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Bioresorbable vascular scaffolds — basic concepts and clinical outcome

Nature Reviews Cardiology volume 13, pages 719–729 (2016)Cite this article

Subjects

Key Points

  • Bioresorbable vascular scaffolds (BVS) are the latest innovation in the field of coronary interventions and are emerging as a promising treatment for patients with coronary artery stenoses

  • Available data from direct comparison in randomized studies showed similar clinical results in patients treated with BVS compared with the current generation of drug-eluting stents

  • Appropriate selection of target lesions and an appropriate implantation technique are crucial to achieving a good long-term result with the currently available devices

  • Some concerns remain about scaffold thrombosis and coronary restenosis

Abstract

The introduction of percutaneous treatment of coronary artery stenosis with balloon angioplasty was the first revolution in interventional cardiology; the advent of metallic coronary stents (bare and drug-eluting) marked the second and third revolutions. However, the latest generation of drug-eluting stents is limited by several factors. Permanent vessel caging impairs arterial physiology, and the incidence of very late stent thrombosis — although lower with the second generation than with the first generation of drug-eluting stents — remains a major concern. This complication is mainly related to the presence of permanent metallic implants, chronic degeneration triggered by an inflammatory response to the coating polymer, and/or adverse effects of antiproliferative drugs on endothelial regeneration. In 2011, self-degrading coronary stents — the bioresorbable vascular scaffolds (BVS) — were introduced into clinical practice, showing good short-term results owing to their adequate strength. The advantage of these devices is the transient nature of vascular scaffolding, which avoids permanent vessel caging. In this Review, we summarize the latest research on BVS, with a particular emphasis on the implantation technique (which is different from that used with metallic stents) to outline the concept that BVS deployment methods have a major effect on procedural success and prognosis of patients with coronary artery stenosis. Furthermore, the clinical outcome of BVS in randomized clinical trials and in phase IV studies are discussed in different pathophysiological settings, such as stable or acute coronary disease. Finally, all the available data on the safety profile of BVS regarding scaffold thrombosis are discussed.

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Figure 1: Milestones in coronary angioplasty.
Figure 2: Timing of strut reabsorption.
Figure 3: Comparison of the strut thickness of different categories of stent.

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Authors and Affiliations

  1. Division of Cardiology, Department of Medical and Surgical Sciences, “Magna Graecia” University, Catanzaro, 88100, Italy

    Ciro Indolfi & Salvatore De Rosa

  2. Department of Medicine, URT-CNR, Consiglio Nazionale delle Ricerche of IFC, Viale Europa S/N, Catanzaro, 88100, Italy

    Ciro Indolfi

  3. Department of Interventional Cardiology, San Raffaele Scientific Institute, via Olgettina 60, Milano, 20132

    Antonio Colombo

  4. EMO-GVM, Centro Cuore Columbus, Via Buonarroti 48, Milan, 20145, Italy

    Antonio Colombo

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  1. Ciro Indolfi
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S.D.R. researched data for the article and wrote the manuscript. All the authors contributed substantially to discussion of content, and reviewed/edited the manuscript before submission.

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Correspondence to Ciro Indolfi.

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C.I. has received educational grants from Abbott Vascular. S.D.R. and A.C. declare no competing interests.

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Indolfi, C., De Rosa, S. & Colombo, A. Bioresorbable vascular scaffolds — basic concepts and clinical outcome. Nat Rev Cardiol 13, 719–729 (2016). https://doi.org/10.1038/nrcardio.2016.151

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