recommend extended DAPT after DES placement,
increasing bleeding risk, requiring good patient
compliance, and added cost.
Bioresorbable vascular scaffolds (BVS) were
proposed as an answer to this dilemma. Efforts
to develop the devices began more than 20 years
ago, but the world first learned of their clinical use
in 2000. The “disappearing” stent became commercially available 11 years later, when Abbott’s
Absorb™ BVS became the first of its kind to be
approved for use in Europe. The everolimus-eluting
device, made of a poly-L-lactide polymer, won its
approval based on results of clinical trials demonstrating that the stent restored blood flow by
opening a blocked vessel, providing support to that
vessel until it dissolved after about 2 years.
Since then, the BVS concept has hit a few snags.
Yes, the conformability and superior flexibility of
BVS allows for minimal changes of vessel geometry
and along with the eventual absorption of the lumenprotruding struts attenuate the unfavorable hemodynamic changes typical of rigid stents. Plus, elimination of late-acquired malapposition (an established
trigger of stent thrombosis) or edge-related vascular
responses in the long term are additional theoretical
benefits of BVS. On the other hand, strut thickness is
larger compared with new-generation DES, leading
to suboptimal crossing profiles, limiting the ability to
treat complex (e.g., excessively tortuous or calcified)
lesions or to implant overlapping BVS, resulting in
inferior immediate, post-procedural angiographic
Stents Disappear but Questions Do Not
outcomes of device performance.
Compared with bare-metal stents (BMS), drugRecent randomized trials have raised concerns
eluting stents (DES) decrease the risk of restenosis
about the possibility of higher stent thrombosis
without increasing the risk of death and MI. How(ST) with BVS. Thus, Alok Saurav, MD, et al. of
ever, unlike their bare-metal counterparts they are
associated with hypersensitivity reactions, delayed Creighton University Medical Center, Omaha, NE,
conducted a meta-analysis of five randomized and
healing, and incomplete endothelialization, which
three observational trials, including data on 2,760
may increase the risk of late and very late stent
BVS patients and 2,212 receiving DES. He presentthrombosis. And, of course, current guidelines
ed the data at CRT.16.
All patients were on DAPT for at
least
1 year. They reported a strong
TAVR: A Revolution in
trend towards higher ‘definite ST’
Evolution
(RR: 1.8; p = 0.06). Clinical outcomes were similar for death (RR:
Josep Rodés-Cabau, MD, Quebec Heart &
0.74; p = 0.57), cardiac death (RR:
Lung Institute at Laval University talks about his
0.83; p = 0.66), TVR (RR: 1.0;
JACC Interventions commentary on the conp = 0.95); and ischemia-driven TVR
tinuing evolution of the TAVR revolution. This
(RR: 1.0; p = 0.6). The difference?
interview was taped at CRT.16.
That would be MI, which was
JACC Interventions commentary: interventions.
significantly higher with BVS (RR:
onlinejacc.org/article.aspx?articleID = 2483103
1.35; p = 0.049).
loon PVI in 762 symptomatic patients. There was
a 90-day blanking period after the procedure, only
after which were endpoint events counted.
The rates of the primary efficacy endpoint (the
first documented AF recurrence, occurrence of
atrial flutter or atrial tachycardia, use of antiarrhythmic drugs, or repeat ablation) were 34.6% for
RFA ablation and 35.9% for cryoballoon (p < 0.001
for noninferiority). There was no difference, either,
in the occurrence of the primary safety endpoint
(a composite of death, cerebrovascular events, or
serious treatment-related adverse events; hazard
ratio, 0.78; p = 0.24).
What does it mean that cryoballoon ablation was
noninferior to RFA (and safety was similar between
approaches)? The study was presented by KarlHeinz Kuck, MD, PhD, St. Georg Hospital, Hamburg,
Germany. He said, “Radiofrequency ablation for atrial
fibrillation is the most challenging procedure in cardiology, but with the cryoballoon, it becomes a very
simple procedure. So, with a single-step approach, we
s