Use of bioresorbable vascular scaffold: a meta-analysis of patients with coronary artery disease

Abstract

BackgroundDifferences in outcomes between bioresorbable vascular scaffold (BVS) systems and drug-eluting metal stents (DES) have not been fully evaluated. We aimed to compare clinical and angiographic outcomes in randomised studies of patients with coronary artery disease (CAD), with a secondary analysis performed among registry studies.MethodsA meta-analysis comparing outcomes between BVS and DES in patients with CAD. Overall estimates of treatment effect were calculated with random-effects model and fixed-effects model.ResultsIn 6 randomised trials (3818 patients), BVS increased the risk of subacute stent thrombosis (ST) over and above DES (OR 2.14; CI 1.01 to 4.53; p=0.05), with a trend towards an increase in the risk of myocardial infarction (MI) (125 events in those assigned to BVS and 50 to DES; OR 1.36; CI 0.97 to 1.91; p=0.07). The risk of in-device late lumen loss (LLL) was higher with BVS than DES (mean difference 0.08 mm; CI 0.03 to 0.13; p=0.004). There was no difference in the risk of death or target vessel revascularisation (TVR) between the two devices. In 6 registry studies (1845 patients), there was no difference in the risk of death, MI, TVR or subacute ST between the two stents. Final BVS dilation pressures were higher in registry than in randomised studies (18.7±4.6 vs 15.2±3.3 atm; p<0.001).ConclusionsPatients treated with BVS had an increased risk of subacute ST and slightly higher LLL compared with those with DES, but this might be related to inadequate implantation techniques, in particular device underexpansion.

Fracture‐Resistant and Bioresorbable Drug‐Eluting Poly(glycerol Sebacate) Coils

“…Featuring less thrombosis risk, the biodegradable DESs have recently been employed as the standard choice for percutaneous coronary intervention (PCI). [25][26][27][28][29] Stent fracture is a high-incidence clinical entity with potential conduction to multiple complications, resulting in serious recurrent angina, myocardial infarction, and even sudden death. [15][16][17][18][19][20] The disadvantages have led to the develpment of fully degradable DESs that are fabricated entirely from biodegradable polymers without any metallic backbones.…”

Long-term clinical results of biodegradable vascular scaffold ABSORB BVS™ using the PSP-technique in patients with acute coronary syndrome

“…A comparison of BVS vs. everolimus eluting stent (EES) in STEMI patients with a high rate of post-dilation showed favorable mid-term results [31]. In the BVS STEMI first propensity score matching comparisons between 151 BVS patients and 151 EES patients, the MACE rate was higher in the BVS group (9.8% vs. 3.6%, p = 0.02, and TLR was 5.7% vs.…”

Everolimus‐eluting bioresorbable vascular scaffold implantation to treat saphenous vein graft disease, single‐center initial experience

“…Nevertheless, the recent literature showed higher risks of device thrombosis with BVS compared to second‐generation DES in native coronary arteries . The underuse of an optimal implantation technique (pre‐dilation, adequate scaffold sizing, and systematic post‐dilation) is believed to be partly responsible for these results, and future trials will ensure these procedures are implemented.…”