Open AccessBioresorbable Coronary Scaffolds: Deployment Tips and Tricks and the Future of the Technology
Author(s) -
J. Ribamar Costa,
Alexandre Abizaid
Publication year - 2018
Publication title -
methodist debakey cardiovascular journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.552
H-Index - 23
eISSN - 1947-6094
pISSN - 1947-6108
DOI - 10.14797/mdcj-14-1-42
Subject(s) - medicine , bioresorbable scaffold , safer , first generation , software deployment , risk analysis (engineering) , scaffold , safety profile , intensive care medicine , coronary artery disease , adverse effect , biomedical engineering , computer science , percutaneous coronary intervention , computer security , population , environmental health , myocardial infarction , operating system
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.