• Bioresorbable Scaffolds and Bifurcations

    This does not sound like a logical combination. After the initial excitement about bioresorbable scaffolds (BRS), it is now clear that first-generation BRS (Absorb BVS, Abbott Vascular, Santa Clara, CA) have a clearly increased stent thrombosis risk for relatively non-complex lesions, as included in the ABSORB series of studies around the world [1]. Using these devices in bifurcation lesions with already-increased stent thrombosis risk is even more challenging [2], especially if a two-stent technique is necessary [3]. Yet, as the authors of the paper by Rampat et al. in this issue of Cardiovascular Revascularization Medicine point out, bifurcation lesions are at an increased risk for recurrent events, even with current-generation drug-eluting metallic stents (DES) [4]. The use of current permanent implants in coronary arteries needs to be seen in a larger perspective. Current median age of patients at first percutaneous coronary intervention (PCI) is 63 years; 87.1% of these survive 5 years, and over 80% of patients younger than 60 survive 10 years [5]. The recent data of the ISAR-TEST 4 randomized trial showed an overall 10-year survival rate of 70.2% [6]. Yet target lesion revascularization (TLR) with modern DES is still over 20% in this last cohort. For other implants like ocular lenses and orthopedic joint replacements, the treatment goals are much higher and in the range of 95% at 10 years. After improving our 1-year post-PCI results, first by the use of bare metal stents (BMS) and later with DES reaching a 1-year TLR rate of <10%, we have to set our next goals in improving our 10-year results at the same level as other implants. The current >20% late TLR rate is simply not acceptable in this wider perspective.

     

    Read the complete article on Science Direct

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