Cobalt-chromium Everolimus-eluting Stent Research Articles

Abstract 13740: Significance of Chronic Low-Grade Inflammation and Diabetes Mellitus (DM) for Coronary Spasm Following Drug-Eluting Stent Implantation in Patients with Coronary Heart Disease (CHD)

Background: Coronary spasm is a manifestation of coronary endothelial dysfunction characterized by transient total or subtotal occlusion or severe diffuse vasoconstriction of an epicardial artery and contributes importantly to the pathogenesis of coronary heart disease (CHD). Coronary spasm and diabetes mellitus (DM) are reported to be associated with low-grade inflammation. However, it is unknown about the relation between chronic inflammation and DM in atherosclerotic high-risk patients following drug-eluting stent (DES) implantation. The aim was to examine the relation between coronary spasm and chronic inflammation or DM. Methods: We performed intracoronary acetylcholine test for coronary spasm provocation in 60 consecutive patients (41 male, age 69.1±9.1yrs) who had underwent new generation DES (cobalt-chromium everolimus-eluting stent, Xience (n=33); or biolimus-eluting stent, Nobori (n=27)) in left ascending coronary artery at 9 months before and examined plasma levels of tumor necrosis factor (TNF) α, interleukin-6 (IL-6), and high sensitivity C-reactive protein (hs-CRP) in the chronic phase without acute inflammation findings. Patients were divided into 3 groups: presence of both coronary spasm and DM (n=18), presence of each spasm or DM (n=31), and non-spasm and non-DM (n=11). Results: Coronary spasm was induced in 31 (51.6%) of 60 patients. Levels of TNFα, IL-6, and hs-CRP in spasm and DM group were increased compared with those in non-spasm and non-DM group (TNFα; 2.123±0.441 vs. 1.267±0.079 pg/ml, P=0.073: IL-6; 2.668±0.429 vs. 1.346±0.241 pg/ml, P=0.039: hs-CRP; 0.183±0.208 vs. 0.058±0.042 mg/dl, P=0.037). Levels of TNFα, IL-6, and hs-CRP in the each spasm or DM group were in between spasm / DM group and non-spasm / non-DM group, respectively (TNFα, 1.901±0.841pg/ml; IL-6, 2.125±0.651pg/ml; hs-CRP; 0.091±0.073mg/dl). Coronary spasm was not induced in statin-users among the total patients, and non-use of statin was associated with positive for coronary spasm (P=0.041) and increased inflammation levels. Conclusions: Coexistence of coronary spasm and DM in the chronic phase after new generation DES implantation may be associated with low-grade inflammation. The prevention of coronary spasm is related to the use of statin.

Effects of cobalt-chromium everolimus eluting stents or bare metal stent on fatal and non-fatal cardiovascular events: patient level meta-analysis

Objectives To examine the safety and effectiveness of cobalt-chromium everolimus eluting stents compared with bare metal stents.Design Individual patient data meta-analysis of randomised controlled trials. Cox proportional regression models stratified...

Stent selection to minimize the risk of stent thrombosis.

Compared with bare metal stents (BMS), first-generation drug-eluting stents (DES) have significantly reduced the risk of ischemia-driven target vessel revascularization, but have been associated with an increased risk of very late (beyond 1 year) stent thrombosis. Second-generation DES have been developed using different platforms, alternative drugs, and either more biocompatible durable polymers or bioabsorbable polymers. In this review, we will analyze whether the improved technology of this new class of devices has improved their safety profile. Recent data accruing from frequentist and network meta-analysis have challenged the notion that DES are less safe than BMS. Several studies have in fact reported that cobalt-chromium everolimus-eluting stents (CoCr-EES) coated with durable fluorinated polymers may be associated with significantly lower rates of stent thrombosis not only compared with other first and second-generation DES, but also compared with BMS. In addition, four independent network meta-analyses have suggested that CoCr-EES may have a better safety profile than bioabsorbable polymer-based DES. Recent data from the last 2 years have suggested a paradigm shift from the notion that DES are less safe than BMS to the converse. Regarding this, the thin-strut CoCr-EES has consistently been associated with the lowest rates of stent thrombosis.

TCT-364 Difference Of Stent Expansion Between Thin Strut Cobalt Chromium Platform And Thick Strut Stainless Platform In Calcified Lesions

Although it has been recognized that thin strut cobalt chromium everolimus-eluting stent (EES; Xience) is associated with less target lesion failure, it has lower radial force, and it had failed to prove superiority to thick strut paclitaxel-eluting stent in diabetes in some studies. We speculated

Comparison of early clinical outcomes between ABSORB bioresorbable vascular scaffold and everolimus‐eluting stent implantation in a real‐world population

To compare the early clinical outcomes between ABSORB bioresorbable vascular scaffold (BVS) (Abbott Vascular, Santa Clara, CA) and cobalt chromium everolimus-eluting stents in real-world patients with mostly complex disease. BVS represents the most interesting development in the drug-eluting stent field over recent years with promising results emerging from clinical trials. Available data however on the use of the ABSORB in real-world patients is limited. All patients (n = 92) treated with BVS and 1296 patients treated with EES were included in this study. Propensity score matching was performed to adjust for differences in baseline clinical characteristics, yielding 92 patient pairs (BVS = 92 patients with 137 lesions and EES = 92 patients with 124 lesions). Clinical outcomes were examined between the 2 groups at 6-months. In both groups, most lesions were classified as either B2 or C (83.9% vs. 77.4%, P = 0.19). Predilatation (97.8% vs. 75.8%, P < 0.01) as well as postdilation (99.3% vs. 77.4%, P < 0.01) was more common in the BVS group. Clinical outcomes at 6-months were similar between the two groups with respect to both target lesion revascularization (3.3% vs. 5.4%, P = 0.41) and major adverse cardiac events (defined as the composite of target vessel revascularization, follow-up myocardial infraction and all-cause death) (3.3% vs. 7.6%, P = 0.19). ABSORB BVS for the treatment of complex lesions appears to be associated with good procedural and early clinical outcomes similar to those observed with conventional drug-eluting stents. Larger studies with long-term follow-up are required in order to fully assess the role of BVS in the treatment of such lesions and how this compares with that of conventional stents. © 2014 Wiley Periodicals, Inc.

Impact of coronary stent designs on acute stent recoil

BackgroundAcute stent recoil has been often observed following stent delivery balloon deflation in coronary arteries and the recoil rate varies by stent design. Accordingly, the purpose of the present study was to evaluate the impact of stent designs on acute stent recoil after new generation drug-eluting stent implantation. Methods and resultsA total of 154 lesions [56 treated with biolimus-eluting stent (BES), 46 with cobalt chromium everolimus-eluting stent (CoCr-EES), and 52 with platinum chromium everolimus-eluting stent (PtCr-EES)] were evaluated. Quantitative coronary angiography was used to measure the minimal lumen diameter (MLD). MLD1 was defined as a MLD of complete expansion of the last stent delivery balloon at the highest pressure. MLD2 was defined as a MLD immediately after the last stent delivery balloon deflation. Acute stent recoil was determined by the calculation as (MLD1−MLD2)/MLD1. Acute stent recoil was significantly higher in the CoCr-EES group versus the BES group and PtCr-EES group (10.1±6.9%, 6.7±5.5%, and 6.5±4.8%, respectively, p=0.01). Multivariate linear regression analysis demonstrated that the use of CoCr-EES and the number of stent delivery balloon inflations were independent predictors of acute stent recoil (r=0.26, β=0.21, p=0.01 and r=−0.51, β=−0.58, p<0.01, respectively). ConclusionAcute stent recoil occurred more frequently with the CoCr-EES compared with both BES and PtCr-EES. Strategies with multiple balloon inflation might be needed to overcome this recoil phenomenon.

Biodegradable-polymer drug-eluting stents vs. bare metal stents vs. durable-polymer drug-eluting stents: a systematic review and Bayesian approach network meta-analysis

The aim of this study was to compare the safety and efficacy of biodegradable-polymer (BP) drug-eluting stents (DES), bare metal stents (BMS), and durable-polymer DES in patients undergoing coronary revascularization, we performed a systematic review and network meta-analysis using a Bayesian framework. Study stents included BMS, paclitaxel-eluting (PES), sirolimus-eluting (SES), endeavor zotarolimus-eluting (ZES-E), cobalt-chromium everolimus-eluting (CoCr-EES), platinium-chromium everolimus-eluting (PtCr-EES), resolute zotarolimus-eluting (ZES-R), and BP biolimus-eluting stents (BP-BES). After a systematic electronic search, 113 trials with 90 584 patients were selected. The principal endpoint was definite or probable stent thrombosis (ST) defined according to the Academic Research Consortium within 1 year. Biodegradable polymer-biolimus-eluting stents [OR, 0.56; 95% credible interval (CrI), 0.33-0.90], SES (OR, 0.53; 95% CrI, 0.38-0.73), CoCr-EES (OR, 0.34; 95% CrI, 0.23-0.52), and PtCr-EES (OR, 0.31; 95% CrI, 0.10-0.90) were all superior to BMS in terms of definite or probable ST within 1 year. Cobalt-chromium everolimus-eluting stents demonstrated the lowest risk of ST of all stents at all times after stent implantation. Biodegradable polymer-biolimus-eluting stents was associated with a higher risk of definite or probable ST than CoCr-EES (OR, 1.72; 95% CrI, 1.04-2.98). All DES reduced the need for repeat revascularization, and all but PES reduced the risk of myocardial infarction compared with BMS. All DESs but PES and ZES-E were superior to BMS in terms of ST within 1 year. Cobalt-chromium everolimus-eluting stents was safer than any DES even including BP-BES. Our results suggest that not only the biodegradability of polymer, but the optimal combination of stent alloy, design, strut thickness, polymer, and drug all combined determine the safety of DES.

Three-Year Results Comparing Platinum-Chromium PROMUS Element and Cobalt-Chromium XIENCE V Everolimus-Eluting Stents in De Novo Coronary Artery Narrowing (from the PLATINUM Trial)

In the randomized PLATINUM trial, the PROMUS Element platinum-chromium everolimus-eluting stent (PtCr-EES; Boston Scientific, Natick, Massachusetts) was noninferior to the XIENCE V cobalt-chromium everolimus-eluting stent (CoCr-EES; Boston Scientific and Abbott Vascular, Santa Clara, California) for the primary end point of 1-year target lesion failure. This study reports the 3-year outcomes. Patients (n=1,530) with 1 or 2 de novo native coronary artery lesions (baseline vessel diameter≥2.50 mm to ≤4.25 mm and length≤24 mm) were randomized 1:1 to PtCr-EES versus CoCr-EES. Three-year follow-up was available in 93.9% (703 of 749) of patients with CoCr-EES and 96.7% (733 of 758) of patients with PtCr-EES. Comparing CoCr-EES with PtCr-EES, 3-year rates of death (4.3% vs 3.7%, hazard ratio [HR] 0.88, 95% confidence interval [CI] 0.52 to 1.48, p=0.62), cardiac death (1.9% vs 1.2%, HR 0.63, 95% CI 0.27 to 1.45, p=0.27), myocardial infarction (2.5% vs 2.3%, HR 0.92, 95% CI 0.48 to 1.79, p=0.81), ischemia-driven target lesion revascularization (4.9% vs 3.5%, HR 0.72, 95% CI 0.43 to 1.20, p=0.21), and Academic Research Consortium definite or probable stent thrombosis (0.5% vs 0.7%, HR 1.23, 95% CI 0.33 to 4.57, p=0.76) were not significantly different. In conclusion, 3-year results of the PLATINUM randomized, controlled, clinical trial demonstrate comparable safety and efficacy outcomes of the PROMUS Element PtCr-EES and the XIENCE V CoCr-EES.

Circulation : Clinical Summaries

<i>Circulation</i> : Clinical Summaries

Comparação da retração aguda do stent entre o suporte vascular bioabsorvível eluidor de everolimus e dois diferentes stents metálicos farmacológicos

INTRODUCAO: Suportes vasculares bioabsorviveis (SVB) tem sido desenvolvidos como forma de fornecer sustentacao a parede do vaso enquanto ocorre o processo de cicatrizacao, apos a intervencao coronaria percutânea (ICP), sendo absorvido posteriormente. Pelo fato da plataforma ser de material polimerico, existe preocupacao em relacao a retracao aguda do dispositivo. Avaliamos aqui a retracao aguda do SVB com a de dois diferentes stents farmacologicos metalicos. METODOS: Foram incluidos 50 pacientes com lesoes nao complexas. Dentre esses pacientes, 25 foram tratados com SVB e comparados a outros 25 pacientes tratados com stent de cromo-cobalto eluidor de everolimus (EES; n = 12) ou stent de aco inoxidavel eluidor de biolimus (BES; n = 13). A retracao aguda foi definida como a diferenca entre o diâmetro medio do balao durante a pressao maxima de inflacao (X) e o diâmetro medio do stent apos o esvaziamento do balao (Y). A porcentagem de retracao aguda foi definida como (X - Y)/X. RESULTADOS: Nao houve diferenca significativa em relacao as caracteristicas clinicas e angiograficas basais. O ganho luminal agudo foi menor com o SVB comparado ao EES e ao BES (1,51 ± 0,41 mm vs. 1,76 ± 0,28 mm vs. 1,9 ± 0,42 mm; P = 0,02). A retracao aguda foi de 0,21 ± 0,13 mm vs. 0,15 ± 0,08 mm vs. 0,14 ± 0,08 mm (P = 0,21), e o porcentual de retracao aguda foi de 7,0 ± 4,6% vs. 5,0 ± 2,2% vs. 5,7 ± 4,1% (P = 0,16). CONCLUSOES: O SVB demonstrou ter retracao aguda ligeiramente maior, embora nao significativa, que os stents metalicos farmacologicos de segunda geracao.

Bare metal stents, durable polymer drug eluting stents, and biodegradable polymer drug eluting stents for coronary artery disease: mixed treatment comparison meta-analysis

Objective To compare the efficacy and safety of biodegradable polymer drug eluting stents with those of bare metal stents and durable polymer drug eluting stents.Design Mixed treatment comparison meta-analysis of...

Clinical Outcomes With Bioabsorbable Polymer- Versus Durable Polymer-Based Drug-Eluting and Bare-Metal Stents: Evidence From a Comprehensive Network Meta-Analysis

This study sought to investigate the relative safety and efficacy of bioabsorbable polymer (BP)-based biolimus-eluting stents (BES) versus durable-polymer (DP)-drug-eluting stents (DES) and bare-metal stents (BMS) by means ofa network meta-analysis. Studies have suggested that BP-BES might reduce the risk of stent thrombosis (ST) and late adverse outcomes compared with first-generation DES. However, the relative safety and efficacy of BP-BES versus newer-generation DES coated with more biocompatible DP have not been investigated in depth. Randomized controlled trials comparing BP-BES versus currently U.S.-approved DES or BMS were searched through MEDLINE, EMBASE, and Cochrane databases. Information on study design, inclusion and exclusion criteria, sample characteristics, and clinical outcomes was extracted. Data from 89 trials including 85,490 patients were analyzed. At 1-year follow-up, BP-BES were associated with lower rates of cardiac death/myocardial infarction (MI), MI, and target vessel revascularization (TVR) than BMS and lower rates of TVR than fast-release zotarolimus-eluting stents. The BP-BES had similar rates of cardiac death/MI, MI, and TVR compared with other second-generation DP-DES but higher rates of 1-year ST than cobalt-chromium everolimus-eluting stents (CoCr-EES). The BP-BES were associated with improved late outcomes compared with BMS and paclitaxel-eluting stents, considering the latest follow-up data available, with nonsignificantly different outcomes compared with other DP-DES although higher rates of definite ST compared with CoCr-EES. In this large-scale network meta-analysis, BP-BES were associated with superior clinical outcomes compared with BMS and first-generation DES and similar rates of cardiac death/MI, MI, and TVR compared with second-generation DP-DES but higher rates of definite ST than CoCr-EES.

Pathology of Second-Generation Everolimus-Eluting Stents Versus First-Generation Sirolimus- and Paclitaxel-Eluting Stents in Humans

Clinical trials have demonstrated that the second-generation cobalt-chromium everolimus-eluting stent (CoCr-EES) is superior to the first-generation paclitaxel-eluting stent (PES) and is noninferior or superior to the sirolimus-eluting stent (SES) in terms of safety and efficacy. It remains unclear whether vascular responses to CoCr-EES are different from those to SES and PES because the pathology of CoCr-EES has not been described in humans. A total of 204 lesions (SES=73; PES=85; CoCr-EES=46) from 149 autopsy cases with duration of implantation >30 days and ≤3 years were pathologically analyzed, and comparison of vascular responses was corrected for duration of implantation. The observed frequency of late and very late stent thrombosis was less in CoCr-EES (4%) versus SES (21%; P=0.029) and PES (26%; P=0.008). Neointimal thickness was comparable among the groups, whereas the percentage of uncovered struts was strikingly lower in CoCr-EES (median=2.6%) versus SES (18.0%; P<0.0005) and PES (18.7%; P<0.0005). CoCr-EES showed a lower inflammation score (with no hypersensitivity) and less fibrin deposition versus SES and PES. The observed frequency of neoatherosclerosis, however, did not differ significantly among the groups (CoCr-EES=29%; SES=35%; PES=19%). CoCr-EES had the least frequency of stent fracture (CoCr-EES=13%; SES=40%; PES=19%; P=0.007 for CoCr-EES versus SES), whereas fracture-related restenosis or thrombosis was comparable among the groups (CoCr-EES=6.5%; SES=5.5%; PES=1.2%). CoCr-EES demonstrated greater strut coverage with less inflammation, less fibrin deposition, and less late and very late stent thrombosis compared with SES and PES in human autopsy analysis. Nevertheless, the observed frequencies of neoatherosclerosis and fracture-related adverse pathological events were comparable in these devices, indicating that careful long-term follow-up remains important even after CoCr-EES placement.

TCT-451 Impact of Stent Recoil and Fracture in RCA Ostium Restenosis Following Stainless Steel or Cobalt Chromium Drug-Eluting Stent Implantation: A Serial Angiographic and IVUS Study

Background: PCI procedure of RCA ostium stenosis is still a challenging issue due to high stent restenosis rate, possibly due to mechanical stress. However, mechanisms of restenosis following cobalt-chromium everolimus-eluting stent (EES) or stainless steel biolimus-eluting stent (BES) implantation have not been well clarified. Methods: Sixty-fourRCAostium restenosis cases after 2ndgenerationDES (40EESand 24 BES) were retrospectively analyzed. Serial (post initial stent and follow-up as revascularization) angiographic and IVUS evaluation were performed. In quantitative angiographic analysis (QCA), incidence of stent fracture (defined as complete separation of the stent segments and/or the absence of a stent strut on magnified fluoroscopic image), and partial (only one of the inner or outer struts was separated) and complete (both the inner and outer struts were disconnected) fracture type were evaluated. In IVUS, serial changes ofminimum lumen and stent area (SA), and degree of stent recoil atminimum lumen area, defined as (follow-up SA baseline SA / baseline SA*100), were also measured. Results: Average follow-up phase was 14 10-months. Angiographic and IVUS morphometric parameters were similar in both groups at baseline. Significant lumen narrowingwas observed from baseline to follow-up in both groups (10.2 4.6 to 2.5 2.0, 10.7 5.4 to 2.4 2.3 mm2 in minimum lumen area, EES vs. BES, p<0.01 from baseline to follow-up for all). Stent fracturewasmore frequently observed inBES than EES (85 vs. 8%, p<0.01). In addition, complete fracturewas highly observed inBES (29%) compared to EES (2%, p<0.05). In contrast, significant stent recoil was observed in EES only (11.8 5.7 to 9.0 5.4 mm2, p<0.01 from baseline to follow-up for EES, 11.6 4.8 to 11.3 3.4 mm2, p1⁄4ns for BES, and degree of stent recoil was significantly larger in EES than BES (23.8 vs. 2.6%, p<0.05). Additionally, there was only 1 BES and no EES case that both stent fracture and significant recoil, resulting in stent restenosis, was observed. Conclusions: Stent fracture appears to be the major cause of RCA ostium restenosis after stainless steel BES, whereas stent recoil seem to be associated with restenosis after cobalt-chromium EES.

Comparison of stent axial integrity in first- versus second-generation drug-eluting stents: insights from intravascular ultrasound analysis

Background: Longitudinal stent deformation (LSD) is a recently reported complication of coronary intervention. To date, however, the axial integrity of stents has not been systematically examined. This study aimed to assess the rate of LSD after implantation using intravascular ultrasound (IVUS). Methods: A total of 182 drug-eluting stents (DES) of 165 patients who underwent IVUS after implantation for de-novo lesions were included. Stent length was determined using automatic pullback device. The absolute value of the difference in length [IVUS - label], and the absolute value of the relative difference in length [(IVUS- label)/label] were analyzed. Results: Stent distribution was as follows: 38.4% sirolimus-eluting stents (SES); 18.7% paclitaxel-eluting stents (PES); 20.3% Cobalt-chromium everolimus-eluting stents (Cc-EES); and 22.5% Platinum-chromium everolimus-eluting stents (Pc-EES). The absolute difference in length did not differ among groups. There were no differences in the absolute value of the relative difference between the Pc-EES and any other stents. The absolute relative difference of >5% was lower in the SES group (p=0.027). Significant change (>15%) in length was low and similar among groups. ![Figure][1] Conclusions: This IVUS analysis proved that SES has the lowest differences in stent length and that there are no significant differences in axial stent integrity among PES and second-generation DES. The anecdotal reports of LSD are unsubstantiated in contemporary clinical practice. [1]: pending:yes

Clinical Outcomes With Drug-Eluting and Bare-Metal Stents in Patients With ST-Segment Elevation Myocardial Infarction: Evidence From a Comprehensive Network Meta-Analysis

The authors investigated the relative safety and efficacy of different drug-eluting stents (DES) and bare metal stents (BMS) in patients with ST-segment elevation myocardial infarction (STEMI) using a network meta-analysis. The relative safety of DES and BMS in patients with STEMI continues to be debated, and whether advances have been made in this regard with second-generation DES is unknown. Randomized controlled trials comparing currently U.S. approved DES or DES with BMS in patients with STEMI were searched using MEDLINE, EMBASE, and Cochrane databases. Information on study design, inclusion and exclusion criteria, sample characteristics, and clinical outcomes was extracted. Twenty-two trials including 12,453 randomized patients were analyzed. At 1-year follow-up, cobalt-chromium everolimus eluting stents (CoCr-EES) were associated with significantly lower rates of cardiac death or myocardial infarction (MI) and stent thrombosis (ST) than BMS. Differences in ST were apparent as early as 30 days and were maintained for 2 years. CoCr-EES were also associated with significantly lower rates of 1-year ST than paclitaxel-eluting stents (PES). Sirolimus-eluting stents (SES) were also associated with significantly lower rates of 1-year cardiac death/myocardial infarction than BMS. CoCr-EES, PES, and SES, but not zotarolimus-eluting stents, had significantly lower rates of 1-year target vessel revascularization (TVR) than BMS, with SES also showing lower rates of TVR than PES. In patients with STEMI, steady improvements in outcomes have been realized with the evolution from BMS to first-generation and now second-generation DES, with the most favorable safety and efficacy profile thus far demonstrated with CoCr-EES.

Biodegradable Polymer Biolimus-Eluting Stent Versus Durable Polymer Everolimus-Eluting Stent: A Randomized, Controlled, Noninferiority Trial

NEXT (NOBORI Biolimus-Eluting Versus XIENCE/PROMUS Everolimus-Eluting Stent Trial) was designed for evaluating the noninferiority of a biolimus-eluting stent (BES) relative to an everolimus-eluting stent (EES) in terms of target lesion revascularization (TLR) at 1 year. Efficacy and safety data comparing biodegradable polymer BES with durable polymer cobalt-chromium EES are currently limited. The NEXT trial is a prospective, multicenter, randomized, open-label, noninferiority trial comparing BES with EES. Between May and October 2011, 3,235 patients were randomly assigned to receive either BES (n = 1,617) or EES (n = 1,618). At 1 year, the primary efficacy endpoint of TLR occurred in 67 patients (4.2%) in the BES group, and in 66 patients (4.2%) in the EES group, demonstrating noninferiority of BES relative to EES (p for noninferiority <0.0001, and p for superiority = 0.93). Cumulative incidence of definite stent thrombosis was low and similar between the 2 groups (0.25% vs. 0.06%, p = 0.18). An angiographic substudy enrolling 528 patients (BES: n = 263, and EES: n = 265) demonstrated noninferiority of BES relative to EES regarding the primary angiographic endpoint of in-segment late loss (0.03 ± 0.39 mm vs. 0.06 ± 0.45 mm, p for noninferiority <0.0001, and p for superiority = 0.52) at 266 ± 43 days after stent implantation. One-year clinical and angiographic outcome after BES implantation was noninferior to and not different from that after EES implantation in a mostly stable coronary artery disease population. One-year clinical outcome after both BES and EES use was excellent, with a low rate of TLR and extremely low rate of stent thrombosis.

Comparison of Platinum Chromium Versus Cobalt Chromium Everolimus-eluting Stent in Real World Practice: Outcomes from the Multicenter Prospective IRIS-DES Registry

Large clinical studies compared platinum chromium everolimus-eluting stent (PtCr EES) and cobalt chromium everolimus-eluting stent (CoCr EES) was limited. Therefore, we sought to evaluate the safety and efficacy of PtCr EES and CoCr EES in “real world” practice.

Comparison of Acute Stent Recoil Between the Everolimus-Eluting Bioresorbable Vascular Scaffold and Two Different Drug-Eluting Metallic Stents

Bioresorbable vascular scaffolds (BVS) have been developed to provide support to the vessel wall during the healing process after percutaneous coronary intervention (PCI), being resorbed afterwards. Because the scaffold is made of polymeric material, there is a concern regarding the acute recoil of the device. We compared the BVS acute recoil with that of two different metal drug-eluting stents. Fifty patients with non-complex lesions were included. Twenty-five of these patients were treated with a BVS who were compared to 25 patients treated with a cobalt-chromium everolimus-eluting stent (EES, n = 12) or a stainless steel biolimus-eluting stent (BES, n = 13). Acute recoil was defined as the difference between the mean diameter of the balloon during its maximum inflation pressure (X) and the mean diameter of the stent immediately after balloon deflation (Y). The percentage of acute recoil was defined as (X-Y)/X. There was no significant difference in the baseline clinical and angiographic characteristics. Acute luminal gain was lower with BVS compared to EES and BES (1.51 ± 0.41 mm vs. 1.76 ± 0.28 mm vs. 1.9 ± 0.42 mm, P = 0.02). Acute recoil was 0.21 ± 0.13 mm vs. 0.15 ± 0.08 mm vs. 0.14 ± 0.08 mm (P = 0.21) and the percentage of acute recoil was 7.0 ± 4.6% vs. 5.0 ± 2.2% vs. 5.7 ± 4.1% (P = 0.16). BVS presented a slightly higher, although not significant, acute recoil than the two second-generation metallic drug-eluting stents. Comparação da Retração Aguda do Stent Entre o Suporte Vascular Bioabsorvível Eluidor de Everolimus e Dois Diferentes Stents Metálicos Farmacológicos Suportes vasculares bioabsorvíveis (SVB) têm sido desenvolvidos como forma de fornecer sustentação à parede do vaso enquanto ocorre o processo de cicatrização, após a intervenção coronária percutânea (ICP), sendo absorvido posteriormente. Pelo fato da plataforma ser de material polimérico, existe preocupação em relação à retração aguda do dispositivo. Avaliamos aqui a retração aguda do SVB com a de dois diferentes stents farmacológicos metálicos. Foram incluídos 50 pacientes com lesões não complexas. Dentre esses pacientes, 25 foram tratados com SVB e comparados a outros 25 pacientes tratados com stent de cromo-cobalto eluidor de everolimus (EES; n = 12) ou stent de aço inoxidável eluidor de biolimus (BES; n = 13). A retração aguda foi definida como a diferença entre o diâmetro médio do balão durante a pressão máxima de inflação (X) e o diâmetro médio do stent após o esvaziamento do balão (Y). A porcentagem de retração aguda foi definida como (X – Y)/X. Não houve diferença significativa em relação às características clínicas e angiográficas basais. O ganho luminal agudo foi menor com o SVB comparado ao EES e ao BES (1,51 ± 0,41 mm vs. 1,76 ± 0,28 mm vs. 1,9 ± 0,42 mm; P = 0,02). A retração aguda foi de 0,21 ± 0,13 mm vs. 0,15 ± 0,08 mm vs. 0,14 ± 0,08 mm (P = 0,21), e o porcentual de retração aguda foi de 7,0 ± 4,6% vs. 5,0 ± 2,2% vs. 5,7 ± 4,1% (P = 0,16). O SVB demonstrou ter retração aguda ligeiramente maior, embora não significativa, que os stents metálicos farmacológicos de segunda geração.

Second Generation Drug-Eluting Stents: A Review of the Everolimus-Eluting Platform

Everolimus-eluting stents (EES) represent the next generation of drug-eluting stents (DES). Important design modifications include thin strut stent backbones, less inflammatory and more biocompatible polymers, and lower drug dosing. The cobalt chromium EES fluoropolymer XIENCE V stent has been the most extensively studied of such stents. In animal models, this stent demonstrated minimal vessel inflammation, a biologically active endothelium with strut coverage similar to a bare metal stent, and inhibition of intimal hyperplasia comparable to that seen with sirolimus-eluting stents. The SPIRIT family of clinical trials demonstrated low rates of late loss, and clinical restenosis, as well as low rates of very late stent thrombosis. These excellent clinical outcomes addressed limitations of the 1st generation DES, and substantiated widespread clinical use of the EES platform.