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. 2017 Jul;25(7-8):419-428.
doi: 10.1007/s12471-017-1014-z.

Recommendations for the use of bioresorbable vascular scaffolds in percutaneous coronary interventions : 2017 revision

B Everaert  1   2 , J J Wykrzykowska  3 , J Koolen  4 , P van der Harst  5 , P den Heijer  6 , J P Henriques  3 , R van der Schaaf  7 , B de Smet  8 , S H Hofma  9 , R Diletti  1 , A Weevers  10 , J Hoorntje  11 , P Smits  12 , R J van Geuns  13
Affiliations

Recommendations for the use of bioresorbable vascular scaffolds in percutaneous coronary interventions : 2017 revision

B Everaert et al. Neth Heart J. 2017 Jul.

Abstract

Background: To eliminate some of the potential late limitations of permanent metallic stents, the bioresorbable coronary stents or 'bioresorbable vascular scaffolds' (BVS) have been developed.

Methods: We reviewed all currently available clinical data on BVS implantation.

Results: Since the 2015 position statement on the appropriateness of BVS in percutaneous coronary interventions, several large randomised trials have been presented. These have demonstrated that achieving adequate 1 and 2 year outcomes with these first-generation BVS is not straightforward. These first adequately powered studies in non-complex lesions showed worse results if standard implantation techniques were used for these relatively thick scaffolds. Post-hoc analyses hypothesise that outcomes similar to current drug-eluting stents are still possible if aggressive lesion preparation, adequate sizing and high-pressure postdilatation are implemented rigorously. As long as this has not been confirmed in prospective studies the usage should be restricted to experienced centres with continuous outcome monitoring. For more complex lesions, results are even more disappointing and usage should be discouraged. When developed, newer generation scaffolds with thinner struts or faster resorption rates are expected to improve outcomes. In the meantime prolonged dual antiplatelet therapy (DAPT, beyond one year) is recommended in an individualised approach for patients treated with current generation BVS.

Conclusion: The new 2017 recommendations downgrade and limit the use of the current BVS to experienced centres within dedicated registries using the updated implantation protocol and advise the prolonged usage of DAPT. In line with these recommendations the manufacturer does not supply devices to the hospitals without such registries in place.

Keywords: Absorb BVS; Bioresorbable vascular scaffold; Percutaneous coronary intervention.

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Conflict of interest statement

B. Everaert, J. Koolen, P. van der Harst, P. den Heijer, J.P. Henriques, R. van der Schaaf, B. de Smet, S.H. Hofma, R. Diletti, A. Weevers, J. Hoorntje and P. Smits declare that they have no competing interests. R.J. van Geuns has received speakers fees from Abbott Vascular. J.J. Wykrzykowska received consultancy/speaker fees from Abbott Vascular. The institutions Erasmus MC and Academic Medical Center, Amsterdam, received research grants from Abbott Vascular. The department of cardiology of the Medical Center Leeuwarden received unrestricted research grants from Abbott Vascular.

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