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...
Although there are 4 approved bioresorbable scaffolds (BRS) in Europe, experts suggest that current drug-eluting stents (DES) are the best option for coronary angioplasty. These new guidelines jointly published by the European Society of Cardiology (ESC) and the Association of Percutaneous Cardiovascular Interventions (EAPCI) are an update on the use of BRS in clinical practice...
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....
The presence of a metallic device interrupts normal laminar flow and creates an artery environment that favors thrombosis, leaving the vessel vulnerable to very late thrombosis. Dual antiplatelet therapy, a better implantation technique, and several improvements in new drug-eluting stents (DES) (thinner struts, and higher polymer stability and biocompatibility) have lowered significantly the incidence of...
Courtesy of the SBHCI. This study presented at PCR and simultaneously published by NEJM still challenges the safety of bioresorbable scaffolds. This was a multicenter noninferiority work carried out in the Netherlands, comparing 1:1 everolimus-eluting bioresorbable scaffold ABSORB and permanent-polymer everolimus-eluting stent Xience. The primary endpoint was target-vessel failure (a composite of cardiac...
Courtesy of Dr. Guillermo Migliaro. In regular clinical practice, overlapping stents are reported in up to 30% of patients undergoing coronary angioplasty, especially due to very long lesions requiring implantation of multiple stents or dissection after the implantation of a first stent. In bare metal stent era, overlapping was associated with unfavorable clinical outcomes...
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...
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...
There is little evidence to support the safety and efficacy of bioresorbable scaffolds (BRS) for the treatment of chronic total occlusions (CTO). This multicenter registry included consecutive patients with CTO receiving BRS (Absorb; Abbott Vascular) vs. 2nd generation drug eluting stents (DES). Primary end point was target vessel failure at long term (composite...
Bioresorbable Vascular Scaffolds (BVS) could change the paradigm of peripheral angioplasty according to several small studies suggesting these everolimus eluting devices could significantly improve symptoms in patients with intermittent claudication. [plain] Three year outcomes of the ESPRIT I trial, presented at VIVA 2016 (held in Las Vegas) showed there were no new events between...