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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\u003Cp id=\u0022p-1\u0022\u003EThe new bioresorbable drug-eluting stents are deliverable, usable at bifurcations, compatible with short-term dual antiplatelet therapy, and low cost. Long-term outcomes are needed, however, to confirm their safety and efficacy compared with permanent drug-eluting stents.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Ecoronary artery disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Estent\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Edrug-eluting stents\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ebare metal stents\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Etarget lesion revascularization\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Estent thrombosis\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecardiology \u0026amp; cardiovascular medicine clinical trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Epercutaneous coronary intervention\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\u003Cp id=\u0022p-2\u0022\u003EPatients with coronary artery disease (CAD) undergoing percutaneous revascularization are treated with either drug-eluting stents (DESs) or bare metal stents. Although new generations of DESs have been developed, these stents continue to have some limitations. Bernard Chevalier, MD, Institut Cardiovasculaire Paris Sud, Massy, France, presented current data on the bioresorbable DESs that are in development.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EFirst-generation, polymer-based DESs had multiple limitations. The polymer was fragile, resulting in uneven drug distribution that increased the risk of focal instent restenosis. The kinetics of drug release were not consistent and increased the risk of diffuse restenosis. Some stents had prolonged elution of the medications designed to prevent restenosis that delayed endothelialization of the stents and increased the risk of stent thrombosis. Subsequent generations of DESs have sought to eliminate these issues.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EDESs with biodegradable polymers are under development in an effort to avoid long-term inflammation and improve clinical outcomes. In the LEADERS trial [Stefanini GG et al. \u003Cem\u003ELancet.\u003C\/em\u003E 2011], patients with CAD were randomized to either a biodegradable biolimus-eluting stent (BES) or a durable polymer sirolimus-eluting stent (SES) and were followed for 4 years. The biodegradable BES was noninferior to the durable polymer SES for the end points of target lesion revascularization (TLR) and definite stent thrombosis (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/16\/15\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Biodegradable Vs Durable Polymer Drug-Eluting Stents\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-512639374\u0022 data-figure-caption=\u0022Biodegradable Vs Durable Polymer Drug-Eluting Stents\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/16\/15\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/16\/15\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/16\/15\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16901\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \u003Cp id=\u0022p-5\u0022 class=\u0022first-child\u0022\u003EBiodegradable Vs Durable Polymer Drug-Eluting Stents\u003C\/p\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EAdapted from \u003Cem\u003EThe Lancet\u003C\/em\u003E, 378, Stefanini GG et al. Long-term clinical outcomes of biodegradable polymer biolimus-eluting stents versus durable polymer sirolimus-eluting stents in patients with coronary artery disease (LEADERS): 4 year follow-up of a randomised non-inferiority trial. 1940\u20131948. Copyright \u00a9 2011, with permission from Elsevier.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-6\u0022\u003EThe NEXT trial [Natsuaki M et al. \u003Cem\u003EJ Am Coll Cardiol.\u003C\/em\u003E 2013] demonstrated that TLR and stent thrombosis occurred at similar, but very low, rates among patients who received the biodegradable BES compared with the durable polymer SES.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EThe CENTURY II trial [Saito S et al. \u003Cem\u003EEur Heart J.\u003C\/em\u003E 2014] randomized patients to either the bioresorbable Ultimaster SES or the permanent Xience everolimus-eluting stent. The Ultimaster stent is made of a PDLLA-PCL copolymer that is resorbed within 3 to 4 months. By contrast, the Xience DES contains a PVDF-HFP nonerodible fluorinated copolymer and is permanent. Patients treated with the Ultimaster stent had a 0.40% higher rate of freedom from target lesion failure (95% CI, \u22122.22 to 3.02; \u003Cem\u003EP\u003C\/em\u003E = .0001) at 9 months. In the cohort of patients from Japan, the cumulative incidence of TLR events was 4.14% (95% CI, 2.52 to 6.78) and 5.67% (95% CI, 3.69 to 8.64) in the Xience arm.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EA variety of other bioresorbable stents, including both polymer- and nonpolymer-based stents, and stents that elute everolimus, novolimus, and sirolimus, have undergone animal and clinical trials. To date, none of the bioresorbable stents are approved for use in the United States. In Europe, only Abbott\u0027s BVS 1.1 polymer-based stent is available for clinical use.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EProf Chevalier described clinical challenges that might arise when deploying bioresorbable stents. Bioresorbable stents are susceptible to mechanical deformation of stent strut with delivery. In addition, as the stent polymer erodes, the radial strength of the polymer decreases, which could result in late lumen loss. The ABSORB II trial [Diletti R et al. \u003Cem\u003EAm Heart J.\u003C\/em\u003E 2012] randomized patients in a 2:1 fashion to receive the Absorb bioresorbable stent or the Xience stent. The primary end points of the study are based on changes in lumen diameter.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EProf Chevalier highlighted that the current limitations of the bioresorbable DES include a large profile (\u0026gt; 1.4 mm), decreased radial strength over time, and limited ability to increase the diameter using postdilation inflations. The potential benefits of a bioabsorbable stent would not begin until after the PCI (eg, strut resorption, conformability, pulsatility, vasomotoricity, plaque regression, and positive remodeling). He cautioned that bioresorbable DESs have been evaluated in a relatively small number of patients and have only been used to treat simple lesions.\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003ECurrent work is focused on developing thinner stent struts with a lower profile in an attempt to reduce occlusion of small side branches. Other areas of work include increasing the ability the stents to be sized further after deployment and the development new polymers and strut designs. In the meantime, Prof Chevalier pointed out that lesion preparation and appropriate sizing are important prior to deployment of a stent, particularly in bioresorbable stents, in order to prevent mechanical deformation and to achieve the best possible outcomes.\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003EIn conclusion, Prof Chevalier stated that the new, bioresorbable stents are deliverable, can be used at bifurcations, are cost-effective, and are compatible with short-term dual antiplatelet therapy. Current data suggest that bioresorbable DESs have similar short-term efficacy and safety as permanent DESs but data on long-term outcomes are needed.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/16\/15.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzlkb2\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzlkb2\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}