Current concepts on coronary revascularization using BRS in patients with diabetes and small vessels disease

Abstract

Diabetes mellitus (DM) and small vessel (SV) disease are two major predictors of adverse outcome in patients treated by percutaneous coronary intervention (PCI), even when last generation metallic drug-eluting stents (DES) are used. Bioresorbable scaffold (BRS) technology has been recently developed to overcome the disadvantages of metallic DES due to their permanent struts. Through the resorption process, BRS may provide a vascular restoration that appears very attractive especially when distal or diffusely diseased coronary segments are involved, as in diabetic patients and SV disease. However, robust evidence on the use of BRS in diabetics is lacking, and recent data have raised concerns on the use of BRS in SVs, particularly when reference vessel diameter (RVD) is <2.25 mm. This review aims at summarizing current evidence related to the use of BRS in diabetics and SV disease.

Small vessel coronary artery disease: How small can we go with myocardial revascularization?

“…Bioresorbable scaffolds (BRS) were designed to allow for gradual resorption of stent components, which seemed to be attractive in the context of possible PCI in SVD [69]. This approach was thought to provide similar benefits as DES, at same time being minimally invasive.…”

Absorb bioresorbable vascular scaffold vs. everolimus‐eluting metallic stent in small vessel disease: A propensity matched analysis of COMPARE II, RAI, and MAASSTAD‐ABSORB studies

“…SVD is a frequently encountered angiographic finding, involving up to 30% of patients treated by PCI . Both the definition of SVD and its optimal treatment remain a matter of debate.…”

“…K E Y W O R D S absorb, bioresorbable vascular scaffold(s), everolimus-eluting metallic stent(s), stent/scaffold thrombosis 1 | I N TR ODU C TI ON Small vessel disease (SVD) is found in up to 30% of patients undergoing percutaneous coronary intervention (PCI). SVD is frequently associated with complex coronary artery disease (CAD) and is an independent predictor of adverse outcome after PCI [1,2]. Accordingly, even current metallic drug-eluting stents (DES) remain associated with increased incidence of adverse events when used in this setting [3][4][5].…”

Percutaneous coronary intervention for patients with type 2 diabetes mellitus: risks and novel way to manage

“…В качестве решения проблемы тромбозов стента, а также микроваскулярного поражения коронарных артерий при СД2 коллективом авторов предложено использование биорезорбируемых стентов [29]. Исследование, посвященное оценке исходов ЧКВ при при-менении биорезорбируемых стентов Absorb, показало эффективность и безопасность применения указанных стентов у пациентов с известным СД.…”