The rationale behind the decision to not add another layer of metal to the artery sounded attractive and this was what paved the way for drug coated balloons as an alternative strategy to treat in-stent restenosis. “We’ve already got a stent in place, we only have to dilate and leave the drug” is what we…
Outcomes of Contemporary DES in Patients with Diabetes: Do They Render Freedom Obsolete?
Despite our high hopes for new-generation drug-eluting stents (DES), patients with diabetes still have a different prognosis, both clinical and angiographic, compared with non-diabetic patients. Authors sought to investigate the impact of diabetes on patients who underwent drug-eluting stent implantation in the BIONICS (BioNIR Ridaforolimus Eluting Coronary Stent System in Coronary Stenosis) trial. This…
Everolimus-Eluting Stents Finally Have a Rival and Not Just a “Non-Inferior” Stent
In this large randomized trial, there were significant differences as regards both target-lesion failure and target-vessel-related infarction, which persisted through a 2-year follow-up and favored treatment with an ultrathin-strut bioresorbable-polymer sirolimus-eluting stent (Orsiro) compared with the gold standard, a durable-polymer everolimus-eluting stent (Xience). Moreover, there were significantly lower rates of target lesion revascularization and late/very…
Several Features Define a Hostile Neck in AAA patients, but Only One Makes the Difference
Patients with infrarenal abdominal aortic aneurysm (AAA) and ≥ 30 mm neck diameter have 3 times higher risk of type 1A endoleak and 5 times higher risk of rupture at follow up after standard endovascular aneurysm repair (EVAR), as well as lower survival rate. This could tilt the scales against EVAR, or at best call…
Early Strut Coverage and Its Implications for Dual Antiplatelet Therapy
Optical coherence tomography (OCT)-guided drug-eluting stent implantation improves early strut coverage compared with angiography-guided angioplasty. No difference was observed in terms of strut coverage between permanent-polymer everolimus-eluting stents and bioresorbable-polymer biolimus-eluting stents. Short-term dual antiplatelet therapy may be feasible in selected patients with early strut coverage. This study sought to measure early strut coverage…
AHA 2018 | New-Generation DES Are Similar to Second-Generation DES Beyond Polymer
Sirolimus-eluting stents with biodegradable polymer did not offer better outcomes compared with instant-classic (and undoubtedly valid) everolimus-eluting stents with durable polymer such as Xience. New-generation drug-eluting stents (DES) offer better outcomes than first-generation devices after a 10-year follow-up, according to the ISAR-TEST 4 trial presented at the American Heart Association (AHA) Congress Scientific Sessions and published…
TCT 2018 | ABSORB IV: Much Life Left for Bioresorbable Scaffolds
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…
TCT 2018 | ReCre8 Trial: Permanent Polymer and Zotarolimus vs. Polymer-Free Amphilimus
Polymer-free amphilimus-eluting stents are a novel technology combining sirolimus and long-chained fatty acids. This enhances the uptake of antiproliferative agents and may be associated with lower restenosis, particularly among patients with diabetes. The new device includes abluminal reservoirs filled with the drug; in consequence, there is no need for polymer. This work compares this new…
TCT 2018 | BIONYX: Durable Polymer-Coated vs. Ultrathin-Strut, Bioresorbable Polymer-Coated DES
This work, presented at TCT 2018 and published simultaneously in The Lancet, is the first randomized study comparing a zotarolimus-eluting stent with a new thin-strut structure and limited radiographic visibility (Onyx), and a bioresorbable polymer-coated sirolimus-eluting stent (Orsiro). Onyx was developed to improve visibility while reducing strut thickness. To that end, a dense platinum–iridium core and…
TCT 2018 | RESET: Everolimus DES vs. Sirolimus First Generation DES at Long Term
This study had published thrombosis and revascularization rates at one year after stenting, but today one year seems rather short, which is why this cohort was followed up for 5 to 7 years more, to be able to properly assess the differences between first and second generation DES. There were no significant differences a t…
TCT 2018 | TALENT: Ultrathin Struts and Bioresorbable Polymer at the Lowest Possible Cost
This study assessed the Ultra-thin Strut Bioresorbable Polymer-based Coronary DES (Supraflex) against the Xience, with special emphasis in the cost-benefit ratio. It included a population of 1435 all-comers from 23 centers in 7 European countries, randomized 1:1 (720 Supraflex and 715 Xience). Primary end point was a composite of cardiac death, target vessel myocardial…