Cardiology Xagena

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DREAMS: absorbable metal scaffold might be an alternative to polymeric absorbable scaffold in patients with de-novo coronary lesions

Bioabsorbable vascular scaffolds were developed to overcome limitations of permanent bare-metal or drug-eluting coronary stents, ie, stent thrombosis ( despite prolonged dual antiplatelet therapy ), the life-long presence of a caged vessel segment that does not allow vasomotion or remodelling, and chronic vessel wall inflammation.

The safety and performance of a new Magnesium-based Paclitaxel-eluting absorbable metal scaffold in symptomatic patients with de-novo coronary lesions were assessed.

Researchers did a prospective, multicentre, first-in-man trial ( BIOSOLVE-1 ) of the drug-eluting absorbable metal scaffold ( DREAMS ). 46 patients with 47 lesions were enrolled at five European centres.

The primary endpoint was target lesion failure, a composite of cardiac death, target vessel myocardial infarction, and clinically driven target lesion revascularisation, at 6 and 12 months.

Clinical follow-up was scheduled at 1, 6, 12, 24, and 36 months. Patients were consecutively assigned to angiographic and intravascular ultrasonographic follow-up at 6 months or 12 months.
Optical coherence tomography was done in some patients.
All patients were recommended to take dual antiplatelet therapy for at least 12 months.

Overall device and procedural success was 100%. Two of 46 ( 4% ) patients had target lesion failure at 6 months ( both clinically driven target lesion revascularisations ), which rose to three of 43 ( 7% ) at 12 months ( one periprocedural target vessel myocardial infarction occurred during angiography at the 12 month follow-up visit.
No cardiac death or scaffold thrombosis was noted.

The results have shown feasibility, a good safety profile, and promising clinical and angiographic performance results up to 12 months for DREAMS.
Absorbable metal scaffolds might be an alternative to polymeric absorbable scaffolds. ( Xagena )

Haude M et al, The Lancet 2013; 381: 836-844