Gioel Gabrio Secco, MD, PhDCardiologia Interventistica
A. O. “Santi Antonio e Biagio e Cesare Arrigo”
Alessandria
ATTUALITA’ IN TEMA DI STENT
BIORIASSORBIBILI?
CardioAlessandria III
22-23 Settembre 2017
I have the following potential conflicts of interest to report
Consulting, research grants, travel reimbursement, speaker honorarium:
1. St Jude Medical
2. Biotronik
3. Boston Scientific
4. SIS Medical
5. Philips Volcano corp
6. Abbott Vascular
In the era of DESs, large-scale randomized trials and
all-comer registries have shown significant reductions
in the need for repeat revascularization
Despite these improvements, newer-generation DESs have not managed to address all
the limitations of permanent coronary stents:- the persistent risks of TLR and neoatherosclerosis;
- hindrance of late lumen enlargement, and the lack of reactive vasomotion;
- the risk of VLST and its clinical sequelae, although substantially reduced still remains!
THEORETICAL BENEFITS
Reduction in long term events
Restoration of shear stress
Suitability for future treatments
Feasibility of non invasive imaging
Use in young / pediatrics subset
MANUFACTURER NAME PLATFORM THICKENESS DRUG
Abbot Absorb PLLA 157 Everolimus
Elixir DESolve PLLA 150 Novolimus
ART ART Pure PDLLA 170 -
Biotronik Magmaris Mg 150 Sirolimus
COMPOSITION ELASTICITY(GPA)
STRENGTH(MPA)
ELONGATIONAT BREAK, %
DEGRADATION TIME
PLLA 3.1 – 3.7 60 - 70 2 - 6 > 24 m
PDLLA 3.1 - 3.7 45 -55 2 - 6 6-12 m
Mg 40 - 45 220 - 330 2 - 20 1 - 3
Cobalt chromium 210 -235 1449 40 biostable
6 RCT (3738 pts) comparing the Absorb BVS with EES
NO DIFFERENCES in the rates of the composite pts & device-oriented adverse events
1 Year FU
Stone GW et al. Lancet 2016
PROGRESS
n=63
BIOSOLVE-I
n=46
BIOSOLVE-II
n=123
BIOSOLVE-III
n=63
12 month 36 month 12 month 6 month
TLF [%] 23.8 6.8 3.4 3.3
Scaffold ThrombosiDefinite or probable
0.0 0.0 0.0 0.0
Clinical trial
Trials Nr. paz FUP [m]
63 84
46 36
123 24
BIOSOLVE-III 63 6
Total 295
Magmaris:
Polymeric scaffold3
Magnesium
Polymer
NAME PLATFORM THICKENESS DRUG DEGRADATION
DESolve CX PLLA 120 Novolimus 2 y
Fantom Desaminotyrosinepolycarbonate with iodine
atoms
125 Sirolimus 1 – 3 y
MeRes PDLLA 100 Sirolimus 4 – 6 m; 100% 2y
FORTITUDE PLLA 150 Sirolimus 10 m
Mirage PLLA 125 Sirolimus 14 m
FireSorb PLLA 100 - 125 Sirolimus 3 y