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The State of the Absorb Bioresorbable Scaffold: Consensus From an Expert Panel.

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Bioresorbable scaffolds (BRS) show promise for coronary artery disease but face safety concerns. Optimizing implantation and patient selection may mitigate risks, potentially rivaling metallic drug-eluting stents (DES).

Keywords:
bioresorbable scaffoldpolymer poly-L-lactic acidscaffold thrombosis

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Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Biomaterials Science

Background:

  • Metallic drug-eluting stents (DES) have advanced percutaneous coronary intervention but leave permanent implants linked to late adverse events.
  • Bioresorbable scaffolds (BRS) were developed to overcome the limitations of permanent metallic stents, aiming for temporary scaffolding.
  • First-generation BRS, like the Absorb scaffold, have encountered safety challenges, including increased risks in clinical trials, mirroring early issues with first-generation DES.

Purpose of the Study:

  • To discuss factors contributing to the excess risks observed with first-generation BRS.
  • To outline strategies for mitigating these risks, focusing on patient and lesion selection, implantation technique, and dual antiplatelet therapy.
  • To evaluate the potential of BRS to match the safety and efficacy of DES while offering the benefit of bioresorption.

Main Methods:

  • Review of clinical trial data and literature concerning BRS and DES performance.
  • Analysis of scaffold characteristics, including strut thickness and material properties.
  • Discussion of procedural factors, such as deployment technique and post-procedural management.

Main Results:

  • First-generation BRS, particularly thick-strut designs like Absorb, have demonstrated an increased risk of adverse events compared to DES.
  • Specific deployment techniques and patient/lesion selection criteria may influence BRS outcomes.
  • The long-term safety and efficacy profile of BRS compared to DES remains under investigation, with ongoing efforts to refine the technology.

Conclusions:

  • While BRS offer the theoretical advantage of disappearing over time, current first-generation devices face significant safety hurdles that need to be addressed.
  • Careful patient selection, meticulous implantation technique, and appropriate dual antiplatelet therapy are crucial for potentially improving BRS outcomes.
  • Further technological iterations and clinical evidence are required to determine if BRS can ultimately provide a safe and effective alternative to metallic DES for coronary artery disease treatment.