Current Status of the Bioresorbable Scaffolds in Coronary Interventions

Drug-eluting stents (DESs) have paved a great path for treatment of coronary atherosclerosis by a dramatic reduction in restenosis although it has its own limitations such as vascular inflammation, local thrombus formation, loss of vasomotor tone, and restenosis of the stented segment continue to be distressing problems.

Stents often show up with occasional late and very late stent thrombosis, stent fatigue fracture, unsuitability of stented segments for future surgical revascularization, impairment of vasomotor tone, and jailing of side branches are unresolved issues with them.

The current review article was presented by Dr. Amar Patnaik and Dr.Jyotsna Maddury in Indian Journal of Cardiovascular Disease in Women, published by Scientific scholar (Scientific scholar)  where it discusses the evolution of Bioresorbable Vascular Scaffolds, in interventional cardiology .

The prototype and most widely used scaffold were absorb bioabsorbable vascular scaffolds. The first version of the device showed a high rate of recoil at 6 months.

ABSORB cohort A was the first-in-man study that used Absorb BVS 1.0, in 30 patients. Early recoil at 6 months was the main drawback. Both 2-year and 5-year MACE were 3.4%. The BVS 1.1 was used in 101 (Cohort B) patients subsequently which yielded better luminal area and good late clinical outcomes - no stent thrombosis at 3 years and MACE rate of 10.1%.

ABSORB-II compared the BVS with an equivalent metallic stent in 501 patients and ABSORB-III enrolled 2008 patients from multiple centers which lead to its approval by FDA. BVS was within the prespecified margin for non-inferiority regarding target lesion failure at 1 year.

However, the device thrombosis was double that of the metallic stent group. A meta-analysis that followed also showed a higher incidence of subacute scaffold thrombosis. ABSORB IV is almost like an extension of ABSORB-III.

In conclusion, BVS is a novel concept with promising clinical data, especially with the new generation of devices. When there is a need for a good late vessel lumen with restored vasomotion BVS is the answer. The initial setbacks are fairly addressed in the new-generation devices and there are improvements in implantation techniques. With maturity in technology and clinical experience, BVS is expected to re-bounce as a promising strategy in interventional cardiology.

Reference:

Patnaik A, Maddury J. Current status of the bioresorbable scaffolds in coronary interventions. Indian J Cardiovasc Dis Women 2022;7:214-9. DOI: 10.25259/IJCDW_11_2022.