous treatment of chronic total occlusions. Methods and Results-We performed a multicenter registry of consecutive chronic total occlusion patients treated with BRS (Absorb; Abbott Vascular) and second-generation drug-eluting stents (DES) at 5 institutions. Long-term targetvessel failure (a composite of cardiac death, target-vessel myocardial infarction, and ischemia-driven target-lesion revascularization) was the primary end point. Inverse probability of treatment weight-adjusted Cox regression was used to account for pretreatment differences between the 2 groups. A total of 537 patients (n=153 BRS; n=384 DES) were included. BRS patients were younger and had lower prevalence of comorbidities. Overall mean Japan-Chronic Total Occlusion (J-CTO) score was 1.43±1.16, with no differences between groups. Procedural success was achieved in 99.3% and 96.6% of BRS-and DES-treated patients, respectively (P=0.07). At a median follow-up of 703 days, there were no differences in target-vessel failure between BRS and DES (4.6% versus 7.7%; P=0.21). By adjusted Cox regression analysis, there were still no significant differences between BRS and DES (hazard ratio, 1.54; 95% confidence interval, 0.69-3.72; P=0.34). However, secondary analyses suggested a signal toward higher ischemiadriven target-lesion revascularization with BRS. Conclusions-Implantation of BRS versus second-generation DES in chronic total occlusion was associated with similar risk of target-vessel failure at long-term follow-up. However, a signal toward increased ischemia-driven target-lesion revascularization with BRS was observed. Large randomized studies should confirm these findings. (Circ Cardiovasc Interv. 2016;9:e004284.

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Section: Azzalini Et Al Brs Vs Des For Cto Pcimentioning

confidence: 99%

Procedural and Long-Term Outcomes of Bioresorbable Scaffolds Versus Drug-Eluting Stents in Chronic Total Occlusions

Azzalini

Giustino

Ojeda

et al. 2016

Circ: Cardiovascular Interventions

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“…Previous reports largely suggested BRS use in simple lesions; however, recent studies have confirmed the safety and efficacy of BRS in chronic total occlusions, bifurcation lesions, and acute coronary syndromes (3,(10)(11)(12) . Approximately 10% of PCIs (in particular, complex lesions) may require overlapping technique due to lesion length or edge dissections (4) .…”

Section: Brs-brs N= 30 Pmentioning

confidence: 99%

Safety and Efficacy Outcomes of Bioresorbable Scaffolds in Long Segment Coronary Lesions

Güneş¹,

Gökdeniz²,

Karaca³

et al. 2018

Kosuyolu Heart Journal

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Introduction: There is limited knowledge about the use of bioresorbable scaffolds (BRSs) in long segment coronary artery lesions. We aimed to evaluate the clinical outcomes of BRS-BRS and drug eluting stents (DESs)-BRS overlapping applications. Patients and Methods:Cross-sectional, single-center study between 2013 and 2016 enrolled 97 patients and 100 lesions scheduled for BRS placement in long segment lesions (> 28 mm). BRS-BRS overlap was performed in 30 patients and 30 lesions, DES-BRS overlap was performed in 67 patients and 70 lesions. Acute procedural success and major adverse cardiac events (MACE) (death, stent thrombosis, and target lesion reintervention) were assessed.Results: Acute procedural success was 97.1% in the overall group. MACE was observed in 6 patients (6.2%) in the entire group, 4 (5.9%) in the DES-BRS group, and 2 (6.6%) in the BRS-BRS group. Bulgular: Akut işlem başarısı %97.1 idi. Tüm hasta grubunda toplam MACE 6 (%6.2) hastada gelişirken, DES-BRS grubunda 4 (%5.9), BRS-BRS grubunda 2 (%6.6) hastada MACE gerçekleşti.Sonuç: Uzun segment lezyonlarda BRS kullanımı seçenek olarak değerlendirilebilinir. BRS-BRS veya BRS-DES overlap yapacak şekilde yerleştiriken kısa segment overlap olacak şekilde gerçekleştirilmelidir.

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“…Safety and feasibility of BVS implantation in CTO has been confirmed also in other registries. 58,59 …”

Section: Bvs In Chronic Total Occlusionsmentioning

confidence: 99%

Coronary Bioresorbable Vascular Scaffold Use in the Treatment of Coronary Artery Disease

Testa

Latib

Montone

et al. 2016

Circ: Cardiovascular Interventions

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Bioresorbable vascular scaffolds (BVS) represent a promising novel approach for the treatment of coronary artery disease. BVS promise to address some of the well-known limitations of current drug-eluting stents, while providing a transient scaffolding of the vessel to prevent acute vessel closure/recoil. Drug elution by BVS prevents neointimal proliferation in a similar fashion to drug-eluting stents, and complete bioresorption is associated with late vessel lumen enlargement, plaque regression, and restoration of vasomotion. Based on the pathophysiological reasons and on the results derived from clinical studies, BVS are increasingly being used in clinical practice. The aim of this review is to provide an overview of the current evidence supporting the use of BVS in clinical practice. In particular, we will discuss the randomized controlled trials and registries evaluating the clinical outcome of these devices, with a special focus on their application in patients with acute coronary syndrome and in specific lesion subsets (bifurcations, chronic total occlusions, and in-stent restenosis).

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Feasibility of everolimus-eluting bioresorbable vascular scaffolds in patients with chronic total occlusion

Cited by 29 publications

References 31 publications

Procedural and Long-Term Outcomes of Bioresorbable Scaffolds Versus Drug-Eluting Stents in Chronic Total Occlusions

Procedural and Long-Term Outcomes of Bioresorbable Scaffolds Versus Drug-Eluting Stents in Chronic Total Occlusions

Safety and Efficacy Outcomes of Bioresorbable Scaffolds in Long Segment Coronary Lesions

Coronary Bioresorbable Vascular Scaffold Use in the Treatment of Coronary Artery Disease

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