Bioresorbable scaffolds advances, challenges, and future directions

Over the past few decades, researchers have attempted to overcome the disadvantages of metallic stents. This led to the birth of the first "Bioresorbable Scaffold" (BRS) model, the Absorb Bioresorbable Vascular Scaffold (BVS), in 1999 by Abbott. A stent that spontaneously resorbs shows a promising theoretical minimal risk of long-term stent thrombosis and omits the need for long-term antiplatelet therapy. However, only one year after its Food and Drug Administration (FDA) approval in 2016, it was voluntarily withdrawn owing to concerns regarding its safety because of the higher risk of target lesion failure. Although long-term follow-up data from the ABSORB IV trial were released in 2023 and showed a comparable long-term safety profile for BRS compared to conventional metallic stents, with only a slightly higher target lesion failure in the first three years, concerns remain regarding their use. Therefore, in this study, we discuss the different adverse events associated with different BRS models. We also discuss various approaches to optimizing the use of BRS, new BRS manufacturing techniques (e.g., 3D printing), and novel BRS models yet to be approved (e.g., DREAM 3G magnesium-based BRS). We suggest carefully selecting patients who could obtain the maximum benefit from BRS through the discussed selection criteria, which could reduce the risk of target lesion failure and BRS complications. Using newer technologies, such as 3D printing, also has excellent potential for making BRS more cost- and market-friendly, owing to their fast output and ability to form individually curated scaffolds.