The Current Literature on Bioabsorbable Stents: a Review

Area of Science:

• Cardiovascular medicine
• Biomaterials science
• Interventional cardiology

Background:

• Coronary stents have evolved from bare-metal stents to drug-eluting stents (DES) to improve outcomes.
• Bioresorbable vascular scaffolds (BVS) were developed to offer a temporary solution, potentially reducing long-term complications.
• The ABSORB BVS was the first fully bioresorbable scaffold, aiming to decrease stent thrombosis and target vessel revascularization.

Purpose of the Study:

• To review the evolution of coronary stents, focusing on bioresorbable vascular scaffolds (BVS).
• To analyze the safety and efficacy data of current BVS stents compared to contemporary DES.
• To discuss ongoing clinical trials for next-generation BVS.

Main Methods:

• Review of existing randomized controlled trials and observational studies on BVS performance.
• Comparison of clinical outcomes, including stent thrombosis and target vessel revascularization, between BVS and DES.
• Examination of proposed mechanisms for BVS thrombogenicity.

Main Results:

• The ABSORB BVS demonstrated higher rates of stent thrombosis, target vessel revascularization, and myocardial infarction compared to current-generation DES.
• These findings led to the ABSORB BVS being withdrawn from the market.
• Proposed reasons for BVS thrombogenicity include higher strut profiles, low radial strength, and neoatherosclerosis.

Conclusions:

• First-generation BVS stents have shown suboptimal performance and safety concerns.
• Despite the challenges, the development of new BVS technologies continues.
• The future role of fully bioresorbable scaffolds in coronary interventions remains uncertain pending further clinical data.