Platelet reactivity over time in coronary artery disease patients treated with a bioabsorbable everolimus-eluting scaffold

Tello‐Montoliu, Antonio; Rivera, José; Hernández-Romero, Diana; Nicolás-Silvente, Ana I.; Jover, Eva; Quintana, Miriam; Orenes‐Piñero, Esteban; Hurtado, José Antonio; Ferreiro, José Luis; Marı́n, Francisco; Valdés, Mariano

doi:10.1080/09537104.2016.1184750

Cited by 5 publications

(3 citation statements)

References 29 publications

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“…Similar results were also shown in the small single center AMC registry, where the rate of early BVS thrombosis was 2.2%: in two cases it was attributable to technical issues and in one to premature dual antiplatelet therapy (DAPT) interruption (5). In this view, we recently proposed that DAPT administration should continue up to 3 years after BVS administration (6) following recent laboratoristic and clinical data on the matter (7,8).…”

Section: Clinical Datasupporting

confidence: 54%

Occurrence and management of bioresorbable vascular scaffold failure in real-life studies

Cortese

Elwany

2017

J. Thorac. Dis.

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Bioresorbable vascular scaffold (BVS) has emerged as a new technology aiming at overcoming some drawbacks of the conventional metallic stent. In spite of the initial promising results, this technology stumbled upon numerous challenges, which were revealed in the real world studies. Thanks to real world trials and registries findings, our knowledge about the BVS has grown over time, thus we have understood on BVS behavior in various settings and formulated better implantation techniques. In this article, we will review the incidence of BVS failure in real world studies, its different etiologies and management strategies.

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Section: Clinical Datasupporting

confidence: 54%

Occurrence and management of bioresorbable vascular scaffold failure in real-life studies

Cortese

Elwany

2017

J. Thorac. Dis.

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“…Another piece of the puzzle comes from a recent study showing an increased platelet reactivity in the BVS group compared to the metallic stent (13), possibly caused by the greater intraluminal mass attributed to intravascular thrombi in BVS compared to its metallic counterpart (14). Although the latter is a small-sample study and these findings should be interpreted cautiously, the idea that has launched seems to be intriguing and provocative and could be annotated as a cause for higher ScaT with BVS.…”

mentioning

confidence: 74%

Should we reconsider dual antiplatelet therapy duration following bioresorbable scaffold angioplasty?

et al. 2017

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In the last years, the fourth revolution of interventional cardiology, represented by bioresorbable vascular scaffolds (BVS), became real. BVS's prerogatives are a good radial force to counter back acute vessel recoil for the time needed, then a complete disappearance after few years. Latest generation drug-eluting stents (DES) showed that a reduction in dual antiplatelet therapy (DAPT) could be afforded if clinically needed without incurring in thrombotic events (1,2), even if the DAPT trial showed that a 2.5 years prolonged DAPT was associated with reduced myocardial infarction, stent thrombosis (ST) and MACE, at the expense of higher bleeding rates (3-5).The principal advantage of avoiding an eternal metallic prosthesis with BVS is expected to be a reduction in very late (generally >3 years) thrombotic events. But in the time being, which is the correct duration of DAPT to prevent scaffold thrombosis (ScaT)?Unfortunately, the scare of ScaT, which has emerged since the early results of the GHOST-EU registry (6), has affected the confidence of a not negligible number of operators. In this light, the authors of this real-life registry concluded that BVS angioplasty with Absorb (Abbott Vascular, Santa Clara, USA) was affected by a higher rate of ScaT if compared with ST with the latest generation of DES. This is particularly true in the patients with diabetes mellitus or presenting with ostial lesions in which BVS strategy should be weighed carefully with an optimal implantation following the manufacturer instructions thus improving the procedural results and evaluating a more aggressive antiplatelet therapy in a bid to minimize ScaT (7).In this view, our group conducted an experts' survey on BVS in 2014 (8,9) and thereafter in 2016 (10) whose results were surprising at that time. Although international guidelines (11) suggest a DAPT duration of one year both after DES and BVS implantation, half of the so-called "Tech-experts" (operators with more than 20 implants until 2014) interviewed in 2014 indicated a longer DAPT duration after Absorb angioplasty in order to prevent ScaT. Interestingly, in the 2016 survey (10) only 8% of Experts suggested prolonging DAPT >12 months, although they also believed that a longer DAPT was needed after BVS implantation compared to DES.In the recently published results of the ABSORB II study (12) the authors reported six very late ScaT between 1 and 3 years in the absorb arm compared to 0 events in the DES group. Notably, no one of the six patients was on DAPT at that time. Conversely, no ScaT occurred in patients on DAPT up to 3 years. Nevertheless it should be highlighted that the study was underpowered for clinical endpoint and affected by suboptimal implantation technique with low rate of BVS postdilatation.Another piece of the puzzle comes from a recent study showing an increased platelet reactivity in the BVS group compared to the metallic stent (13), possibly caused by the greater intraluminal mass attributed to intravascular thrombi in BVS compared to its metallic counterpa...

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“…These include a more demanding implantation technique and presence of quadratic thicker struts associated with larger in-scaffold areas exposed to high endothelial shear stress leading to release of potent platelet agonists (i.e. adenosine diphosphate and thromboxane A 2 ) with eventually greater induction of platelet activation and increased thrombogenicity [ 9 – 11 ]. Late scaffold thrombosis has been associated with DAPT discontinuation [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Guided de-escalation of DAPT in acute coronary syndrome patients undergoing percutaneous coronary intervention with BVS implantation: a post-hoc analysis from the randomized TROPICAL-ACS trial

Kołtowski

Tomaniak

Groß

et al. 2019

J Thromb Thrombolysis

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To investigate the safety and efficacy of an early platelet function testing (PFT)-guided de-escalation of dual antiplatelet treatment (DAPT) in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) with bioresorbable vascular scaffolds (BVS). Early DAPT de-escalation is a new non-inferior alternative to 12-months DAPT in patients with biomarker positive ACS treated with stent implantation. In this post-hoc analysis of the TROPICAL-ACS trial, which randomized 2610 ACS patients to a PFT-guided DAPT de-escalation (switch from prasugrel to clopidogrel) or to control group (uniform prasugrel), we compared clinical outcomes of patients (n = 151) who received a BVS during the index PCI. The frequency of the primary endpoint (cardiovascular death, myocardial infarction, stroke or BARC ≥ 2 bleeding) was 8.8% (n = 6) in the de-escalation group vs. 12.0% (n = 10) in the control group (HR 0.72, 95% CI 0.26–1.98, p = 0.52) at 12 months. One early definite stent thrombosis (ST) occurred in the control group (day 19) and 1 possible ST (sudden cardiovascular death) in the de-escalation group (day 86), both despite prasugrel treatment and in a background of high on-treatment platelet reactivity assessed at day 14 after randomization (ADP-induced platelet aggregation values of 108 U and 59 U, respectively). A PFT-guided DAPT de-escalation strategy could potentially be a safe and effective strategy in ACS patients with BVS implantation but the level of platelet inhibition may be of particular importance. This hypothesis-generating post-hoc analysis requires verification in larger studies with upcoming BVS platforms.

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Platelet reactivity over time in coronary artery disease patients treated with a bioabsorbable everolimus-eluting scaffold

Cited by 5 publications

References 29 publications

Occurrence and management of bioresorbable vascular scaffold failure in real-life studies

Occurrence and management of bioresorbable vascular scaffold failure in real-life studies

Should we reconsider dual antiplatelet therapy duration following bioresorbable scaffold angioplasty?

Guided de-escalation of DAPT in acute coronary syndrome patients undergoing percutaneous coronary intervention with BVS implantation: a post-hoc analysis from the randomized TROPICAL-ACS trial

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