Bifurcation treatment with novel, highly flexible drug-eluting coronary stents in all-comers: 2-year outcome in patients of the DUTCH PEERS trial

BACKGROUND: Percutaneous coronary intervention (PCI) in bifurcated lesions with second-generation drug-eluting stents (DES) was associated with increased myocardial infarction (MI) rates. Flexible stent designs that accommodate well to vessel tapering may be of benefit in challenging anatomies such as bifurcated target lesions, but so far data are scarce. METHODS: We analyzed the 2-year follow-up data of the DUTCH PEERS (TWENTE II) trial, which randomized 1811 all-comer patients to PCI with newer generation resolute integrity zotarolimus-eluting (Medtronic) or promus element everolimus-eluting stents (Boston Scientific). In bifurcated lesions, provisional stenting was generally performed. Target vessel failure is a composite endpoint, consisting of cardiac death, target vessel MI, or target vessel revascularization. RESULTS: Patients with at least one bifurcated lesion (n = 465, 25.7 %) versus patients with non-bifurcated target lesions only (n = 1346, 74.3 %) showed similar rates of clinical endpoints including target vessel failure (9.2 versus 7.9 %, p = 0.36) and definite stent thrombosis (0.4 versus 1.0 %, p = 0.38). Target vessel MI was more common in patients with bifurcated lesions (3.4 versus 1.6 %, p = 0.02); but after multivariate analysis with propensity score adjustment, bifurcation treatment was found not to be an independent predictor of target vessel MI (HR 1.40, 95 % CI 0.71-2.76; p = 0.34). Among patients with bifurcated lesions, DES type and side-branch size did not affect outcome, but periprocedural MI occurred more often after two-stent approaches (9.0 versus 2.1 %; p = 0.002). CONCLUSION: All-comer patients treated for bifurcated and non-bifurcated target lesions showed similar and low rates of clinical endpoints, suggesting that the DES used are efficacious and safe for treating bifurcated target lesions

Chemical Durability of Glasses

International audienceThe chemical durability of silicate glasses has long been studied for many applications, in particular when glasses are subjected to environmental weathering and aqueous corrosion. Typical applications include optical instruments, glass vessels, radioactive waste confinement, and bone reparation. Glass corrosion involves ion exchange, water diffusion, network dissolution-recondensation, and secondary phase precipitation. These reactions may impact, among other things, the release of contaminants from waste glasses, and the glass mechanical, optical and catalytic properties. The glass corrosion mechanisms and alteration product formation have been well studied as a function of many environmental parameters (temperature, pH, water composition, etc.).The present chapter describes the general phenomena behind glass corrosion and details glass dissolution in aqueous conditions on one hand and glass vapor hydration on the other hand. The latter phenomenon has not received the same level of attention in the literature relative to the corrosion in aqueous solutions. Research and development needs, in particular in complex systems such as radioactive waste geological repositories, are discussed in the conclusion of the chapter