Bioresorbable stents: The future of interventional cardiology?

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FIGURE 1
Reduction of restenosis rates by stent type.
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FIGURE 2
Second- vs first-generation drug-eluting stents.
Reprinted from JACC: Cardiovascular Interventions (Gada H, et al. 5-Year results of a randomized comparison of XIENCE V everolimus-eluting and TAXUS paclitaxel-eluting stents: final results from the SPIRIT III trial (clinical evaluation of the XIENCE V everolimus eluting coronary stent system in the treatment of patients with de novo native coronary artery lesions). JACC: Cardiovasc Interv 2013; 6:1263–1266) with permission from Elsevier. © The American College of Cardiology Foundation. http://www.sciencedirect.com/science/journal/19368798
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FIGURE 3
Components of drug-eluting and bioresorbable stents.
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FIGURE 4
ABSORB learnings: MICAT. Pre-dilation with noncompliant balloon sized 1:1 to normal vessel with complete balloon expansion; post-dilation at 14–16 atmospheres.
Reprinted from the Journal of the American College of Cardiology (Puricel S, et al. Bioresorbable coronary scaffold thrombosis: multicenter comprehensive analysis of clinical presentation, mechanisms, and predictors. JACC 2016; 67:921–931) with permission from Elsevier. © The American College of Cardiology Foundation. http://www.sciencedirect.com/science/journal/07351097

TABLE 1

Construction of first- and second-generation drug-eluting stents (DES) and proposed pathophysiological mechanism of late adverse events

	Construction	Mechanism
First-generation DES	Thick struts Uneven polymer distribution with poor integrity and thick coating of durable polymers High drug dose	Uncovered struts Hypersensitivity Malapposition from fibrin deposition Stent fracture Neoatherosclerosis (especially for second-generation DES)
Second-generation DES	Thinner struts More biocompatible polymer (durable) Reduced drug dose

TABLE 2

Key elements of technique with the Absorb scaffold

Properly choose the lesion

Definitely ≥ 2.5–3.75 mm in diameter (if in doubt, check intravascular ultrasound or optical coherence tomography)
No excessive tortuosity or calcium proximal

Prepare the lesion by 1:1 predilation and confirm < 40% diameter residual stenosis

Post-dilate with 1:1 noncompliant balloon at ≥ 14 atmospheres

Pay attention to expansion limits