There might come the time when we are finally able to leave nothing behind, at least in the context of primary PCI. The REVELATION study, soon to be published in J Am Coll Cardiol Intv, has shown that paclitaxel coated balloons resulted non inferior to drug eluting stents (DES) in terms of FFR (fractional flow...
Drug-Eluting Stents vs. Balloons While Paclitaxel Is in the Eye of the Storm
Even after the US Food and Drug Administration (FDA) issued an alert on paclitaxel devices in patients with femoropopliteal artery disease, which caused the interruption of a few ongoing studies, reality indicates that the efficacy of these devices has been proven and that they are still used. The increased mortality observed in the meta-analysis that...
Drug eluting Stents vs. Drug Coated Balloons for In-Stent Restenosis
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...
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...
TCT 2018 | IMPERIAL: First Study Comparing Drug-Eluting Stents in Patients with Femoropopliteal Disease
The IMPERIAL trial compared the safety and efficacy of a nitinol self-expanding polymer-free placlitaxel-eluting stent (Zilver PTX, Cook Medical, already approved by the US Food and Drug Administration [FDA]) and a nitinol self-expanding polymer-coating placlitaxel-eluting stent (Eluvia, Boston Scientific). This was a single-blind randomized trial in patients with symptomatic intermittent claudication (Rutherford categories 2, 3, or...
Bioresorbable scaffolds with drug-eluting stents: do they entail a higher thrombosis risk?
Courtesy of Dr. Leiva. Bioresorbable scaffolds with drug-eluting stents (bioresorbable vascular scaffolds, BVS) have been added to the list of endovascular treatment options for coronary disease. The ABSORB III trial showed the non-inferiority of this stent type to everolimus-eluting metallic stents as regards target-lesion revascularization (TLR) at one year. However, reports have suggested a higher...
Biolimus and Everolimus Eluting Stents in Coronary Artery Disease: Similar Safety?
Courtesy of Dr. Guillermo Migliaro. Events such as very late stent thrombosis and restenosis after first generation DES stenting were associated to the inflammatory response of site implantation. The presence of a durable or permanent polymer was thought to play a central role in said inflammatory process, which caused, among other things, delayed re-endothelialization and...
Very Late Thrombosis: Bioresorbable Scaffolds vs. Everolimus-Eluting Metallic Drug-Eluting Stents
This study sought to compare the 2-year outcomes between bioresorbable vascular scaffolds (BVS) and everolimus-eluting metallic drug-eluting stents (EES), since the occurrence of very late thrombosis (thrombosis beyond 1 year after implantation) is an increasing concern in relation to new devices. This meta-analysis was conducted based on 24 studies (BVS: n = 2567 and EES: n = 19,806) reporting the...
Edge Restenosis with Everolimus Eluting Stents: a few Predictors
Stent edge restenosis continues to be a weakness of drug eluting stents (DES). The aim of this study was to determine its predictors using optical coherence tomography (OCT). The study retrospectively analyzed 319 patients receiving OCT immediately after everolimus eluting stent implantation (EES) looking into the immediate outcome, and follow up angiography at 9...
IVUS vs. Angiography in New-Generation Drug-Eluting Stents Preimplantation
Courtesy of Dr. Guillermo Migliaro. The latest 2011 American College of Cardiology (ACC) guideline states that “coronary intravascular ultrasonography (IVUS) may be considered for guidance of coronary stent implantation, particularly in cases of left main coronary artery stenting (Class IIB, Level of Evidence: B).” This has been long debated with no clear winners. This analysis provides new information...