Key result
Bioresorbable scaffolds require optimal lesion preparation, accurate sizing, and high-pressure postdilation to minimize the increased risk of early scaffold thrombosis observed with first-generation devices.
This review provides practical guidance on optimizing bioresorbable scaffold deployment to mitigate early thrombosis risks while highlighting the potential of next-generation devices.
Optimal technique is essential with first-generation scaffolds to limit thrombosis; leaves open whether next-generation devices will improve safety.
Bioresorbable scaffolds (BRS) were developed as an alternative to drug-eluting stents (DES) to facilitate vessel restoration and reduce the risk of future adverse events. However, recent meta-analyses and "real-world" registries have raised some concern about the safety of this novel technology, especially due to an increased risk of thrombosis within the first weeks of scaffold implantation. These devices appear to be less forgiving to poor implantation strategies when compared to contemporary DES. Moreover, problems with the first generation of these devices-bulky struts and high crossing prolife, prolonged resorption time, lack of x-ray visibility, and limited tolerance to postdilation-have restricted their clinical application and negatively impacted their short- to mid-term safety performance. However, the potential for long-term improvements has encouraged further research into strategies to overcome these limitations, and potentially safer next-generation devices are already undergoing in-human clinical evaluations. Based on the current literature and our center's experience with these devices, this review discusses various approaches to optimize BRS implantation, drawbacks related to current-generation BRS, and potentially advantageous features of three next-generation scaffold systems.
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Costa et al. (2018) conducted a review in Coronary artery disease. Bioresorbable scaffolds vs. Metallic drug-eluting stents was evaluated. Bioresorbable scaffolds require optimal lesion preparation, accurate sizing, and high-pressure postdilation to minimize the increased risk of early scaffold thrombosis observed with first-generation devices.
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