Abstract
The technology of percutaneous coronary intervention (PCI) is constantly being refined in order to overcome the shortcomings of present day technologies. Even though current generation metallic drug-eluting stents (DES) perform very well in the short-term, concerns still exist about their long-term efficacy. Late clinical complications including late stent thrombosis (ST), restenosis, and neoatherosclerosis still exist and many of these events may be attributed to either the metallic platform and/or the drug and polymer left behind in the arterial wall. To overcome this limitation, the concept of totally bioresorbable vascular scaffolds (BRS) was invented with the idea that by eliminating long-term exposure of the vessel wall to the metal backbone, drug, and polymer, late outcomes would improve. The Absorb-bioabsorbable vascular scaffold (Absorb-BVS) represented the most advanced attempt to make such a device, with thicker struts, greater vessel surface area coverage and less radial force versus contemporary DES. Unfortunately, almost one year after its initial approval by the U.S. Food and Drug Administration, this scaffold was withdrawn from the market due to declining devise utilization driven by the concerns about scaffold thrombosis (ScT) seen in both early and late time points. Additionally, the specific causes of ScT have not yet been fully elucidated. In this review, we discuss the platform, vascular response, and clinical data of past and current metallic coronary stents with the Absorb-BVS and newer generation BRS, concentrating on their material/design and the mechanisms of thrombotic complications from the pre-clinical, pathologic, and clinical viewpoints.
Highlights
Percutaneous coronary intervention (PCI) using stents continues to be the dominant means by which symptomatic coronary disease is treated
Limitations include the development of neoatherosclerosis, lack of adaptive remodeling due to vessel caging by metal prosthesis, and abnormal coronary vasomotion
We review the design, vascular response, and clinical data of past and current generation metallic coronary stents, as well as the Absorb-BVS and newer generation bioresorbable vascular scaffolds (BRS) focusing on the relationship between their material/design and the mechanisms of thrombotic complications from the pre-clinical, pathologic, and clinical viewpoints
Summary
Percutaneous coronary intervention (PCI) using stents continues to be the dominant means by which symptomatic coronary disease is treated. Since PCI was introduced in the mid-1970s, innovation of this technology (e.g., coronary stent and anti-platelet therapy) is constantly being refined to overcome limitations such as in-stent restenosis (i.e., development of drug eluting stent [DES]). Limitations include the development of neoatherosclerosis, lack of adaptive remodeling due to vessel caging by metal prosthesis, and abnormal coronary vasomotion. To overcome these issues, the concept of totally bioresorbable vascular scaffolds (BRS) was invented with the idea that by eliminating long-term exposure of the vessel wall to drug and polymer, vessel wall physiology and long-term outcomes would improve. We review the design, vascular response, and clinical data of past and current generation metallic coronary stents, as well as the Absorb-BVS and newer generation BRS focusing on the relationship between their material/design and the mechanisms of thrombotic complications from the pre-clinical, pathologic, and clinical viewpoints
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