Bioresorbable Scaffolds for Coronary Revascularization: From Concept to Clinical Maturity

Area of Science:

• Cardiovascular Medicine
• Biomaterials Science
• Interventional Cardiology

Background:

• Bioresorbable scaffolds (BRSs) were developed to provide temporary coronary artery support, elute drugs, and resorb, aiming to restore natural vessel function.
• First-generation BRSs faced challenges like scaffold thrombosis and late adverse events due to thick struts and unpredictable degradation.
• Advancements include thinner struts, improved radial strength, and refined resorption profiles in newer polymeric and magnesium-based scaffolds.

Purpose of the Study:

• To review the design principles, clinical outcomes, and procedural considerations of drug-eluting bioresorbable scaffolds (BRSs).
• To synthesize recent meta-analytic evidence and emerging insights on BRS device mechanics and clinical performance.
• To discuss future directions in BRS technology, including material science, implantation strategies, and patient selection.

Main Methods:

• Review of clinical trials and meta-analyses (e.g., ABSORB, AIDA, BIOSOLVE, BIOSTEMI) evaluating BRS performance.
• Analysis of device mechanics, including the impact of strut thickness on radial strength.
• Synthesis of data on procedural optimization strategies, such as the PSP approach and intravascular imaging.

Main Results:

• Optimized procedural strategies (PSP approach, intravascular imaging) significantly reduce BRS thrombosis and restenosis rates.
• Next-generation BRSs demonstrate progress toward achieving transient scaffolding and long-term vessel restoration.
• Challenges remain regarding inflammatory responses, mechanical fragility in complex lesions, and optimal patient selection.

Conclusions:

• While early BRSs had limitations, current and future platforms show significant progress.
• Optimized techniques and material science are crucial for realizing the potential of BRSs as alternatives to metallic stents.
• Bioresorbable scaffold technology is advancing towards fulfilling its vision of safe, effective, and fully resorbable coronary interventions.