Key result
Bioresorbable vascular scaffolds show no further clinical benefit over newer-generation DES.
Why the study?
Coronary artery stenting is the treatment of choice for coronary angioplasty, motivating a review of major advancements in stent technology and adjunctive therapies.
Newer-generation drug-eluting stents are the standard of care for coronary angioplasty due to improved safety and efficacy, while bioresorbable scaffolds are limited by increased thrombosis risk.
Supports DES as PCI standard; leaves open whether redesigned scaffolds can overcome prior limitations.
Coronary artery stenting is the treatment of choice for patients requiring coronary angioplasty. We describe the major advancements with this technology. There have been significant developments in the design of stents and adjunctive medical therapies. Newer-generation drug-eluting stents (DES) have almost negligible restenosis rates and, when combined with proper anti-platelet treatment and optimal deployment, a low risk of stent thrombosis. The introduction of newer-generation DES with thinner stent struts, novel durable or biodegradable polymer coatings, and new antiproliferative agents has further improved the safety profile of early-generation DES. In parallel the effectiveness has been kept, with a significant reduction in the risk of target lesion revascularization compared with the early-generation DES. However, to date, the development of completely bioresorbable vascular scaffolds has failed to achieve further clinical benefits and has been associated with increased thrombosis. Newer-generation DES-including both durable polymer as well as biodegradable polymer-have become the standard of care in all patient and lesion subsets, with excellent long-term results.
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Kobo et al. (2020) conducted a review in Coronary artery disease. Newer-generation drug-eluting stents vs. Early-generation DES, bare-metal stents, and bioresorbable vascular scaffolds was evaluated. Newer-generation drug-eluting stents have become the standard of care with excellent long-term results, whereas bioresorbable vascular scaffolds have failed to achieve further clinical benefits.
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