Imaging Bioresorbable Vascular Scaffolds – at the Border between Science and Technology

Abstract

PERcuTAnEOus cOROnARy REvAscuLARIzATIOn -fROm bALLOOn TO bIOREsORbAbLE scAffOLDsCoronary artery disease (CAD), in its various forms of clinical presentations, including acute coronary syndromes and stable CAD, continues to negatively impact the quality of life, mortality and morbidity, while concomitantly increasing healthcare costs. As the number of patients with CAD increases, the need for optimal revascularization strategies rises, both in the area of interventional cardiology and in coronary artery by-pass grafting techniques, which have substantially developed during the last decades. 1 Percutaneous coronary revascularization techniques have undergone considerable progress in the last four decades, from the first use of balloon angioplasty, which provided a mechanical vascular patency but with a high risk of early recoil, to the introduction of the first metal stents that were able to provide better long-term results compared to balloon dilation. In spite of this, bare metal stents presented several disadvantages, including high rates of in-stent restenosis, therefore a need for an upgrade emerged that led to the development of drugeluting stents (DES). The main advantage of DES consisted in being coated with anti-proliferative pharmacological agents that inhibit neointimal proliferation, thus preventing restenosis. However, there were major concerns regarding the increased risk of late in-stent thrombosis which was higher in DES, meaning longer dual-antiplatelet therapy regimens, with their associated adverse effects. [2][3][4][5] Newer-generation DES have been shown to present lower rates of late and very late thrombosis if associated with prolonged double-antiplatelet therapies. Their remaining main disadvantages include the failure to restore the native vascular motricity, architecture, and physiological function due to implantation of a rigid metallic cage-like structure at the site of the coronary lesion. 6 The development of bioresorbable vascular scaffolds (BVS) has revolutionized percutaneous coronary revascularization procedures, as they provide proper radial support CORRESPONDENCE András Mester Str. Gheorghe Marinescu nr. 38