Bioresorbable vascular scaffold failure – Post factum research to look for the reasons

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Bioresorbable vascular scaffolds (BVS) were developed to provide early mechanical support and antiproliferative drug delivery similar to metallic drug-eluting stents (DES) followed by gradual and complete reabsorption within a few years following implantation [ [1] Kereiakes D.J. Onuma Y. Serruys P.W. Stone G.W. Bioresorbable vascular scaffolds for coronary revascularization. Circulation. 2016; 134: 168-182 Crossref PubMed Scopus (87) Google Scholar ]. It was hoped that BVS would overcome disadvantages of permanent presence of a metallic structure within the coronary arteries including permanent caging and impairment of vessel vasomotion, side branch jailing and lack of possibility of late lumen enlargement, non-invasive imaging or future surgical revascularization of stented segments [ [1] Kereiakes D.J. Onuma Y. Serruys P.W. Stone G.W. Bioresorbable vascular scaffolds for coronary revascularization. Circulation. 2016; 134: 168-182 Crossref PubMed Scopus (87) Google Scholar ]. However, a growing body of evidence suggests that the use of Absorb BVS – the most investigated BVS – was associated with increased risk of target lesion failure driven by higher rates of device thrombosis, target vessel myocardial infarction and ischemia-driven target lesion revascularization compared with contemporary DES [ [2] Cassese S. Byrne R.A. Juni P. Wykrzykowska J.J. Puricel S. Ndrepepa G. et al. Midterm clinical outcomes with everolimus-eluting bioresorbable scaffolds versus everolimus-eluting metallic stents for percutaneous coronary interventions: a meta-analysis of randomised trials. EuroIntervention. 2018; 13: 1565-1573 Crossref PubMed Scopus (29) Google Scholar ]. These issues and the decision by the manufacturer to withdraw from the market the most widely-used BVS (Absorb) discourage the use of these devices in patients with coronary artery disease (CAD). Inevitably these developments raised concerns regarding the safety of patients already implanted with BVS and stimulated research on the underlying mechanisms mediating the BVS failure. The evidence is limited regarding the use of BVS in patients with ST-segment elevation myocardial infarction (STEMI) [ [3] Sabate M. Windecker S. Iniguez A. Okkels-Jensen L. Cequier A. Brugaletta S. et al. Everolimus-eluting bioresorbable stent vs. durable polymer everolimus-eluting metallic stent in patients with ST-segment elevation myocardial infarction: results of the randomized ABSORB ST-segment elevation myocardial infarction-TROFI II trial. Eur. Heart J. 2016; 37: 229-240 Crossref PubMed Scopus (206) Google Scholar , [4] Brugaletta S. Gori T. Low A.F. Tousek P. Pinar E. Gomez-Lara J. et al. Absorb bioresorbable vascular scaffold versus everolimus-eluting metallic stent in ST-segment elevation myocardial infarction: 1-year results of a propensity score matching comparison: the BVS-EXAMINATION study (bioresorbable vascular scaffold-a clinical evaluation of everolimus eluting coronary stents in the treatment of patients with ST-segment elevation myocardial infarction). JACC Cardiovasc. Interv. 2015; 8: 189-197 Crossref PubMed Scopus (157) Google Scholar ]. Furthermore, whether timing and mechanisms of BVS failure differ according to the clinical syndrome remains largely unknown. Predictors of bioresorbable scaffold failure in STEMI patients at 3 years follow-upInternational Journal of CardiologyVol. 268PreviewLittle data are available on the long-term outcomes of bioresorbable scaffold (BRS) in the setting of ST-segment elevation myocardial infarction (STEMI). The aim of this study is to investigate three-years outcomes and predictors of BRS failure in patients presenting with STEMI. Full-Text PDF