Vol 27, No 2 (2020)
Original articles — Interventional cardiology
Published online: 2018-08-24

open access

Page views 2214
Article views/downloads 958
Get Citation

Connect on Social Media

Connect on Social Media

Two-year longitudinal evaluation of a second-generation thin-strut sirolimus-eluting bioresorbable coronary scaffold with hybrid cell design in porcine coronary arteries

Pawel Gasior12, Yanping Cheng1, Jinggang Xia1, Gerard B. Conditt1, Jennifer C. McGregor1, Renu Virmani3, Juan F. Granada1, Grzegorz L. Kaluza1
Pubmed: 30155861
Cardiol J 2020;27(2):115-125.

Abstract

Background: The first commercially available bioresorbable scaffold (BRS) had a strut thickness of 156 microns. As such, it had the potential for delivery challenges and higher thrombogenicity. The aim herein, is to evaluate biomechanical performance, pharmacokinetics and vascular healing of a novel thin strut (100 μm) sirolimus eluting BRS (MeRes-100, Meril Life Sciences, Gujarat, India) against the once clinically used BRS (Absorb BVS, Abbott, Santa Clara, CA) in porcine coronary arteries.

Methods: Following device implantation, angiographic and optical coherence tomography (OCT) evaluation were performed at 45, 90, 180 days, 1 year and 2 years. Histological evaluation was per­formed at 30, 90 and 180 days.

Results: At 2 years, both lumen (MeRes-100 7.07 ± 1.82 mm2 vs. Absorb BVS 7.57 ± 1.39 mm2, p = NS) and scaffold areas (MeRes-100 9.73 ± 1.80 mm2 vs. Absorb BVS 9.67 ± 1.25 mm2, p = NS) were comparable between tested and control scaffolds. Also, the late lumen area gain at 2 years was similar in both groups tested (MeRes-100 1.03 ± 1.98 mm2 vs. Absorb BVS 0.85 ± 1.56 mm2, p = NS). Histologic examination up to 6 months showed comparable healing and inflammation profiles for both devices.

Conclusions: The novel sirolimus-eluting BRS with thinner struts and hybrid cell design showed similar biomechanical durability and equivalent inhibition of neointimal proliferation when compared to the first-ever Absorb BVS up to 2 years in normal porcine coronary arteries.

Article available in PDF format

View PDF Download PDF file

References

  1. Onuma Y, Ormiston J, Serruys PW. Bioresorbable scaffold technologies. Circ J. 2011; 75(3): 509–520.
  2. Ellis SG, Kereiakes DJ, Metzger DC, et al. Everolimus-Eluting Bioresorbable Scaffolds for Coronary Artery Disease. N Engl J Med. 2015; 373(20): 1905–1915.
  3. Serruys PW, Chevalier B, Dudek D, et al. A bioresorbable everolimus-eluting scaffold versus a metallic everolimus-eluting stent for ischaemic heart disease caused by de-novo native coronary artery lesions (ABSORB II): an interim 1-year analysis of clinical and procedural secondary outcomes from a randomised controlled trial. Lancet. 2015; 385(9962): 43–54.
  4. Serruys PW, Chevalier B, Sotomi Y, et al. Comparison of an everolimus-eluting bioresorbable scaffold with an everolimus-eluting metallic stent for the treatment of coronary artery stenosis (ABSORB II): a 3 year, randomised, controlled, single-blind, multicentre clinical trial. Lancet. 2016; 388(10059): 2479–2491.
  5. Kereiakes DJ, Ellis SG, Metzger C, et al. ABSORB III Investigators. 3-Year Clinical Outcomes With Everolimus-Eluting Bioresorbable Coronary Scaffolds: The ABSORB III Trial. J Am Coll Cardiol. 2017; 70(23): 2852–2862.
  6. Otsuka F, Cheng Qi, Yahagi K, et al. Acute Thrombogenicity of a Durable Polymer Everolimus-Eluting Stent Relative to Contemporary Drug-Eluting Stents With Biodegradable Polymer Coatings Assessed Ex Vivo in a Swine Shunt Model. JACC Cardiovasc Interv. 2015; 8(9): 1248–1260.
  7. Koskinas KC, Chatzizisis YS, Antoniadis AP, et al. Role of endothelial shear stress in stent restenosis and thrombosis: pathophysiologic mechanisms and implications for clinical translation. J Am Coll Cardiol. 2012; 59(15): 1337–1349.
  8. Azzalini L. L'Allier PL. Bioresorbable vascular scaffold thrombosis in an all-comer patient population: single-center experience. J Invasive Cardiol. 2015; 27: 85–92.
  9. Onuma Y, Serruys PW, Gomez J, et al. Comparison of in vivo acute stent recoil between the bioresorbable everolimus-eluting coronary scaffolds (revision 1.0 and 1.1) and the metallic everolimus-eluting stent. Catheter Cardiovasc Interv. 2011; 78(1): 3–12.
  10. Cheng Y, Gasior P, Shibuya M, et al. Comparative characterization of biomechanical behavior and healing profile of a novel ultra-high-molecular-weight amorphous poly-l-lactic acid sirolimus-eluting bioresorbable coronary scaffold. Circ Cardiovasc Interv. 2016; 9(10).
  11. Gomez-Lara J, Brugaletta S, Diletti R, et al. A comparative assessment by optical coherence tomography of the performance of the first and second generation of the everolimus-eluting bioresorbable vascular scaffolds. Eur Heart J. 2011; 32(3): 294–304.
  12. Strandberg E, Zeltinger J, Schulz DG, et al. Late positive remodeling and late lumen gain contribute to vascular restoration by a non-drug eluting bioresorbable scaffold: a four-year intravascular ultrasound study in normal porcine coronary arteries. Circ Cardiovasc Interv. 2012; 5(1): 39–46.
  13. Yazdani SK, Pacheco E, Nakano M, et al. Vascular, downstream, and pharmacokinetic responses to treatment with a low dose drug-coated balloon in a swine femoral artery model. Catheter Cardiovasc Interv. 2014; 83(1): 132–140.
  14. Stone GW, Gao R, Kimura T, et al. 1-year outcomes with the Absorb bioresorbable scaffold in patients with coronary artery disease: a patient-level, pooled meta-analysis. Lancet. 2016; 387(10025): 1277–1289.
  15. Tenekecioglu E, Torii R, Bourantas C, et al. Preclinical assessment of the endothelial shear stress in porcine-based models following implantation of two different bioresorbable scaffolds: effect of scaffold design on the local haemodynamic micro-environment. EuroIntervention. 2016; 12(10): 1296.
  16. Gogas BD, King SB, Timmins LH, et al. Biomechanical assessment of fully bioresorbable devices. JACC Cardiovasc Interv. 2013; 6(7): 760–761.
  17. Chatzizisis YS, Coskun AU, Jonas M, et al. Role of endothelial shear stress in the natural history of coronary atherosclerosis and vascular remodeling: molecular, cellular, and vascular behavior. J Am Coll Cardiol. 2007; 49(25): 2379–2393.
  18. Koppara T, Cheng Qi, Yahagi K, et al. Thrombogenicity and early vascular healing response in metallic biodegradable polymer-based and fully bioabsorbable drug-eluting stents. Circ Cardiovasc Interv. 2015; 8(6): e002427.
  19. Kang J, Han JK, Yang HM, et al. Bioresorbable vascular scaffolds: are we facing a time of crisis or one of breakthrough? Circ J. 2017; 81(8): 1065–1074.
  20. Suzuki T, Kopia G, Hayashi S, et al. Stent-based delivery of sirolimus reduces neointimal formation in a porcine coronary model. Circulation. 2001; 104(10): 1188–1193.
  21. Vetrovec GW, Rizik D, Williard C, et al. Sirolimus PK trial: a pharmacokinetic study of the sirolimus-eluting Bx velocity stent in patients with de novo coronary lesions. Catheter Cardiovasc Interv. 2006; 67(1): 32–37.
  22. Seth A, Onuma Y, Costa R, et al. First-in-human evaluation of a novel poly-L-lactide based sirolimus-eluting bioresorbable vascular scaffold for the treatment of de novo native coronary artery lesions: MeRes-1 trial. EuroIntervention. 2017; 13(4): 415–423.