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State of the art: the inception, advent and future of fully bioresorbable scaffolds

1. Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; 2. The New York Presbyterian Hospital, Columbia University Medical Center, and the Cardiovascular Research Foundation, New York, NY, USA; 3. Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands; 4. Department of Cardiology, Imperial College London, London, United Kingdom

To overcome the limitations of metallic stents, the development of the bioresorbable vascular scaffold started about 30 years ago. Researchers anticipated a transformative revolution from “vascular reparative therapy” by BRS at the beginning of its development. To date, there are five commercially available bioresorbable scaffolds which have already gained CE mark. However, recent studies, including randomised trials and meta-analyses evaluating clinical results of BRS, have raised concerns about the safety and efficacy of the device in the first few years prior to its complete bioresorption, compared to contemporary metallic DES. As one of the efforts to address these concerns, the impact of implantation technique was investigated. In addition, there are several aspects to be improved such as mechanical integrity, strut configuration, and late structural discontinuity. Intensive researches into the underlying causes of the greater device thrombosis rates with BRS have stimulated improvement of implantation technique and the development of next-generation BRS. Just as we have witnessed the evolution from first- to second-generation metallic DES, we anticipate that future generations of BRS with thinner struts and enhanced mechanical properties will result in substantially improved intermediate-term outcomes and safety.

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