Bioresorbable polymer-based
drug-eluting stents (BP-EES) are comparable to durable polymer-based
drug-eluting stents (DP-ZES), suggested
the results from TRANSFORM-OCT, a prospective, randomized trial using
optical coherence tomography (OCT) to evaluate strut coverage and
neoatherosclerosis (NA).
Findings were reported at the 28th annual Transcatheter
Cardiovascular Therapeutics (TCT) scientific symposium. Sponsored by the
Cardiovascular Research Foundation (CRF), TCT is the world's premier
educational meeting specializing in interventional cardiovascular
medicine.
Role Of Strut Sirolimus-Eluting Stents In Treating Chronic Total Occlussions
Hybrid sirolimus-eluting stents with biodegradable polymer did not improve angiographic outcomes compared to everolimus-eluting stents with durable polymer.
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‘High rate of strut coverage and low rates of neoatherosclerosis with thin strut bioresorbable polymer-based and durable polymer-based drug-eluting stents has been observed in imaging studies.’
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To mitigate the risk related to durable polymer (DP), bioabsorbable polymers (BP) that coat only the abluminal side of the stent, avoiding contact with circulating blood, and render stent surface similar to those of BMS after complete absorption, have been developed. Whether BP abluminal coating may counteract in-vivo delayed healing and NA development in current thin-strut DES is unknown.
TRANSFORM-OCT
randomized 90 patients with multivessel disease (1:1) to a BP
everolimus-eluting stent (BP-EES, Synergy) or a DP zotarolimus-eluting
stent (DP-ZES, Resolute Integrity). The primary endpoints were maximum
length of consecutive frames with uncovered struts at three months
(powered for non-inferiority of BP-EES) and the percentage of patients
presenting with frames of NA at 18 months (powered for superiority of
BP-EES) as measured by OCT.
![Scientists Develop Bioresorbable Stents With Drug-delivering Nanoparticles]( "Scientists Develop Bioresorbable Stents With Drug-delivering Nanoparticles")
Several companies are now focusing on using biodegradable scaffolds that completely break down into smaller components to be reabsorbed by the body.
The three-month median percentage of covered struts was 79.1 (IQR 60.4, 89.8) for BP-EES and 78.4 (IQR 62.1, 87.8) for DP-ZES, P=0.93. The 18-month median percentage of covered struts was 99.4 (IQR 96.6-100) for BP-EES and 98.0 (IQR 94.4-99.8) for DP-ZES, P=0.14. The co-primary endpoint of in-stent NA at 18 months from 98.9% of all eligible patients was 11.6 % for BP-EES versus 15.9% in DP-ZES (P=0.59) with low percentage of frames with NA in both stent types (1.1 ± 3.1 for BP-EES versus 2.5 ± 9.1 for DP-ZES, P=0.33)
"In this head-to-head in-vivo comparison of early and late healing response, the bioresorbable abluminal polymer Synergy everolimus-eluting stent was non-inferior at three-month and similar at 18-month follow-up to the durable conformal polymer Resolute zotarolimus-eluting stent," said Giulio Guagliumi with Ospedale Giovanni XXIII in Bergamo, Italy. "TRANSFORM-OCT adds a novel mechanistic dimension to the assessment of new-generation drug-eluting stents, consolidating the understanding that well designed and biocompatible polymers, regardless of whether they are durable or biodegradable, may favorably impact the long-term vascular response of these stents."
Source: Eurekalert
Scientists Develop Bioresorbable Stents With Drug-delivering Nanoparticles
Several companies are now focusing on using biodegradable scaffolds that completely break down into smaller components to be reabsorbed by the body.
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The three-month median percentage of covered struts was 79.1 (IQR 60.4, 89.8) for BP-EES and 78.4 (IQR 62.1, 87.8) for DP-ZES, P=0.93. The 18-month median percentage of covered struts was 99.4 (IQR 96.6-100) for BP-EES and 98.0 (IQR 94.4-99.8) for DP-ZES, P=0.14. The co-primary endpoint of in-stent NA at 18 months from 98.9% of all eligible patients was 11.6 % for BP-EES versus 15.9% in DP-ZES (P=0.59) with low percentage of frames with NA in both stent types (1.1 ± 3.1 for BP-EES versus 2.5 ± 9.1 for DP-ZES, P=0.33)
"In this head-to-head in-vivo comparison of early and late healing response, the bioresorbable abluminal polymer Synergy everolimus-eluting stent was non-inferior at three-month and similar at 18-month follow-up to the durable conformal polymer Resolute zotarolimus-eluting stent," said Giulio Guagliumi with Ospedale Giovanni XXIII in Bergamo, Italy. "TRANSFORM-OCT adds a novel mechanistic dimension to the assessment of new-generation drug-eluting stents, consolidating the understanding that well designed and biocompatible polymers, regardless of whether they are durable or biodegradable, may favorably impact the long-term vascular response of these stents."
Source: Eurekalert
Benefits in Selective Use of Drug-eluting Stents
Limiting the use of drug-eluting stents to a selected group of patients saves money and do not increase death or heart attack risk.
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 Drug Eluting Stents Have Delayed Adverse EventsDrug eluting stents were better at preventing thrombosis, bleeding and cardiac problems than a bare metal coronary stent with continued thienopyridine. | Advertisement
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