Summary: | Coronary angioplasty was first introduced in 1977. From plain old balloon
angioplasty to the introduction of bare metal stents in 1986 and dual
antiplatelet therapy in 1992 to much more later on. Due to the unacceptable rate
of stent restenosis, drug eluting stents (DES) were introduced in 2000. The first
generation showed an increase in late stent thrombosis which led to the
introduction of the second generation DES with biocompatible or biodegradable
polymers and thinner platforms. However very late stent thrombosis and late
restenosis might still pose problems in the latter. Furthermore, there has been
major debate regarding the impact of long-term vessel caging on normal
vasomotricity and long-term positive remodeling. To resolve these issues, the
bioresorbable vascular scaffolds (BVS) were launched into the real world in 2011,
showing promising initial results. Multiple randomized trials, meta-analyses, and
registries were performed, mainly with the Absorb Bioresorbable Vascular Scaffold
System (Abbott Vascular, Chicago, IL, USA). This new technology is hindered by certain
features, such as the BVS radial strength, its strut thickness, and the
inflammatory process related to scaffold degradation. Moreover, there is known
data indicating higher thrombosis rate with the Absorb BVS compared with the new
generation of DES, despite similar 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: is the
bioresorbable technology still the way to the future?
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