Ultrathin Struts Drug-Eluting Stents: A State-of-the-Art Review

Leone, Attilio; Simonetti, Fiorenzo; Avvedimento, Marisa; Angellotti, Domenico; Molaro, Maddalena Immobile; Franzone, Anna; Esposito, Giovanni; Piccolo, Raffaele

doi:10.3390/jpm12091378

Cited by 15 publications

(13 citation statements)

References 62 publications

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“…Despite the undeniable development of stent technology and the undisputed revolution linked with the introduction to the clinical practice of second-generation DES 25 still, the diabetes population seems to have a faint advantage from this novel technology 26,27 Several conceptional improvements in stent design and modality had been postulated and introduced to clinical practice to overcome these limitations. 28,29 Especially high expectations had been associated with bioresorbable materials [30][31][32] -two different concepts have been proposed to use the advantage of these novel materials. First used combination of modern DES technology with bioresorbable polymers designed for optimal release kinetic of the antiproliferative drugs.…”

Section: Discussionmentioning

confidence: 99%

Mid-term safety and efficacy of magnesium bioresorbable vascular scaffolds – magmaris in diabetic population. 2-Years outcome in acute coronary syndrome cohort

Włodarczak

Rola

Barycki

et al. 2023

Diabetes and Vascular Disease Research

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Background Diabetes type 2 is one of the strongest risk factors affecting coronary artery disease (CAD) and is also a marker of poor short and long-term prognosis in subjects with acute coronary syndrome (ACS) treated with percutaneous coronary intervention (PCI) with subsequent drug-eluting stent (DES) implantation. Chronic local vascular inflammation along with endothelial dysfunction is postulated to be the pathophysiological background of unfavorable results. The second generation of metallic magnesium BRS –Magmaris (Biotronik, Berlin, Germany) had been introduced to clinical practice to overcome these limitations. Methods We evaluated 2-years clinical outcomes after Magmaris BRS implantation in NSTE-ACS diabetic ( n-72) and non-diabetic ( n-121) cohorts. Results No significant differences between diabetic and non-diabetes cohorts were noticed in terms of Primary Outcome (cardiac death, myocardial infarction, stent thrombosis) (8.1% vs 3.3% p = 0.182) and Principal secondary outcome – TLF- target lesion failure (9.5% vs 3.3% p = 0.106) at 2-years follow-up. Conclusions 2-years outcome suggests good safety and efficacy of the magnesium BRS (Magmaris) in NSTE- ACS and concomitant DM. Nevertheless, there is a strong need for large multicenter, randomized, prospective studies for a full assessment of this novel device in diabetic patients with ACS.

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Section: Discussionmentioning

confidence: 99%

Mid-term safety and efficacy of magnesium bioresorbable vascular scaffolds – magmaris in diabetic population. 2-Years outcome in acute coronary syndrome cohort

Włodarczak

Rola

Barycki

et al. 2023

Diabetes and Vascular Disease Research

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“…A smaller surface area accelerates endothelialization and strut coverage after implantation. According to the recent meta-analysis of 16 randomized trials, ultrathin-strut DESs were associated with reduced risks of TLF and target-vessel failure (TVF) compared with conventional second-generation thin-strut DESs [ 28 ]. Subgroup analysis according to the different DES types and comparators showed no relative interaction, supporting the concept that the ultra-thin strut design was responsible for the advantage reported in these trials.…”

Section: Stent Design and Outcomesmentioning

confidence: 99%

Drug-Eluting Stents: Technical and Clinical Progress

et al. 2023

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Drug-eluting stents (DES) demonstrated superior efficacy when compared to bare metal stents and plain-old balloon angioplasty and are nowadays used in almost all percutaneous revascularization procedures. The design of the stent platforms is constantly improving to maximize its efficacy and safety. Constant development of DES includes adoption of new materials used for scaffold production, new design types, improved overexpansion abilities, new polymers coating and, finally, improved antiproliferative agents. Especially nowadays, with the immense number of available DES platforms, it is crucial to understand how different aspects of stents impact the effect of their implantation, as subtle differences between various stent platforms could impact the most important issue—clinical outcomes. This review discusses the current status of coronary stents and the impact of stent material, strut design and coating techniques on cardiovascular outcomes.

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“…chronic total occlusion), ultrathin-strut DESs (60 mm) have resulted in higher degrees of late lumen loss compared with thin-strut (81 mm) DES. 15 A stent fracture is defined as a complete or partial separation of a stent that appears contiguous at the time of original implantation. This complication affects local drug delivery and causes a loss of platform support.…”

Section: Predisposing Factors For In-stent Restenosismentioning

confidence: 99%

In-stent restenosis after percutaneous coronary intervention: emerging knowledge on biological pathways

Pelliccia,

Zimarino,

Niccoli

et al. 2023

European Heart Journal Open

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Percutaneous coronary intervention (PCI) has evolved significantly over the past four decades. Since its inception, in-stent restenosis (ISR) – the progressive reduction in vessel lumen diameter after PCI – has emerged as the main complication of the procedure. Although the incidence of ISR has reduced from 30% at 6 months with bare-metal stents (BMS) to 7% at 4 years with drug-eluting stents (DES), its occurrence is relevant in absolute terms because of the dimensions of the population treated with PCI. The aim of this review is to summarize the emerging understanding of the biological pathways that underlie ISR. ISR is associated with several factors, including patient-related, genetic, anatomic, stent, lesion and procedural characteristics. Regardless of associated factors, there are common pathophysiologic pathways involving molecular phenomena triggered by the mechanical trauma caused by PCI. Such biologic pathways are responses to the denudation of the intima during balloon angioplasty and involve inflammation, hypersensitivity reactions, and stem cell mobilization in particular of endothelial progenitor cells (EPCs). The results of these processes are either vessel wall healing or neointimal hyperplasia and/or neoatherosclerosis. Unraveling the key molecular and signal pathways involved in ISR is crucial to identify appropriate therapeutic strategies aimed at abolishing the ‘Achille’s heel’ of PCI. With this regard, we discuss novel approaches to prevent DES restenosis. Indeed, available evidence suggests that EPCs-capturing stents promote a rapid stent re-endothelisation, which in turn has the potential to decrease the risk of stent thrombosis and allow the use of a shorter duration of dual antiplatelet therapy.

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Ultrathin Struts Drug-Eluting Stents: A State-of-the-Art Review

Cited by 15 publications

References 62 publications

Mid-term safety and efficacy of magnesium bioresorbable vascular scaffolds – magmaris in diabetic population. 2-Years outcome in acute coronary syndrome cohort

Mid-term safety and efficacy of magnesium bioresorbable vascular scaffolds – magmaris in diabetic population. 2-Years outcome in acute coronary syndrome cohort

Drug-Eluting Stents: Technical and Clinical Progress

In-stent restenosis after percutaneous coronary intervention: emerging knowledge on biological pathways

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