The Absorb bioresorbable vascular scaffold for the treatment of coronary artery disease

ABSTRACT

Introduction: Every decade the field of interventional cardiology is revolutionized by new technology. The fully bioresorbable everolimus-eluting scaffold (ABSORB BVS) technology would preserve the benefits of metallic stents by sealing balloon-induced dissections, avoiding elastic recoil and vessel occlusion. The polymeric scaffold would be resorbed to restore the natural integrity of the vessel, superseding the consequence of the permanent presence of a foreign body in the coronary artery.

Areas covered: This technology evaluation focuses on the clinical evidence for the use of bioresorbable everolimus-eluting scaffold for the treatment of coronary artery disease.

Expert opinion: The current generation of the bioresorbable scaffold has structural and mechanical limitations that might preclude the widespread use in clinical practice. The strut thickness (150 µm) limits deliverability and creates laminar flow disruptions that might be the nidus of an increased rate of scaffold thrombosis. In the next generation of bioresorbable scaffolds, the resorption process should be faster and in particular, strut thickness must be reduced. This will probably represent a significant step forward in an attempt to increase the efficacy and safety profile of the device and achieve a similar performance with the current generation drug-eluting stent even in complex scenarios.

KEYWORDS:

• Biodegradable scaffold
• Absorb
• coronary artery disease

Article highlights

• The Absorb bioresorbable scaffold backbone is made of poly-L-lactide (PLLA) coated with poly-D, L-lactide acid (PDLLA), which are both fully bioresorbable.

• The bioresorption process of Absorb has been associated with the return of vasomotion, cyclic strain and restoration of the vascular integrity of the vessel.

• Randomised clinical trials have demonstrated non-inferiority of Absorb vascular scaffold compared to drug-eluting stents for the treatment of non-complex coronary artery disease.

• There appears to be a higher rate of scaffold thrombosis compared to best-in-class drug eluting stent.

• The implantation technique for appropriate sizing of the scaffold to the target vessel is of paramount importance to avoid adverse events.

• Long-term follow-up is warranted to assess whether the potential benefit of scaffold bioresorption appears after a period.

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Declaration of interest

Y Onuma and PW Serruys are members of the International Advisory Board for Abbott Vascular. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This paper was not funded.