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The State of the Absorb Bioresorbable Scaffold: Consensus From an Expert Panel. [Review]

MedStar author(s):

1936-8798

Name of journal: JACC. Cardiovascular interventionsAbstract: Copyright (c) 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.Significant progress has been made in the percutaneous coronary intervention technique from the days of balloon angioplasty to modern-day metallic drug-eluting stents (DES). Although metallic stents solve a temporary problem of acute recoil following balloon angioplasty, they leave behind a permanent problem implicated in very late events (in addition to neoatherosclerosis). BRS were developed as a potential solution to this permanent problem, but the promise of these devices has been tempered by clinical trials showing increased risk of safety outcomes, both early and late. This is not too dissimilar to the challenges seen with first-generation DES in which refinement of deployment technique, prolongation of dual antiplatelet therapy, and technical iteration mitigated excess risk of very late stent thrombosis, making DES the treatment of choice for coronary artery disease. This white paper discusses the factors potentially implicated in the excess risks, including the scaffold consideration and deployment technique, and outlines patient and lesion selection, implantation technique, and dual antiplatelet therapy considerations to potentially mitigate this excess risk with the first-generation thick strut Absorb scaffold (Abbott Vascular, Abbott Park, Illinois). It remains to be seen whether these considerations together with technical iterations will ultimately close the gap between scaffolds and metal stents for short-term events while at the same time preserving options for future revascularization once the scaffold bioresorbs.All authors: Armstrong EJ, Attizzani GF, Avula SB, Bangalore S, Batchelor W, Bertolet BD, Bezerra HG, Caputo RP, Chehab BM, Choi JW, Chrysant GS, Dave RM, DeGregorio J, Ellis SG, Foster MT, Gigliotti OS, Gollapudi R, Gordon JB, Grines CL, Kaki A, Kalyanasundaram A, Kondur A, Korngold E, Li J, Maksoud A, Matar F, Merritt RF, Murphy BE, Naidu SS, Nicholson W, Parikh MA, Potluri SP, Quesada R, Rizik DG, Samuels B, Shah AP, Spaedy AJ, Stys TP, Sumar R, Toma C, Torguson R, Waksman R, Wang JC, Yakubov SJ, Zidar JPFiscal year: FY2018Digital Object Identifier:

https://dx.doi.org/10.1016/j.jcin.2017.09.041

Date added to catalog: 2017-12-12

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Title notes ( 4 )

Holdings
Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	29216997	Available		29216997

Available online through MWHC library: 2008 - present

Significant progress has been made in the percutaneous coronary intervention technique from the days of balloon angioplasty to modern-day metallic drug-eluting stents (DES). Although metallic stents solve a temporary problem of acute recoil following balloon angioplasty, they leave behind a permanent problem implicated in very late events (in addition to neoatherosclerosis). BRS were developed as a potential solution to this permanent problem, but the promise of these devices has been tempered by clinical trials showing increased risk of safety outcomes, both early and late. This is not too dissimilar to the challenges seen with first-generation DES in which refinement of deployment technique, prolongation of dual antiplatelet therapy, and technical iteration mitigated excess risk of very late stent thrombosis, making DES the treatment of choice for coronary artery disease. This white paper discusses the factors potentially implicated in the excess risks, including the scaffold consideration and deployment technique, and outlines patient and lesion selection, implantation technique, and dual antiplatelet therapy considerations to potentially mitigate this excess risk with the first-generation thick strut Absorb scaffold (Abbott Vascular, Abbott Park, Illinois). It remains to be seen whether these considerations together with technical iterations will ultimately close the gap between scaffolds and metal stents for short-term events while at the same time preserving options for future revascularization once the scaffold bioresorbs.

English