Nagi Azzi1* and Wassim Shatila2,3
1Department of Cardiology, Lebanese American University-Rizk Hospital, Lebanon
2Department of Cardiology, Texas Heart Institute, Houston, USA
3Baylor College of Medicine, Houston, Texas, USA
Coronary angioplasty was born in 1977, and since then it has not stopped evolving. Starting with plain old balloon angioplasty, the discipline knew the advent of the bare metal stent in 1986 and dual antiplatelet therapy since 1992. Due to the unacceptable rate of stent restenosis, the Drug Eluting Stents (DES) emerged in 2000, with a first generation that later knew an increase in late stent throm¬bosis. Therefore, the second-generation DES came with biocompatible or biodegradable polymers and thinner platforms; however very late stent thrombosis and late restenosis still remain at residual rate due to different DES components. Also, long-term vessel caging in particular impairs normal vasomotricity and long-term positive remodeling. To resolve these issues, the Bioresorbable Vascular Scaffolds (BVS) came into clinical practice in 2011, showing good initial results. Several randomized trials, meta-analyses and registries were performed, most of which with the Absorb Bioresorbable Vascular Scaffold System (Abbott Vascular, USA). This new technology is still hindered by some factors, such as the BVS radial strength, its strut thickness, and the inflam¬matory reaction related to scaffold degradation. Moreover, there is existing data showing a higher thrombosis rate observed with the Absorb BVS compared with the new generation of DES, despite not affecting cardiovascular death. In this Review, we discuss the clinical procedural and technical evidence on BVS, with emphasis on their clinical impact. We finally tackle the future directions on device and procedural improvement while asking the question: is the bioresorbable technology still the way to the future?
Percutaneous interventions; Bioresorbable vascular scaffolds; ST; ICI
Azzi N, Shatila W. The Bioresorbable Vascular Scaffolds: Actual Knowledge and Future Prospects. J Heart Stroke. 2019; 4(1): 1057.