Wyniki dotyczące skuteczności i bezpieczeństwa implantacji bioresorbowalnego rusztowania naczyniowego ABSORBTM w badaniach klinicznych

Od 2006 roku na całym świecie wwarunkach badań klinicznych ABSORB kohorta A i B, ABSORB Extend oraz ABSORB II implantowano niewiele ponad 600 rusztowań bioresorbowalnych firmy Abbott Vascular. Ze względu na odmienne w stosunku do stentów metalowych właściwości rusztowania bioresorbowalnego ABSORB™ (DES BVS) sposób doboru średnicy do wymiaru naczynia oraz implantacja tego urządzenia odbiegają od rutynowo stosowanych wprzypadku stentów metalowych. Dodatkowo dotychczas zebrane doświadczenia oparte są na wyselekcjonowanych pod względem klinicznym i angiograficznym grupach pacjentów. W2012 roku bioresorbowalne rusztowanie naczyniowe pod nazwą ABSORB™ zostało dopuszczone do sprzedaży w krajach Unii Europejskiej i świata, z zastrzeżeniem stosowania jedynie przez przeszkolonych kardiologów interwencyjnych. Wzwiązku z dużym doświadczeniem naszego ośrodka, wktórym już od 2006 roku kontynuowane są prace nad tą oraz innymi platformami stentów biodegradowalnych, pragniemy się podzielić uwagami, które mogą być przydatne dla lekarzy chcących się przygotować do implantacji rusztowań ABSORB™ w swoich pracowniach. W poniższym artykule pragniemy przedstawić dane i dowody naukowe pochodzące z badań klinicznych, podać informacje dotyczące odpowiedniego doboru zarówno klinicznego, jak i angiograficznego pacjentów, a także procesu doboru i implantacji BVS ABSORB™, które mogą być przydatne w trakcie przezskórnych interwencji wieńcowych (percutaneous coronary intervention – PCI) z zastosowaniem BVS.Since 2006, over 600 biodegradable vascular scaffolds (BVS) have been implanted worldwide in clinical trials such as ABSORB cohort A and B, ABSORB Extend and ABSORB II RCT. Due to completely changed construction and mechanical properties of BVS, the choice of proper scaffold diameter and its implantation differ significantly from those used in the case of metal stents (bare metal stent (BMS) or drug eluting stent (DES)). Furthermore, all data concerning BVS efficacy and safety come from clinical trials, conducted in a selected group of patients. In 2012 BVS ABSORB™ was approved as the first biodegradable scaffold for the treatment of coronary artery disease in EU and other countries, with a limitation of use only for experienced and trained interventional cardiologists. As one of the most experienced clinical centers in Europe and the first one that in 2006 implanted BVS ABSORB™ in Poland we have a great pleasure and honor to share our experience with interventional cardiologists who would like to prepare for BVS ABSORB™ implantation in their centers. In this article we wanted to summarize the clinical data from already finished and ongoing trials, give a short overview of patient selection, and provide a detailed description of the implantation process with tips which could be helpful during BVS use

An interesting case of a self-apposing stent implantation in an aneurysmatically dilated artery in acute myocardial infarction with high quality optical coherence tomography images

56-Year-old man with non-ST-segment elevation myocardial infarction. Coronary angiography showed aneurysmatic changes of the left circumflex artery with near occlusion of this vessel. We have decided to implant a Self-Apposing® Coronary Stent Xposition S (Stentys SA, Paris, France). In optical coherence tomography a good stent apposition has been confirmed. A complete distal flow in the infarct-related artery was achieved. Implantation of DES in a large vessel, especially with aneurysmatic dilatation is limited due to difficulties in choosing a proper stent size. Undersizing may cause stent malapposition which carries an increased risk of late and very late stent thrombosis. Oversizing may lead to dissection or even vessel perforation. In presented case choosing a proper stent size was not so easy because of aneurysmatic changes of the artery. The vessel diameter in the aneurysm area was about 6 mm. Regular DES are commercially available in maximal sizes up to 4.5–5.0 mm. In this case we have chosen the largest Stentys stent size available (3.5–4.5 × 27 mm) which is designed to target vessels of diameter between 3.5 and 6.0 mm. Self-apposing stents present useful features which might have advantages over conventional drug-eluting stents in specific angiographic situations

Comparison of hyperemic efficacy between femoral and antecubital fossa vein adenosine infusion for fractional flow reserve assessment

Introduction: Intravenous infusion of adenosine via the femoral vein is commonly used to achieve maximum hyperemia for fractional flow reserve (FFR) assessment in the catheterization laboratory. In the era of transradial access for coronary interventions, obtaining additional venous access with sheath insertion in the groin is unpractical and may be associated with a higher risk of bleeding complications. In a vast majority of cases, patients scheduled for the catheterization laboratory are already equipped with peripheral vein access in antecubital fossa vein. However, only limited data exist to support non-central vein infusion of adenosine instead of the femoral vein for FFR assessment. Aim: To compare infusion of adenosine via a central versus a peripheral vein for the assessment of peak FFR. Material and methods: We enrolled 50 consecutive patients with 125 borderline coronary lesions that were assessed by FFR using adenosine femoral and antecubital vein infusion of 140 μg/kg/min. Results: Physiological severity assessed with femoral vein adenosine infusion at 140 μg/kg/min was mean 0.82 ±0.09, and with antecubital vein adenosine infusion at 140 μg/kg/min was 0.82 ±0.09. The mean time from initiation of adenosine infusion to maximal stable hyperemia was significantly shorter for 140 μg/kg/min femoral vein infusion as compared to antecubital vein infusion (49 ±19 s vs. 68 ±23 s; p < 0.001). There was a strong correlation between FFR values obtained from 140 μg/kg/min femoral and antecubital vein infusion (r = 0.99; p < 0.001). Conclusions: Antecubital vein adenosine infusion achieved FFR values are very similar to those obtained using femoral vein adenosine administration. However, time to maximal hyperemia is longer with infusion via the antecubital vein