Bioresorbable scaffolds: current concepts and future technology / "Scaffolds" bioabsorbibles: conceptos actuales y tecnología futura

The introduction of the drug-eluting (DES) stent to percutaneous coronary intervention (PCI) had a significant impact on patient management of coronary artery disease and has been called the "third revolution" in interventional cardiology after the first 2 revolutions of balloon angioplasty and bare-metal stents. The promise of adaptive remodeling, restoration of vasomotion, late luminal enlargement, and retained potential for future coronary artery bypass grafting at the site of previous PCI has been the driving force behind bioresorbable stent/scaffold (BRS) technology development. Moreover, because of the inherent risk of late and very late stent thrombosis, BRS potentially offers a solution and recent years have seen heightened interest, hype, and hope. In this current review, we are aiming to shed light on strength and weakness of various BRS including the future perspective. (AU)

La introducción del stent liberador de fármacos (DES) en la intervención coronaria percutánea (ICP) tuvo un impacto significativo en el tratamiento de los pacientes con enfermedad de las arterias coronarias y se ha denominado la "tercera revolución" en cardiología intervencionista después de las dos primeras revoluciones de la angioplastia con balón y stents de metal desnudo. La promesa de remodelación adaptativa, restauración de la vasomoción, agrandamiento luminal tardío y potencial retenido para futuros injertos de derivación de la arteria coronaria en el sitio de la PCI anterior ha sido la fuerza impulsora detrás del desarrollo de la tecnología de stent/armazón biorreabsorbible (BRS). Además, debido al riesgo inherente de trombosis del stent tardía y muy tardía, la BRS ofrece potencialmente una solución y en los últimos años se ha visto un mayor interés, entusiasmo y esperanza. En esta revisión actual, nuestro objetivo es arrojar luz sobre la fortaleza y la debilidad de varios BRS, incluida la perspectiva futura. (AU)

Techniques and material used in the percutaneous treatment of chronic coronary occlusions. Data from the CIBELES study.

INTRODUCTION: In recent years, various specific techniques and materials have been developed for the treatment of coronary chronic total occlusions (CTO). OBJECTIVE: To evaluate the current situation in the treatment of CTO (techniques and material) in our setting. METHODS: We evaluated data on techniques and material used in the CIBELES (ChronIc coronary occlusion treated By EveroLimus Eluting Stent) trial, a randomized comparison of sirolimus- and everolimus-eluting stents in 207 patients with CTO in 13 centers in Spain and Portugal. RESULTS: A radial approach was used in 23% of patients, and retrograde techniques were used in only 5%. A high number of balloons were used (2.2±0.9 per patient). Microcatheters were used in 33% of patients, and post-dilatation balloons in only 25%. The mean number of stents implanted per patient was 2.1±1.0, with a mean total stent length of 49±24 mm. Other devices and techniques used were: Tornus penetration catheter in 4% of patients, rotational atherectomy in 2%, and cutting balloon in 1%. Intracoronary ultrasound was used in only 6% of patients. In 34% of cases, operators used guidewires that were not specifically for CTO. Considerable variability between centers was detected in the use of different techniques, the highest and lowest variability being observed in the use of intracoronary ultrasound and the use of CTO guidewires, respectively. CONCLUSIONS: In the CIBELES trial, techniques and devices specifically designed for the treatment of CTO were used in a relatively low proportion of patients. Considerable variability between centers was detected.

Seguimiento a mediano plazo tras la implantación de stents coronarios convencionales en mujeres / Medium term follow-up after an implantation conventional coronary stents in women

El rol del género tras la implantación de stents coronarios aún suscita controversias. Se diseñó un estudio para caracterizar la evolución, a mediano plazo, de mujeres tratadas con stents coronarios entre enero del 2006 y diciembre del 2007. Se consideraron eventos cardíacos adversos mayores (ECAM): muerte cardíaca, infarto del miocardio no fatal y necesidad de revascularización de la lesión diana. Las tasas de supervivencia fueron estimadas por el método de Kaplan Meier. Se empleó el modelo de regresión de Cox en el análisis multivariado. Se incluyeron 162 mujeres, durante el seguimiento (12,9±4,7 meses), 32 sufrieron algún evento mayor, 3 presentaron infarto del miocardio no fatal y sólo una falleció. Las tasas de supervivencia libres de ECAM y revascularización de la lesión diana al a±o resultaron de 69,49 y 78,07 por ciento, respectivamente. La intervención multiarterial, la implantación de stents con diámetro menor de 3 mm y la disfunción sistólica del ventrículo izquierdo ensombrecieron el pronóstico durante el seguimiento(AU)

Gender role after coronary stents implantation even arouse controversies. This is a study to characterize the medium term course of women treated with coronary stents from January 2006 to December 2007. The following adverse cardiac major events (ACME) were considered: cardiac death, non-fatal myocardium infarct, and the need of revascularization of target lesion. Survival rates were estimated by means of Kaplan Meier method. In multivariate analysis Cox regression model was used. Were included 162 women during follow-up (12,9±4,7 months), 32 had some mayor event, 3 had a non-fatal myocardium infarct with only one deceased . ACME-free survival and revascularization of target lesions at a year were of 69,49 and 78,07 percent, respectively. Multi-arteries intervention, stents implantation with a diameter lesser than 3 mm, and systolic dysfunction of left ventricle shadowed the prognosis during follow-up(AU)

Seguimiento a mediano plazo tras la implantación de stents coronarios convencionales en mujeres / Medium term follow-up after an implantation conventional coronary stents in women

El rol del género tras la implantación de stents coronarios aún suscita controversias. Se diseñó un estudio para caracterizar la evolución, a mediano plazo, de mujeres tratadas con stents coronarios entre enero del 2006 y diciembre del 2007. Se consideraron eventos cardíacos adversos mayores (ECAM): muerte cardíaca, infarto del miocardio no fatal y necesidad de revascularización de la lesión diana. Las tasas de supervivencia fueron estimadas por el método de Kaplan Meier. Se empleó el modelo de regresión de Cox en el análisis multivariado. Se incluyeron 162 mujeres, durante el seguimiento (12,9±4,7 meses), 32 sufrieron algún evento mayor, 3 presentaron infarto del miocardio no fatal y sólo una falleció. Las tasas de supervivencia libres de ECAM y revascularización de la lesión diana al año resultaron de 69,49 y 78,07 %, respectivamente. La intervención multiarterial, la implantación de stents con diámetro menor de 3 mm y la disfunción sistólica del ventrículo izquierdo ensombrecieron el pronóstico durante el seguimiento.

Gender role after coronary stents implantation even arouse controversies. This is a study to characterize the medium term course of women treated with coronary stents from January 2006 to December 2007. The following adverse cardiac major events (ACME) were considered: cardiac death, non-fatal myocardium infarct, and the need of revascularization of target lesion. Survival rates were estimated by means of Kaplan Meier method. In multivariate analysis Cox regression model was used. Were included 162 women during follow-up (12,9±4,7 months), 32 had some mayor event, 3 had a non-fatal myocardium infarct with only one deceased . ACME-free survival and revascularization of target lesions at a year were of 69,49 and 78,07 %, respectively. Multi-arteries intervention, stents implantation with a diameter lesser than 3 mm, and systolic dysfunction of left ventricle shadowed the prognosis during follow-up.

Intervenções percutâneas em pacientes multiarteriais / Percutaneous coronary intervention in patients with multivessel disease

Discutimos os resultados dos sete estudos randomizados comparando a angioplastia transluminal coronária e a cirurgia de revascularização miocárdica no tratamento da doença coronária obstrutiva em pacientes multiarteriais. Os resultados demonstram que a mortalidade tardia foi semelhante entre as duas opções de tratamento e que a necessidade de reintervenção foi maior nos pacientes tratados com angioplastia. Os stents coronários foram capazes de reduzir as complicações imediatas e a reestenose coronária pós-angioplastia convencional. Analisamos os dois estudos já publicados, ARTS e ERACI II, comparando-se novamente as duas opções de tratamento. Os stents coronários otimizaram os resultados da angioplastia e reduziram a necessidade de reintervenção nos pacientes tratados percutaneamente. É possível que, no futuro, stents liberadores de drogas, tais como sirolimus e taxol,possam ser utilizados no tratamento desses pacientes, reduzindo ou mesmo abolindo as reintervenções pós-angioplastia...

We reviewed the results of 7 randomized trials, comparing percutaneous transluminal coronary angioplasty vs. coronary artery bypass grafting in the treatment of patients with multivessel coronary heart disease. The results showed no differences in the late mortality, but with more reinterventions in patients treated by percutaneous transluminal coronary angioplasty. The utilization of the coronary stents reduced the acute complications and the restenosis of percutaneous transluminal coronary angioplasty. In the analysis of the two published ARTS and ERACI II trials, we found an important reduction in the need of reinterventions in patients with multivessel disease. In the future the utilization of drug eluting stent with sirolimus or taxol can improve the results of percutaneous transluminal coronary angioplasty and reduce or abolish the need of reinterventions