Bioresorbable scaffolds on the bench Ormiston, John; Motreff, Pascal; Darremont, Olivier ...
EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology,
2015, Volume:
11 Suppl V
Journal Article
Bioresorbable scaffolds (BRS) in bifurcations have all of the potential advantages of BRS in non-bifurcating lesions and, in addition, the absorption of side branch (SB) ostial struts may at least ...partially release the branch from "jail". Polymeric BRS struts may break when post-dilated beyond their safe limits and multiple fractures may lead to adverse clinical events. Bench testing provides insights into the behaviour of different BRS in bifurcations and helps the interventional cardiologist to choose, deliver and post-dilate appropriately. Bench testing of polymeric BRS must be in a water bath at 37ºC as polymer performance is temperature sensitive. Balloon dilatation through the side of a BRS or a durable metallic stent causes distortion corrected by mini-kissing balloon post-dilatation (mini-KBPD) where the SB balloon extends only a short distance into the main branch (MB), limiting the length of MB scaffold exposed to the inflation of two balloons. The safe pressure threshold for SB dilatation of a 3.0 mm Absorb scaffold with a 3.0 mm non-compliant balloon is 10 atm and for mini-KBPD with two 3.0 mm balloons it is 5 atm. Strategies such as culotte, crush and simultaneous kissing scaffolds (SKS) may not be appropriate for the current Absorb scaffold.
Consensus from the 5th European Bifurcation Club meeting Hildick-Smith, David; Lassen, Jens Flensted; Albiero, Remo ...
EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
6, Issue:
1
Journal Article
The currently recommended duration of dual antiplatelet therapy (DAPT) in drug-eluting stent (DES) recipients is 12 months to reduce the risk of late stent thrombosis, particularly in those with ...acute coronary syndrome (ACS).
This study hypothesized that antiplatelet treatment with DAPT for 6 months may be noninferior to 24-month DAPT in aspirin-sensitive patients.
A multicenter, randomized study assigned patients undergoing implantation of everolimus-eluting stents with confirmed nonresistance to aspirin to receive 6- or 24-month DAPT. The primary endpoint was a composite of death, myocardial infarction, urgent target vessel revascularization, stroke, and major bleeding at 12 months post-stenting.
A total of 2,031 patients were enrolled in 70 European and Middle Eastern centers. The trial was prematurely terminated due to recruitment problems, leaving 941 patients randomized to 24-month DAPT and 953 to 6-month DAPT. The 2 treatment groups had similar baseline and procedural characteristics. There was no significant difference in the primary endpoint (24-month: 1.5% vs. 6-month: 1.6%; p = 0.85). Noninferiority was demonstrated for 6- versus 24-month DAPT, with an absolute risk difference of 0.11% (95% confidence interval: -1.04% to 1.26%; p for noninferiority = 0.0002). There were no significant differences in stent thrombosis or bleeding complications. In the 792 (44%) high-risk patients with ACS, primary and secondary endpoints did not significantly differ (hazard ratio: 1.7 95% confidence interval: 0.519 to 6.057; p = 0.361).
Rates of bleeding and thrombotic events were not significantly different according to 6- versus 24-month DAPT after PCI with new-generation DES in good aspirin responders. (Is There A LIfe for DES After Discontinuation of Clopidogrel ITALICplus; NCT01476020).
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