Bioresorbable vascular scaffolds in patients with acute myocardial infarction: a new step forward to optimized reperfusion?

Alfonso, Fernándo; Cuesta, Javier; Bastante, Teresa; Rivero, Fernando; García-Guimarães, Marcos; Alvarado, Teresa; Benedicto, Amparo; Cortese, Bernardo; Byrne, Robert A.; Kastrati, Adnan

doi:10.21037/jtd.2016.03.75

Cited by 7 publications

(5 citation statements)

References 26 publications

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“…In particular, bioresorbable vascular scaffolds (BVS) are a commonly used polymeric endovascular implant, and, in spite of their benefits, concern has been raised due to the excess thrombosis and myocardial infarctions associated with BVS. 14,15 These adverse complications of BVS are a result of the large strut size, which alters the pulsatile arterial flow patterns and leads to arterial thrombosis and myocardial infarctions. Safe use of this technology requires a greater understanding of the basic mechanics of erosion 10 and interaction with the blood vessel wall.…”

Section: Introductionmentioning

confidence: 99%

Polymeric endovascular strut and lumen detection algorithm for intracoronary optical coherence tomography images

et al. 2018

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Polymeric endovascular implants are the next step in minimally invasive vascular interventions. As an alternative to traditional metallic drug-eluting stents, these often-erodible scaffolds present opportunities and challenges for patients and clinicians. Theoretically, as they resorb and are absorbed over time, they obviate the long-term complications of permanent implants, but in the short-term visualization and therefore positioning is problematic. Polymeric scaffolds can only be fully imaged using optical coherence tomography (OCT) imaging-they are relatively invisible via angiography-and segmentation of polymeric struts in OCT images is performed manually, a laborious and intractable procedure for large datasets. Traditional lumen detection methods using implant struts as boundary limits fail in images with polymeric implants. Therefore, it is necessary to develop an automated method to detect polymeric struts and luminal borders in OCT images; we present such a fully automated algorithm. Accuracy was validated using expert annotations on 1140 OCT images with a positive predictive value of 0.93 for strut detection and an R2 correlation coefficient of 0.94 between detected and expert-annotated lumen areas. The proposed algorithm allows for rapid, accurate, and automated detection of polymeric struts and the luminal border in OCT images.

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Section: Introductionmentioning

confidence: 99%

Polymeric endovascular strut and lumen detection algorithm for intracoronary optical coherence tomography images

et al. 2018

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“…The general plea today (50,51,62,65,66) is that further studies are required to gain a better understanding on advantages and limitations of bioresorbable and bioabsorbable stents as well as on the incidence and etiology of the feared stent thrombosis in real-world practice. This will enable physicians to prevent such daunting consequences.…”

Section: Discussionmentioning

confidence: 99%

Thrombotic responses to coronary stents, bioresorbable scaffolds and the Kounis hypersensitivity-associated acute thrombotic syndrome

et al. 2017

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Percutaneous transluminal coronary angioplasty with coronary stent implantation is a lifesaving medical procedure that has become, nowadays, the most frequent performed therapeutic procedure in medicine. Plain balloon angioplasty, bare metal stents, first and second generation drug-eluting stents, bioresorbable and bioabsorbable scaffolds have offered diachronically a great advance against coronary artery disease and have enriched our medical armamentarium. Stented areas constitute vulnerable sites for endothelial damage, endothelial dysfunction, flow turbulence, hemorheologic changes, platelet dysfunction, coagulation changes and fibrinolytic disturbances. Implant surface attracts several proteins such as albumin, fibronectin, fibrinogen, and complement that lead to complement system activation. Macrophages recognize the implant as foreign substance due to protein adsorption and its continuous presence results in macrophage differentiation and fusion into foreign body giant cells. Polymer coating, stent metallic platforms and the released drugs can act as strong antigenic complex that apply continuous, repetitive, persistent and chronic hypersensitivity irritation to the coronary intima. The concomitant administration of oral antiplatelet drugs and environmental exposures can induce hypersensitivity inflammation. A class of platelets, activated via high-affinity and low-affinity IgE hypersensitivity receptors FCγRI, FCγRII, FCεRI and FCεRII, can induce Kounis hypersensitivity-associated thrombotic syndrome inside the stented coronaries. Type III variant of this syndrome is diagnosed when coronary artery stent thrombosis is associated with thrombus infiltrated by eosinophils or mast cells and/or when coronary intima, media and adventitia adjacent to stent, is infiltrated by eosinophils or mast cells. Careful history of hypersensitivity reactions to all implanted materials and concomitant drugs with monitoring of inflammatory mediators as well as lymphocyte transformation studies to detect hypersensitivity must be undertaken in order to avoid disastrous consequences. Food and Drug Administration recommendations for coronary stent implantation should be applied also to bioresorbable scaffolds. Further studies with inert and non-allergenic implants are necessary.

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“…With such technology, all stent components (drug, polymer, or scaffold) are absorbed and none is left behind [13]. Although the evidence on such technology is promising, it is still limited [14].…”

Section: Discussionmentioning

confidence: 99%

Plaque Rupture-Induced Myocardial Infarction and Mechanical Circulatory Support in Alpha-Gal Allergy

Radwan

Gill

Ghazzal

et al. 2020

Case Reports in Cardiology

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Alpha-gal (AG) allergy is an IgE-mediated allergic reaction to galactose-alpha-1,3-galactose found in mammalian meat. Heparin, being derived from porcine intestinal tissue, may have a degree of cross-reactivity with AG antigen and thus place patients at risk for allergic and even anaphylactic reactions. This is especially important in patients with myocardial infarction (MI) and mechanical circulatory support, such as a left ventricular assist device (LVAD), since anticoagulation is immediately required. Therefore, individualized assessment and preoperative planning is needed regarding the use of heparin vs. nonheparinoid products in such a population.

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Bioresorbable vascular scaffolds in patients with acute myocardial infarction: a new step forward to optimized reperfusion?

Cited by 7 publications

References 26 publications

Polymeric endovascular strut and lumen detection algorithm for intracoronary optical coherence tomography images

Polymeric endovascular strut and lumen detection algorithm for intracoronary optical coherence tomography images

Thrombotic responses to coronary stents, bioresorbable scaffolds and the Kounis hypersensitivity-associated acute thrombotic syndrome

Plaque Rupture-Induced Myocardial Infarction and Mechanical Circulatory Support in Alpha-Gal Allergy

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