Biodegradable- Versus Durable-Polymer Drug-Eluting Stents for STEMI

Pilgrim, Thomas; Müller, Olivier; Heg, Dik; Roffi, Marco; Kurz, David J.; Moarof, Igal; Weilenmann, Daniel; Kaiser, Christoph; Tapponnier, Maxime; Losdat, Sylvain; Eeckhout, Éric; Valgimigli, Marco; Jüni, Peter; Windecker, Stephan; Iglesias, Juan F.

doi:10.1016/j.jcin.2020.12.011

Cited by 43 publications

(35 citation statements)

References 21 publications

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“…Generally, stents are needed temporarily (until healing and re-endothelialization are obtained) for their short-term benefits, while in the long term they tend to create severe complications associated with leftover metal. To diminish adverse effects, like chronic inflammation, restenosis, late-stage thrombosis, and vessel size mismatch, a new generation of devices (described in the literature as bioresorbable stents, biodegradable stents, or bioresorbable vascular scaffolds) is currently being developed [25,30,32,75,[78][79][80][81].…”

Section: Bioresorbable Stentsmentioning

confidence: 99%

“…They have been proven to be well-tolerated in vivo, having similar mechanical properties to non-degradable metals [31,32,110]. By reducing the contact time between the stent surface and the blood flow, bioabsorbable stents provide positive outward remodeling after biodegradation, an improved possibility of later surgical revascularization, facilitation of secondary reintervention, and a lower risk of late stent thrombosis [19,25,80,111].…”

Section: Bioresorbable Stentsmentioning

confidence: 99%

“…Years later, as a solution to these issues, the deployment of drug-eluting stents (DESs) became an integral treatment option for patients with coronary artery disease [ 23 ]. Coronary DESs not only revolutionized PCI treatment but have also been approved as the current standard as they significantly reduce restenosis of vascular stents and mitigate the need for repeat revascularizations [ 20 , 24 , 25 ].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Cardiovascular Stents: A Review of Past, Current, and Emerging Devices

et al. 2021

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One of the leading causes of morbidity and mortality worldwide is coronary artery disease, a condition characterized by the narrowing of the artery due to plaque deposits. The standard of care for treating this disease is the introduction of a stent at the lesion site. This life-saving tubular device ensures vessel support, keeping the blood-flow path open so that the cardiac muscle receives its vital nutrients and oxygen supply. Several generations of stents have been iteratively developed towards improving patient outcomes and diminishing adverse side effects following the implanting procedure. Moving from bare-metal stents to drug-eluting stents, and recently reaching bioresorbable stents, this research field is under continuous development. To keep up with how stent technology has advanced in the past few decades, this paper reviews the evolution of these devices, focusing on how they can be further optimized towards creating an ideal vascular scaffold.

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Section: Bioresorbable Stentsmentioning

confidence: 99%

Section: Bioresorbable Stentsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cardiovascular Stents: A Review of Past, Current, and Emerging Devices

et al. 2021

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“…In the BIOSTEMI trial, there was no signi cant difference in clinical indicated TLR at 1year, but a signi cant difference in the TLR was permitted at the 2 year follow-up. [4,5] TLR was mainly caused by in-stent restenosis mostly due to neointimal hyperplasia.…”

Section: Discussionmentioning

confidence: 99%

Better vascular healing of ultrathin strut biodegradable-polymer sirolimus-eluting stents in patients with acute coronary syndrome

Kawamura¹,

Egami²,

Kawanami³

et al. 2021

Preprint

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This study aimed to compare the strut coverage between Orsiro ultrathin struts biodegradable polymer sirolimus-eluting stents (O-SES) and Xience thin struts durable polymer everolimus-eluting stents (X-EES) in acute coronary syndrome (ACS) patients using optical coherence tomography (OCT). In BIOSTEMI trial, O-SESs were superior to X-EESs with respect to target lesion failure (TLF) in ACS patients. However, there were few reports comparing intravascular imaging between the two stents in ACS. Between August 2016 and February 2020, 50 lesions from 50 ACS patients who underwent OCT-guided percutaneous coronary intervention (PCI) were enrolled. We compared mid-term vascular healing using OCT between O-SESs and X-EESs at 8-month after stenting. The protocol was approved by the Osaka Rosai Hospiral ethics committee. Among 50 lesions, the X-EES group consisted of 25 lesions and the O-SES of 25 lesions. The percentage of covered strut, the percentage of malapposed strut and mean neointimal thickness at 8-month were evaluated. In the 8-month OCT analysis, the proportion of covered strut was significantly higher in the O-SES group than in in the X-EES group (97.3% vs. 86.0%; p = 0.001). On the other hand, there were no significant differences in the frequency of malapposed strut (0.4% vs 1.0%, p = 0.238). The O-SES group had the tendency of thinner neointima compared to the X-EES group (60µm vs 76µm, p = 0.089). Compared to X-EESs, O-SESs showed better mid-term vascular healing and tended to have thinner neointima in ACS patients. Ultra-thin strut may play a key role in better vascular healing.

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“…It was surprising to see a group of BP-DES with Orsiro among them fail to outperform DP-DES for late stent thrombosis. Recent 2-year clinical data from the BIOSTEMI trial comparing DP-DES Xience (Abbot) to BP-DES Orsiro (Biotronik) in STEMI patients also showed that DP-DES Xience performance was non-inferior to BP-DES Orsiro performance for stent-thrombosis [23].…”

Section: Introductionmentioning

confidence: 99%

Factors Influencing 1st and 2nd Generation Drug-Eluting Stent Performance: Understanding the Basic Pharmaceutical Drug-in-Polymer Formulation Factors Contributing to Stent Thrombosis Do We Really Need to Eliminate the Polymer?

Srdanovic

2021

J Pharm Pharm Sci

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Drug-eluting stents (DES) have a major role in treating cardiovascular disease. The evolution of bare metal stents into 1st generation durable-polymer DES (DP-DES) reduced the rate of in-stent restenosis (ISR) and the need for repeat-revascularization. However, clinical outcomes showed similar rates of late stent thrombosis (ST<1 year) and higher rates of very late stent thrombosis (ST>1 year) necessitating the advent of 2nd generation more biocompatible polymer DES and biodegradable-polymer DES (BP-DES) that reduced ST rates with shorter dual anti-platelet therapy (DAPT). Despite the improvements in drugs and polymer biocompatibility for both durable and biodegradable polymers, stent thrombosis remains an issue. Doubts remain about the safety and efficacy of the more biocompatible 2nd generation durable polymers in respect to vessel inflammatory and thrombogenic response as compared to biodegradable polymers despite clinical trial and meta-analyses evidence indicating that 2nd generation DP-DES are non-inferior to BP-DES for stent thrombosis. A long-term presence of the polymer can cause inflammation and thrombogenesis. However, the cause of stent thrombosis is multi-factorial from a drug-in-polymer formulation perspective; e.g., drug release kinetics, drug physiochemical and pharmacological properties, degradation kinetics; polymer biocompatibility and hemocompatibility and coating properties. It appears that the focus should be on controlling burst release and developing more biocompatible, durable polymers, especially considering the cost of PCI utilizing biodegradable, polymer-free and bioresorbable scaffolds. This may give an insight into certain DP-DES effectiveness as compared to BP-DES for the existing clinical data and improve future stent development.

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Biodegradable- Versus Durable-Polymer Drug-Eluting Stents for STEMI

Cited by 43 publications

References 21 publications

Cardiovascular Stents: A Review of Past, Current, and Emerging Devices

Cardiovascular Stents: A Review of Past, Current, and Emerging Devices

Better vascular healing of ultrathin strut biodegradable-polymer sirolimus-eluting stents in patients with acute coronary syndrome

Factors Influencing 1st and 2nd Generation Drug-Eluting Stent Performance: Understanding the Basic Pharmaceutical Drug-in-Polymer Formulation Factors Contributing to Stent Thrombosis Do We Really Need to Eliminate the Polymer?

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