Bioresorbable scaffolds in peripheral arterial disease

Abstract

The risk of in-stent restenosis has been dramatically reduced with the use of thin-strut nitinol and balloon-expandable drug-eluting stents in the peripheral arterial territory. However, the presence of a permanent endovascular device is linked to a series of events that can lead to restenosis and stent thrombosis. Significant advances in the technology of bioresorbable materials have delivered the potential for fully bioresorbable scaffolds (BRS), which are able to mechanically support the artery wall and elute an anti-restenotic drug for a predetermined time period after which the scaffold becomes fully absorbed into the vascular wall. Currently, several vascular BRS are available, undergoing evaluation either in clinical trials or in preclinical settings. The aim of this review is to present the new developments in BRS technology, describe the mechanisms involved in the resorption process, and discuss the current and potential future prospects of this innovative treatment option for peripheral arterial disease.

Keywords::

• below-the-knee arteries
• bioresorbable vascular scaffold
• design
• femoropopliteal axis
• peripheral arterial disease

Financial & competing interests disclosure

The authors have no 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Stents are used in a variety of peripheral arterial disease (PAD) lesions as a bailout method of suboptimal angioplasty or as a primary treatment to reduce restenosis, which commonly occurs within the first few months. After this period, there is no proven need for stent scaffolding.

• Permanent metal stents are obstacles to additional endovascular or surgical treatments.

• Novel bioresorbable vascular scaffold (BVS) technology may be an ideal alternative, as it offers the acute and mid-term advantages of a conventional or drug-eluting stent combined with late luminal gain and late positive remodeling, which are detected only after balloon angioplasty.

• Dedicated peripheral BVS should be developed to address the needs of the different arterial and lesion characteristics encountered in PAD patients.

• Ongoing trials investigating BVS in PAD will soon set the first indications for their use in everyday clinical practice.