New-generation metallic DES (EES/BES) were not superior to BVS in terms of angiographic LLL and clinical outcomes. (Comparison of Everolimus- and Biolimus-Eluting Stents With Everolimus-Eluting Bioresorbable Vascular Scaffold Stents [EVERBIO II]; NCT01711931).

Background— Everolimus-eluting bioresorbable vascular scaffolds have been developed to improve late outcomes after coronary interventions. However, recent registries raised concerns regarding an increased incidence of scaffold thrombosis (ScT). The mechanism of ScT remains unknown. Methods and Results— The present study investigated angiographic and optical coherence tomography findings in patients experiencing ScT. Fifteen ScT (14 patients, 79% male, age 59±10 years) occurred at a median of 16 days (25%–75% interquartile range: 1–263 days) after implantation. Early ScT (<30 days) occurred in 8 cases (53%). Possible causal factors in these patients included insufficient platelet inhibition in 2 cases and procedural factors (scaffold underexpansion, undersizing, or geographical miss) in 4 cases. No obvious cause could be found in 2 early ScT. In late (>1 month) and very late (>1 year) ScT (respectively, 5 and 2 cases), 5 scaffolds showed intimal neovessels or marked peristrut low-intensity areas. Scaffold fractures were additionally found in 2 patients, and scaffold collapse was found in 1 patient with very late ScT. Extensive strut malapposition was the presumed cause for ScT in 1 case. One scaffold did not show any morphological abnormality. Thrombectomy specimens were analyzed in 3 patients and did not demonstrate increased numbers of inflammatory cells. Conclusions— The mechanisms of early ScT seem to be similar to metallic stents (mechanical and inadequate antiplatelet therapy). The predominant finding in late and very late ScT is peristrut low-intensity area.

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We sought to compare operator radiation exposure during procedures using right femoral access (RFA), right radial access (RRA), and left radial access (LRA) during coronary angiography (CA) and percutaneous coronary intervention (PCI). Because of an increased incidence of long-term malignancy in interventional cardiologists, operator radiation exposure is of rising concern. This prospective study included all consecutive patients who underwent elective or emergency CA -PCI from September 2014 to March 2015. The primary end point was operator radiation exposure, quantified as the ratio of operator cumulative dose (CD) and patient radiation reported as dose-area product ( The LRA showed lower CD compared with RRA (p <0.001). There were no significant differences in DAP among the 3 access sites. FT was similar for the 3 groups (RFA 7 -7, RRA 5 -5, LRA 6 -5 minutes, RFA vs RRA: p [ 1, RFA vs LRA: p [ 0.16, RRA vs LRA: p [ 0.52). In conclusion, the use of RFA during CA -PCI is associated with significantly lower operator radiation exposure compared with RRA. LRA is associated with significantly lower operator radiation exposure compared with RRA.Because of a presumably increased stochastic risk of cancer induction among interventional cardiologists, especially neoplasms of the unprotected brain, nasopharyngeal tract, and upper extremities, operator radiation exposure during coronary angiography (CA) and/or percutaneous coronary intervention (PCI) is of rising concern. 1,2 Therefore, we undertook a comparison of operator radiation exposure during right femoral access (RFA), left radial access (LRA), and right radial access (RRA) during CA and CA followed by ad hoc PCI in a real-world population. MethodsFrom September 2014 to March 2015 at the University and Hospital Fribourg, all consecutive procedures of elective or emergency CA and CA followed by ad hoc PCI were prospectively considered for operator radiation exposure measurements. Procedures were performed by 5 senior interventional cardiologists with significant experience (>3,000 PCI each) in both femoral and radial access routes. Selection of the percutaneous access site was left to the discretion of the operator. Crossover access site procedures were excluded. This study was part of the Catheterization Registry Fribourg (CardioFR), which was approved by the Ethics Committee of Canton Vaud (protocol no: 339/14).The primary end point of the study was operator radiation exposure, expressed as the cumulative equivalent dose (in mSv) over the lead apron at chest level, normalized for the patient radiation exposure (dose-area product [DAP] in Gycm 2 ). Secondary end points included cumulative dose (CD), DAP, and fluoroscopy time (FT).Procedures were performed on a digital single-plane cineangiography unit (Allura FD10; Philips Medical Systems, Hamburg, Germany) with an undertable x-ray tube MRC20025 with a magnification factor leading to a field of view of 21 cm and an acquisition frequency of 15 frames/s. All procedures were performed with respect to current guidel...

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AimsTo compare endothelium-dependent vasomotor function and vascular healing 15 months after implantation of two new-generation drug-eluting stents and biovascular scaffolds (BVS).Methods and resultsA total of 28 patients previously treated with a SYNERGY stent (bioabsorbable polymer everolimus-eluting stents (BP-EES)), a PROMUS stent (persistent polymer everolimus-eluting stents (PP-EES)) or an ABSORB (BVS) underwent control coronary angiography, 15 months after implantation, coupled with optical coherence tomography imaging and supine bicycle exercise. Intracoronary nitroglycerin was administered after exercise testing. Coronary vasomotor response was assessed using quantitative coronary angiography at rest, during supine bicycle exercise and after nitroglycerin. The primary end point was the percent change in mean lumen diameter compared with baseline. Secondary end points were strut coverage and apposition.There were no significant differences in vasomotor response between the three treatment groups. Patients with PP-EES showed significant vasoconstriction of the proximal peristent segment at maximum exercise (P=0.02). BP-EES (2.7%, 95% CI 0 to 5.5) and BVS (3.2%, 95% CI 0 to 6.7) showed less uncovered struts than PP-EES (12.1%, 95% CI 2.9 to 21.3, P=0.02 and 0.09, respectively). Complete strut apposition was more frequently seen with BP-EES (99.6%, 95% CI 99.2 to 100) than with BVS (98.9%, 95% CI 98.2 to 99.6, P=0.04) or PP-EES (95.0%, 95% CI 91.6 to 98.5, P=0.001).ConclusionBVS and thin strut BP-EES have a reassuring vasomotion profile, suggesting minimal endothelial dysfunction 15 months after implantation.