5-year followup of bioresorbable scaffolds in selected and better prepared lesions (ABSORB IV). Historically, when comparing previously used therapies, such as conventional balloon angioplasty (BA) against bare metal stent (BMS) and later against drug eluting stent (DES) implantation, we see significantly improved outcomes. These advances have shown reduced recoil and more effective restenosis inhibition, compared...
Courtesy of SBHCI. This study showed that using the everolimus eluting stent with bioabsorbable polymer Synergy followed by 4 months of dual antiplatelet therapy (DAPT) to treat left main stenosis (LMS) was safe and effective, compared against using the everolimus eluting stent with permanent polymer Xience followed by the conventional 12 months DAPT. This study...
Previous studies have documented higher rates of adverse events with bioresorbable scaffolds (ABSORB) compared with metallic drug-eluting stents (DES). However, these studies included lesions smaller than recommended for these scaffolds and a suboptimal implantation technique. The ABSORB IV study, presented by Dr. Stone at TCT 2018 and published simultaneously in The Lancet, randomized patients to polymeric everolimus-eluting scaffold Absorb...
Most drug-eluting stents are coated by a polymer that is used to contain the antiproliferative drug. Once the drug is released, the polymer remains in place and its presence has been associated with inflammation, restenosis, and neoatherosclerosis. The MiStent device features a polymer that becomes bioabsorbable once the drug has been released, which could, theoretically,...
Courtesy of the SBHCI. The 3-year outcomes of the ABSORB III trial, which randomized 2008 patients 2:1 to an everolimus eluting bioresorbable scaffold (1322 patients) vs. a metallic stent with permanent everolimus eluting polymer (686 patients), was published with low profile and great disappointment. Primary end-point, a composite of target vessel failure, occurred in 13.4% of patients receiving...
Courtesy of the SBHCI. The Absorb IV trial randomized 2604 patients in a 1:1 ratio to receive an Absorb everolimus-eluting bioresorbable scaffold or a Xience stent. With the aim of minimizing the problems observed in previous studies, the Absorb IV protocol excluded small caliber (<2.5 mm) vessels and included mandatory aggressive pre-dilation followed by non-complacent balloon post-dilation. Patients could...
Courtesy of the SBHCI. The ABSORB II study sought to assess the mechanical properties of everolimus-eluting bioresorbable scaffolds, such as the increase in minimal lumen area and the recovery of the vasomotor properties of the treated artery. Last year saw the publishing of negative results for the primary endpoints, registering a higher rate of complications at...
By restoring vascular physiology and eliminating the inflammatory focus and the chance of fracture and neo atherosclerosis inherent to DES, bioresorbable scaffolds offer the potential to improve long term outcomes. A number of bioresorbable materials have been tested, mainly polylactic acid, with several limitations that have taken the Absorb bioresorbable scaffold out of the market....
J Am Coll Cardiol Intv has recently published a special issue on bioresorbable scaffolds. Abbott’s decision to pull Absorb off the market probably prompted the fast publishing of all related articles sent to the journal. Bioresorbable scaffolds were developed in hopes that they would reduce the rates of events per year 1 year post-implantation by 1.5%-3%...
The two year outcomes of ABSORB III, presented at the scientific sessions of the American College of Cardiology 2017, have shown the bioresorbable scaffold Absorb GT1 (BVS, Abbott Vascular) was associated with increased risk of target vessel failure, compared against the everolimus eluting stent Xience. At 25 months, target vessel failure occurred in 11%...