Korean Circ J.  2018 Jan;48(1):24-35. 10.4070/kcj.2017.0194.

Bioresorbable Scaffolds in Coronary Intervention: Unmet Needs and Evolution

• Capodanno

• KMID: 2405043
• DOI: http://doi.org/10.4070/kcj.2017.0194

Abstract

Bioresorbable scaffolds (BRS) represent a novel paradigm in the 40-year history of interventional cardiology. Restoration of cyclic pulsatility and physiologic vasomotion, adaptive vascular remodeling, plaque regression, and removal of the trigger for late adverse events are expected BRS benefits over current metallic drug-eluting stents. However, first-generation BRS devices have significant manufacturing limitations and rely on optimal implantation technique to avoid experiencing an excess of clinical events. There are currently at least 22 BRS devices in different stages of development, including many trials of device iterations with thinner (<150 µm) struts than first-generation BRS. This article reviews the outcomes of commercially available and potentially upcoming BRS, focusing on the most recent stages of clinical development and future directions for each scaffold type.

Keyword

Bioresorbable scaffolds; ABSORB; Biodegradable stents; Angioplasty; Coronary stents

MeSH Terms

Angioplasty
Cardiology
Drug-Eluting Stents
Vascular Remodeling

Figure

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  Figure 1 Strut thickness of early and current generation BRS. BRS = bioresorbable scaffolds.

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  Figure 2 Key features of BRS currently approved by the CE. BRS = bioresorbable scaffolds; CE = European Conformity; Mg = magnesium; PDLLA = poly-d,l-lactic acid; PLLA = poly-l-lactic acid; TP = tyrosine polycarbonate.

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  Figure 3 Schematic representation of the parabolic trajectory of the first-generation ABSORB BRS. After presentation of 3-year follow-up results of the ABSORB 2 trial, the gap between expectations and reality appears unacceptable. This has been corroborated by 2-year follow-up results of the ABSORB 3 trial, the AIDA trial, and subsequent meta-analyses. Technological refinements and adherence to strict implantation protocol are necessary to bring this technology to the next phase. AIDA = Amsterdam Investigator-initiateD Absorb Strategy All-comers Trial; BRS = bioresorbable scaffolds.

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