Bioresorbable Vascular Scaffolds: a Dissolving Dream?

Excerpt

The first bioresorbable vascular scaffold (BVS), the Absorb BVS™ (Abbott Vascular, Santa Clara, CA, USA) made of poly-l-lactic acid came to the market in 2011 raising great expectations of another “revolution” in interventional cardiology. BVS was designed to mimic the acute results of drug-eluting metallic stents (DES) while avoiding the long-term penalties of stent thrombosis by maintaining the natural architecture of the vessel through temporary mechanical support with subsequent scaffold resorption. It was hypothesized that scaffold resorption would restore vasomotion, allowing luminal expansion and constriction as physiologically appropriate, and lessen subsequent plaque accretion. Empiric studies have not fulfilled these hopes. Rather, the Absorb BVS was associated with a higher risk of myocardial infarction and target lesion failure compared with 2nd generation DES [1]. An individual-patient-data pooled meta-analysis of the 4 randomized ABSORB trials in which patients were treated with everolimus-eluting Absorb BVS or cobalt-chromium everolimus-DES showed at 3 years a higher rate of target lesion failure (11.7% versus 8.1%; risk ratio [RR], 1.38; 95% confidence interval [CI], 1.10–1.73; P = 0.006), driven by greater target vessel myocardial infarction (7.8% versus 4.2%; RR, 1.72; P = 0.0006) and ischemia-driven target lesion revascularization (6.6% versus 4.4%; RR, 1.44; p = 0.02), with comparable cardiac mortality of 1.1%. Device thrombosis rates were also higher with BVS (2.4% versus 0.6%; RR, 3.71; P = 0.001) [2]. …