eISSN: 1897-4295
ISSN: 1734-9338
Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej
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SCImago Journal & Country Rank
3/2018
vol. 14
 
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abstract:
Original paper

Procedural advantages of a novel coronary stent design with ultra-thin struts and bioabsorbable abluminal polymer coating in an all-comers registry

Haitham Abu Sharar, Bruna Gomes, Emmanuel Chorianopoulos, Ziya Kaya, Christian A. Gleissner, Hugo A. Katus, Raffi Bekeredijan

Adv Interv Cardiol 2018; 14, 3 (53): 240–246
Online publish date: 2018/09/21
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Introduction
The implications of novel drug-eluting stent (DES) design modifications including ultra-thin struts and new concepts of polymer coating for procedural efficacy are still unknown.

Aim
To evaluate procedural efficacy and short-term safety of a novel DES design.

Material and methods
In this all-comers registry, 407 consecutive patients were enrolled upon undergoing percutaneous coronary interventions (PCI) with the thin-strut bioabsorbable abluminal polymer-coated SYNERGY stent. These patients were then compared with the previous 407 patients undergoing PCI performed by the same interventionalists using currently established second-generation DES (Promus Element plus, Xience prime, Resolute Integrity). Several clinical and procedural data were compared, and the coronary artery complexity was assessed by the American College of Cardiology/American Heart Association classification and SYNTAX Score.

Results
The study population consisted of 814 patients. A total of 859 Synergy stents were deployed in 480 target vessels in the Synergy group (n = 407), and 904 stents in 469 vessels in the second-generation DES group (n = 407). Coincidentally, target lesions in the Synergy group (A 2.7%, B1 13.8%, B2 38.6%, C 45.0%) were more complex (p < 0.01) than those in the second-generation DES group (A 4.9%, B1 18.7%, B2 42.3%, C 34.2%). In cases with severe lesions (B2/C), the median contrast agent amount and fluoroscopy time were significantly lower in the Synergy group, indicating improved deliverability (110 ml vs. 150 ml; p < 0.01 and 7.2 min vs. 9.1 min; p = 0.01). Rates of in-hospital major adverse cardiovascular events were comparable between the two groups.

Conclusions
In an all-comers, real-world PCI population, novel stent design modifications including ultra-thin struts and abluminal bioabsorbable polymer coating are associated with improved procedural performance.

keywords:

coronary artery disease, percutaneous coronary intervention, drug-eluting stent, stent design, bioabsorbable polymer

references:
Kastrati A, Mehilli J, Dirschinger J, et al. Intracoronary stenting and angiographic results: strut thickness effect on restenosis outcome (ISAR-STEREO) trial. Circulation 2001; 103: 2816-21.
Foin N, Lee RD, Torii R, et al. Impact of stent strut design in metallic stents and biodegradable scaffolds. Int J Cardiol 2014; 177: 800-8.
Sullivan TM, Ainsworth SD, Langan EM, et al. Effect of endovascular stent strut geometry on vascular injury, myointimal hyperplasia, and restenosis. J Vasc Surg 2002; 36: 143-9.
Hara H, Nakamura M, Palmaz JC, et al. Role of stent design and coatings on restenosis and thrombosis. Adv Drug Deliv Rev 2006; 58: 377-86.
Briguori C, Sarais C, Pagnotta P, et al. In-stent restenosis in small coronary arteries: impact of strut thickness. J Am Coll Cardiol 2002; 40: 403-9.
Farb A, Weber DK, Kolodgie FD, et al. Morphological predictors of restenosis after coronary stenting in humans. Circulation 2002; 105: 2974-80.
Timmins LH, Miller MW, Clubb FJ, et al. Increased artery wall stress post-stenting leads to greater intimal thickening. Lab Invest 2011; 91: 955-67.
Stettler C, Wandel S, Allemann S, et al. Outcomes associated with drug-eluting and bare-metal stents: a collaborative network meta-analysis. Lancet 2014; 370: 937-48.
Dawkins KD, Grube E, Guagliumi G, et al.; TAXUS VI Investigators. Clinical efficacy of polymer-based paclitaxel-eluting stents in the treatment of complex, long coronary artery lesions from a multicenter, randomized trial: support for the use of drug-eluting stents in contemporary clinical practice. Circulation 2005; 112: 3306-13.
Camenzind E, Steg PG, Wijns W. Stent thrombosis late after implantation of first-generation drug-eluting stents: a cause for concern. Circulation 2007; 115: 1440-55.
Nordmann AJ, Briel M, Bucher HC. Mortality in randomized controlled trials comparing drug-eluting vs. bare metal stents in coronary artery disease: a meta-analysis. Eur Heart J 2006; 27: 2784-814.
Lagerqvist B, James SK, Stenestrand U, et al.; SCAAR Study Group. Longterm outcomes with drug-eluting stents versus bare-metal stents in Sweden. N Engl J Med 2007; 356: 1009-19.
Joner M, Finn AV, Farb A, et al. Pathology of drug eluting stents in humans: delayed healing and late thrombotic risk. J Am Coll Cardiol 2006; 48: 193-202.
Koppara T, Joner M, Bayer G, et al. Histopathological comparison of biodegradable polymer and permanent polymer based sirolimus eluting stents in a porcine model of coronary stent implantation. Thromb Haemost 2012; 107: 1161-71.
Kang SH, Park KW, Kang DY, et al. Biodegradable-polymer drug-eluting stents vs. bare metal stents vs. durable-polymer drug-eluting stents: a systematic review and Bayesian approach network meta-analysis. Eur Heart J 2014; 35: 1147-58.
Finn AV, Joner M, Nakazawa G, et al. Pathological correlates of late drug-eluting stent thrombosis: strut coverage as a marker of endothelialization. Circulation 2007; 115: 2435-41.
Daemen J, Wenaweser P, Tsuchida K, et al. Early and late stent thrombosis of sirolimus-eluting and paclitaxel-eluting stents in routine clinical practice: data from a large two-institutional cohort study. Lancet 2007; 369: 667-78.
Meredith IT, Verheye S, Dubois CL, et al. Primary endpoint results of the EVOLVE trial: a randomized evaluation of a novel bioabsorbable polymer coated, everolimus-eluting coronary stent. J Am Coll Cardiol 2012; 59: 1362-70.
Meredith IT, Verheye S, Weissman NJ, et al. Six-month IVUS and two-year clinical outcomes in the EVOLVE FHU trial: a randomised evaluation of a novel bioabsorbable polymer-coated, everolimus-eluting stent. Eurointervention 2013; 9: 308-15.
Kereiakes DJ, Meredith IT, Windecker S, et al. Efficacy and safety of a novel bioabsorbable polymer-coated, everolimus-eluting coronary stent: the EVOLVE II Randomized Trial. Circ Cardiovasc Interv 2015; 8: pii: e002372.
Wilson GJ, Huibregtse BA, Pennington DE, et al. Comparison of the SYNERGY with the PROMUS (XIENCE V) and bare metal and polymer-only element control stents in porcine coronary arteries. Eurointervention 2012; 8: 250-7.
Sianos G, Morel MA, Kappetein AP, et al. The SYNTAX Score: an angiographic tool grading the complexity of coronary artery disease. EuroIntervention 2005; 1: 219-27.
Escaned J, Collet C, Ryan N, et al. Clinical outcomes of state-of-the-art percutaneous coronary revascularization in patients with de novo three vessel disease: 1-year results of the SYNTAX II study. Eur Heart J 2017; 38: 3124-34.
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