Bioresorbable scaffolds in coronary intervention: unmet needs and perspectives Feb. 19, 2024, 10:31 a.m.
Restoration of cyclic pulsatility and physiologic vasomotion, adaptive vascular remodeling, plaque regression, and removal of the trigger for late adverse events are expected BRS benefits over current generation metallic DES. However, first-generation BRS devices have significant manufacturing limitations and rely on optimal implantation to minimize clinical events. In addition, the clinical benefits of BRS after bioresorption compared to DES are not fully known. This is a crucial investigational point because future device improvements are expected to match but not necessarily improve the early and mid-term performance of best-in-class DES. The ABSORB BRS is not currently associated with tangible long-term advantages over DES (i.e., angina reduction, vasomotion, TLF). For successful clinical adoption, the BRS technology must meet this standard of evidence.
Comparison of a Novel Biodegradable Polymer Sirolimus-Eluting Stent With a Durable Polymer Everolimus-Eluting Stent Feb. 18, 2024, 5:04 p.m.
Compared with durable polymer X-EES, novel biodegradable polymer–based O-SES was found noninferior for the primary end point in-stent late lumen loss at 9 months. Clinical event rates were comparable without cases of stent thrombosis throughout 1 year of follow-up.
Addressing the Inflammatory Response to Clinically Relevant Polymers by Manipulating the Host Response Using ITIM Domain-Containing Receptors Feb. 18, 2024, 3:34 p.m.
Aberrant biocompatibility of implanted biomaterials and devices are a significant burden to the healthcare system and account for a large proportion of post-surgical clinical complications. Targeting the body’s natural mechanisms of inhibiting the immune response is a logical way to combat inflammation caused by implantable materials. This can be accomplished specifically through utilizing the ITIM family and related immune inhibitory receptors, which are involved in attenuating the inflammatory response. Given that these inhibitory receptors are expressed on immune cells makes them attractive targets for drug design or functionalization on implantable devices. Herein, we discussed the potential use of a select few immune inhibitory receptors some bearing classical ITIMs and others with alternative signaling mechanisms in attenuating the inflammatory response. We detailed the potential uses for recombinant CD47, the ligand for the ITIM receptor SIRPα, that we believe to be the best suited for promoting long-term biocompatibility of implanted medical devices. The further we expand our understanding of the role that ITIM proteins have in fine tuning the immune response, the better suited we will be to utilize ITIM proteins to increase medical device biocompatibility.
Biodegradable polymer sirolimus-eluting stents versus durable polymer everolimus-eluting stents in patients undergoing percutaneous coronary intervention Feb. 15, 2024, 5:28 p.m.
There were no differences between ultrathin strut, biodegradable polymer sirolimus-eluting stents and thin-strut, durable polymer everolimus-eluting stents with regards to cardiac death, target-vessel myocardial infarction, and clinically-driven target-lesion revascularization.
Is CD47 a potentially promising therapeutic target in cardiovascular diseases? Feb. 15, 2024, 5:22 p.m.
CD47 (cluster of differentiation 47) is a ubiquitously expressed transmembrane protein that belongs to the immunoglobulin superfamily. CD47 is both a receptor for the matricellular protein thrombospondin-1 (TSP-1) and a ligand for signal-regulatory protein alpha (SIRPα). Suppression of CD47 activity enhances angiogenesis and blood flow, restores phagocytosis by macrophages, improves ischemic tissue survival, attenuates ischemia reperfusion injury, and reverses atherosclerotic plaque formation. In conclusion, these observations suggest a pathogenic role of CD47 in the development of cardiovascular diseases (CVDs) and indicate that CD47 might be a potentially promising molecular target for treating CVDs. Herein, we highlight the role of CD47 in the CVD pathogenesis and discuss the potential clinical application by targeting CD47 for treating CVDs.
Enhanced biocompatibility of CD47-functionalized vascular stents Feb. 15, 2024, 5:19 p.m.
These experiments demonstrated the efficacy of the use of immobilized CD47 in inhibiting early inflammatory and thrombotic events that contribute to the pathophysiology of arterial injury post-stent angioplasty. Specifically, we show stent surfaces can be modified with either recombinant CD47 or peptide derived from CD47 Ig domain. We also demonstrated, using in vitro and in vivo model systems, immunomodulatory activity and platelet inhibition with CD47 modified metal surfaces. In addition, our
Bioresorbable Scaffolds in Coronary Intervention: Unmet Needs and Evolution Feb. 15, 2024, 5:12 p.m.
Current issues identified by histopathological evaluation of BRS at the preclinical level include mild increases in inflammation during bioresorption, greater acute thrombogenicity, delayed re-endothelialization of thicker stent struts, and ultimately a higher risk of device thrombosis and other clinical events than DES. There is a clear need for technological refinement and progress in manufacturing to improve mechanical integrity (i.e., better ductility, higher tensile strength and stiffness, better elongation-at-break). Clinical concerns can be resolved only from well conducted and large randomized trials that embrace late-generation devices and optimal implantation practices. With at least 22 BRS devices in different stages of development, including trials of device iterations with thinner (<150 µm) struts than the ABSORB BRS, the development journey of BRS in interventional cardiology continues.
Global Impacts of Western Diet and Its Effects on Metabolism and Health: A Narrative Review Feb. 15, 2024, 5:07 p.m.
The most important highlights of this review are, firstly, that fruits, vegetables, fiber, and complex carbohydrates can combat not only metabolic disorders that an individual may be afflicted with, but also cancer and its development in relation to the consumption of typical Western diet foods. Secondly, in this regard, consuming a healthier diet rich in micronutrients and antioxidants such as magnesium, potassium, iron, vitamins B6, B12, A, and C, carotenoids, and flavonoids as well as engaging in physical activity reduce inflammatory processes, which has consequences such as improving mental health, increasing beneficial bacteria in the gut, enhancing mitochondrial function, and boosting our immune system.
Heart disease risk factors rise in young adults Feb. 15, 2024, 4:58 p.m.
One person dies every 34 seconds from cardiovascular disease in the U.S., according to the Centers for Disease Control and Prevention, making it the leading cause of death for men, women, and people of most racial and ethnic groups, and steady declines in cardiovascular mortality throughout the second half of the 20th century have stalled over the past decade. Public health experts have expressed concern that these trends may reflect worsening cardiovascular health among younger adults in their 20s, 30s, and 40s.
The Influence of Sex, Age, and Race on Coronary Artery Disease: A Narrative Review Feb. 15, 2024, 4:57 p.m.
Coronary artery disease in the elderly, female, minority, and Black patients is associated with a higher mortality rate. Acknowledging the prevalence of certain risk factors, signs, results, and responses to treatment in certain socio-demographic groups, as well as the provision and accessibility of diagnosis and treatment, would lead to a better outcome for all individuals. The impact of this shift can range from an earlier diagnosis of CAD to a faster and more customized treatment plan tailored to each patient's individual requirements.
Coronary Artery Disease in Very Young (< 40) Patients: Analysis of Risk Factors and Long-Term Follow-Up Feb. 15, 2024, 4:51 p.m.
In our study, current smokers, dyslipidemia, and familial history of CAD were found to be significantly associated with the existence of severe CAD in patients of ≤40 years. The presence of dyslipidemia and hypertriglyceridemia increases the risk of MACE at long-term follow-up. Focusing efforts on primary prevention and optimal control of these factor is necessary. A detailed genetic analysis of high-risk populations with a family history of CAD must be considered.
Cardiovascular Risk Factor Prevalence, Treatment, and Control in US Adults Aged 20 to 44 Years, 2009 to March 2020 Feb. 15, 2024, 4:50 p.m.
These data show a high and rising burden of most cardiovascular risk factors in young US adults, especially for Black, Hispanic, and Mexican American individuals.
Understanding the rising incidence of coronary artery disease in young adults Feb. 15, 2024, 4:28 p.m.
Although coronary artery disease primarily occurs in patients over the age of 40, experts stress that there has been a rising incidence of the disease in young adults.
Current status and future direction of metallic and polymeric materials for advanced vascular stents Feb. 15, 2024, 4:14 p.m.
All materials for the next-generation stents must meet the following requirements. The first requirement of the stent materials is biodegradability. Non-absorbable DESs containing drugs with durable polymers or metals permanently retain the durable polymer platform and metal struts in the human body after complete drug release, which can cause long-term adverse effects such as local inflammation, neoatherosclerosis, and ST.
A new resorbable magnesium scaffold for de novo coronary lesions (DREAMS 3): one-year results of the BIOMAG-I first-in-human study Feb. 14, 2024, 8:31 a.m.
Data at the end of the resorption period of DREAMS 3G showed that the third-generation bioresorbable magnesium scaffold is clinically safe and effective, making it a possible alternative to DES.
CE-approval for BIOTRONIK’s Next-Gen Metallic Bioresorbable Scaffold Freesolve Feb. 13, 2024, 6:28 p.m.
BIOTRONIK announces the CE approval and launch of Freesolve™ Resorbable Magnesium Scaffold (RMS). This third generation RMS has been engineered to provide optimized vessel support, yet achieves magnesium resorption within 12 months.1 The new Freesolve RMS is a groundbreaking vascular advancement based on reliable clinical evidence. Recent BIOMAG-I trial data highlights an exceptional 99.3% magnesium strut degradation 12 months after implantation2, consistent performance, regardless of lesion characteristics, and restoration of vasomotion.3
Innova Vascular announces successful early commercial use of Laguna thrombectomy system in patients Feb. 12, 2024, 12:33 p.m.
The Laguna thrombectomy system encompasses two devices developed by Innova Vascular: the Malibu aspiration catheter system and the Laguna clot retriever system. Both devices received US Food and Drug Administration (FDA) 510(k) clearance in June 2023.
Detection and Treatment of Vulnerable Plaques and Vulnerable Patients Feb. 12, 2024, 9:16 a.m.
The extensive activity described here has great promise to enhance the detection and treatment of vulnerability and thereby prevent coronary events. The net result of improved risk stratification will be better assessment of the risk/benefit relationships for the novel therapies that are needed. This balance will require increased attention because novel antiatherosclerotic agents and treatments are likely to be costly and may carry unanticipated side effects.
Histoire et évolution de la cardiologie interventionnelle Feb. 9, 2024, 10:05 a.m.
La cardiologie interventionnelle représente sans aucun doute une révolution dans l’histoire de la cardiologie car elle s’inscrit indiscutablement dans une évolution plus générale du remplacement de gestes agressifs par un procédé peu invasif. Elle fut rapidement adoptée par les médecins et les patients qui ont vite apprécié une approche percutanée, sans cicatrice et autorisant une sortie rapide de l’hôpital
En 1964, dans un article dans Circulation, Charles Dotter, radiologue américain et “père de la radiologie interventionnelle” et Melvin Judkins décrivent la technique de recanalisation des artères périphériques en enfilant successivement des cathéters d’un diamètre toujours plus important. La première angioplastie percutanée transluminale fut effectuée par Dotter au niveau de l’artère poplitée chez une jeune patiente atteinte de gangrène.