Safety and efficacy of everolimus-eluting bioresorbable vascular scaffolds versus durable polymer everolimus-eluting metallic stents assessed at 1-year follow-up: A systematic review and meta-analysis of studies

Abstract

During the first year of follow-up, patients treated with BVS had a higher incidence of MI and scaffold thrombosis. The risk of DOCE was not significantly different. As BVS may pay off later, future robust data on long-term clinical outcome will be of paramount importance.

Hemodynamic analysis of a novel bioresorbable scaffold in porcine coronary artery model

“…Bioresorbable scaffolds (BRS) have been introduced to overcome these issues with potential benefits of allowing future treatments, non‐invasive imaging procedures and recovering vessel physiology during bioresorption process of the scaffold. Despite its theoretical benefits, recent reports of neoatherosclerosis and scaffold thrombosis have emerged concerns about the designs of BRS . Thicker struts, bulky structure, non‐streamlined strut geometry and early mechanical disruption have been charged for underlying pathological mechanisms.…”

Assessment of the hemodynamic characteristics of Absorb BVS in a porcine coronary artery model

“…Bioresorbable scaffold (BRS) has been introduced to overcome the drawbacks of metallic drug-eluting stents such as late stent thrombosis-due to delayed/incomplete healing-, neoatherosclerotic lesion development, and permanent metallic caging engenders abnormal vessel wall physiology (1). Stent/scaffold implantation induces crucial changes in local hemodynamic microenvironment in the treated vessel segment that greatly influences the reaction of the vessel wall (2).…”

Coronary Aneurysm Formation After Bioresorbable Vascular Scaffold Implantation Resulting in Acute Myocardial Infarction

“…However, a recent meta-analysis of 6 trials with 5588 patients comparing BVS with EES at 1-year follow-up showed that BVS had an increased risk of MI (4.3% vs. 2.3%; OR: 1.63, 95%CI: 1.18–2.25, p<0.01) and definite-or-probable scaffold thrombosis (1.3% vs. 0.6%; OR: 2.10, 95%CI: 1.13–3.87, p=0.02). Possible causes suggested by the authors included: 1) thicker struts that may trigger platelet aggregation; 2) suboptimal implantation causing device malapposition and under-expansion affecting coronary flow pattern and activating the coagulation cascade; 3) excessive overexpansion leading to fractures of the polymer, causing thrombus formation; 4) late scaffold recoil; 5) presence of uncovered BVS struts after 12 months with discontinuation of dual antiplatelet therapy; and 6) late scaffold discontinuity causing dislocation of the strut remnants into the lumen, disturbing flow patterns, shear stress to vessel wall and subsequent recruitment of platelets, and thrombosis [4]. …”