Bioresorbable vascular scaffolds-time to vanish?

Area of Science:

• Cardiovascular medicine
• Biomaterials science
• Interventional cardiology

Background:

• Bioabsorbable vascular scaffolds (BVS) were developed to mitigate late adverse events like device thrombosis associated with coronary stenting.
• Composed of polylactic acid, BVS are designed for gradual absorption within the body over several years.
• Initial use in low-risk patients with simple lesions yielded positive results, fostering optimism for improved patient outcomes.

Purpose of the Study:

• To evaluate the safety and efficacy of fully bioabsorbable vascular scaffolds (BVS) in coronary stenting.
• To investigate the reasons behind early device thrombosis observed in higher-risk patients and complex lesions.
• To compare mid-term outcomes of BVS with metallic drug-eluting stents.

Main Methods:

• Analysis of initial clinical experiences and mid-term outcomes from large-scale randomized clinical trials.
• Comparison of BVS performance against metallic everolimus-eluting stents.
• Assessment of the impact of implantation technique on BVS performance.

Main Results:

• High rates of early device thrombosis were observed when BVS were used in higher-risk patients with complex lesions.
• Mid-term outcomes were disappointing, with a trend towards increased myocardial infarction and device thrombosis in the first year compared to metallic stents.
• While non-inferiority to metallic stents was met, the expected long-term advantages of BVS remain to be proven.

Conclusions:

• The performance of BVS is highly dependent on optimal implantation techniques, differing from metallic stent procedures.
• Current evidence suggests caution regarding the widespread use of BVS in complex coronary lesions due to early thrombosis risks.
• Long-term data (3-5 years) are crucial to determine if the theoretical benefits of BVS, such as vessel remodeling, will ultimately outweigh the observed risks.