Bioresorbable vascular scaffolds - is therapy already at an end or is there a renaissance?

Abstract

Bioresorbable vascular scaffolds - is therapy already at an end or is there a renaissance? Abstract. The principle of bioresorbable vascular scaffolds is a good approach to solving the residual problem of percutaneous coronary interventions, which despite the introduction and immense further development of metal stents have shown a continuous increase in undesirable events over the years. As an advantage, bioresorbable vascular scaffolds can on the one hand ensure the restoration of the physiological vascular properties; on the other hand - after resorption - in contrast to permanent metal implants, the cause of the development of in-stent re-stenoses or late stent thromboses, which still represent the greatest limitation of the metal stents, is resolved. The first real representative of the bioresorbable vascular scaffolds (Absorb) was able to deliver good results initially; but that could not be confirmed in the end, so that it was withdrawn from the market. However, important insights were gained from the error analyzes that influenced the further development of the currently approved scaffolds, so that scaffolds are now on the market that have a strut thickness comparable to metal stents and thereby produce good study results. Even if the number of patients treated and the quality of the studies are not yet sufficient to change the current European guidelines, which are solely based on the Absorb-data; there is a promising data situation now compared to 2018 when the guidelines were written. The promising results of the studies in the treatment of infrapopliteal stenosis and the attendance of manufacturers to work on further product generations show that the therapy with BRS is far from over but is - after a bumpy start - at the beginning of a renaissance.