Department of Cardiology, Lebanese American University - Rizk Hospital, 1100 Beirut, Lebanon.
Department of Cardiology, Texas Heart Institute, Houston, TX 77030, USA.
Rev Cardiovasc Med. 2021 Mar 30;22(1):137-145. doi: 10.31083/j.rcm.2021.01.225.
Coronary angioplasty was first introduced in 1977. From plain old balloon angioplasty to the introduction of bare metal stents in 1986 and dual antiplatelet therapy in 1992 to much more later on. Due to the unacceptable rate of stent restenosis, drug eluting stents (DES) were introduced in 2000. The first generation showed an increase in late stent thrombosis which led to the introduction of the second generation DES with biocompatible or biodegradable polymers and thinner platforms. However very late stent thrombosis and late restenosis might still pose problems in the latter. Furthermore, there has been major debate regarding the impact of long-term vessel caging on normal vasomotricity and long-term positive remodeling. To resolve these issues, the bioresorbable vascular scaffolds (BVS) were launched into the real world in 2011, showing promising initial results. Multiple randomized trials, meta-analyses, and registries were performed, mainly with the Absorb Bioresorbable Vascular Scaffold System (Abbott Vascular, Chicago, IL, USA). This new technology is hindered by certain features, such as the BVS radial strength, its strut thickness, and the inflammatory process related to scaffold degradation. Moreover, there is known data indicating higher thrombosis rate with the Absorb BVS compared with the new generation of DES, despite similar cardiovascular death. In this review, we discuss the clinical procedural and technical evidence on BVS, with emphasis on their clinical impact. We finally tackle the future directions on device and procedural improvement while asking: is the bioresorbable technology still the way to the future?
冠状动脉血管成形术于 1977 年首次引入。从单纯的球囊血管成形术到 1986 年裸金属支架的引入以及 1992 年双重抗血小板治疗，再到后来更多的进展。由于支架内再狭窄的不可接受率，药物洗脱支架（DES）于 2000 年被引入。第一代支架显示出晚期支架血栓形成率增加，这导致了第二代 DES 的引入，其具有生物相容性或可生物降解的聚合物和更薄的平台。然而，在后者中，非常晚期的支架血栓形成和晚期再狭窄仍然可能是问题。此外，关于长期血管笼对正常血管舒缩性和长期正性重塑的影响，一直存在重大争议。为了解决这些问题，生物可吸收血管支架（BVS）于 2011 年被引入现实世界，初步结果显示出良好的前景。进行了多项随机试验、荟萃分析和注册研究，主要是使用 Absorb Bioresorbable Vascular Scaffold System（Abbott Vascular，芝加哥，IL，美国）。这项新技术受到某些特征的限制，例如 BVS 的径向强度、其支柱厚度以及与支架降解相关的炎症过程。此外，有已知数据表明，与新一代 DES 相比，Absorb BVS 的血栓形成率更高，尽管心血管死亡率相似。在这篇综述中，我们讨论了关于 BVS 的临床程序和技术证据，重点是它们的临床影响。最后，我们探讨了设备和程序改进的未来方向，并提出了这样一个问题：生物可吸收技术是否仍然是未来的方向？
