One Ring to Revascularize Them All: Assessing The End Results of Coronary Bioresorbable Vascular Scaffolds as Revascularization Approach for Chronic Total Occlusions

Following the era of percutaneous coronary intervention (PCI), the occurrence of revascularization in chronic total occlusions (CTO) is correlated with positive and longstanding echocardiographic and clinical outcomes. The beneficial outcomes of bioresorbable vascular scaffolds (BVS) treatment to manage CTO are currently inconclusive, since patients presenting with CTO were frequently ruled out from a vast number of randomized clinical trials (RCTs) which assess BVS. This systematic review is aimed to review and recapitulate available reports on the clinical outcomes of CTO with BVS treatment. Available data in the Cochrane Library, EMBASE, MEDLINE, and, clinicaltrials.gov are being examined to gather investigations on BVS-treated CTO. Outcomes of concern involved vessel restenosis, scaffold thrombosis, target lesion revascularization, myocardial infarction, major adverse cardiac events (MACE), and all-cause mortality. Thirteen papers have met the criteria for inclusion. All papers were written based on observational studies cumulative population samples of 1,077. Two papers were found to involve retrospective comparison of drug-eluting stents (DES) group with BVS group. The investigations had varying group size and duration of follow-up. This review presented beneficial results for BVS-treated CTO. In double-arm studies, the recorded MACE incidence diverged from 0% to 6.7% with no notable differences between DES and BVS populations. While reports on the implantation of the first-generation BVS in CTO populations are infrequent and recruited only insufficient observational studies samples, the available data is promising. The data shows satisfactory results which are analogous to second-generation DES. However, additional investigation by means of RCTs and the application of more novel scaffolds is necessitated.

One Ring to Revascularize Them All: Assessing The End Results of Coronary Bioresorbable Vascular Scaffolds as Revascularization Approach for Chronic Total Occlusions

Following the era of percutaneous coronary intervention (PCI), the occurrence of revascularization in chronic total occlusions (CTO) is correlated with positive and longstanding echocardiographic and clinical outcomes. The beneficial outcomes of bioresorbable vascular scaffolds (BVS) treatment to manage CTO are currently inconclusive, since patients presenting with CTO were frequently ruled out from a vast number of randomized clinical trials (RCTs) which assess BVS. This systematic review is aimed to review and recapitulate available reports on the clinical outcomes of CTO with BVS treatment. Available data in the Cochrane Library, EMBASE, MEDLINE, and, clinicaltrials.gov are being examined to gather investigations on BVS-treated CTO. Outcomes of concern involved vessel restenosis, scaffold thrombosis, target lesion revascularization, myocardial infarction, major adverse cardiac events (MACE), and all-cause mortality. Thirteen papers have met the criteria for inclusion. All papers were written based on observational studies cumulative population samples of 1,077. Two papers were found to involve retrospective comparison of drug-eluting stents (DES) group with BVS group. The investigations had varying group size and duration of follow-up. This review presented beneficial results for BVS-treated CTO. In double-arm studies, the recorded MACE incidence diverged from 0% to 6.7% with no notable differences between DES and BVS populations. While reports on the implantation of the first-generation BVS in CTO populations are infrequent and recruited only insufficient observational studies samples, the available data is promising. The data shows satisfactory results which are analogous to second-generation DES. However, additional investigation by means of RCTs and the application of more novel scaffolds is necessitated.

The DESolve® novolimus bioresorbable scaffold

A longtime aspiration of interventional cardiologists remains to improve the long-term impact of stent permanence in coronaries to restore original vessel patency and physiological endothelium response. Bioresorbable vascular scaffolds were considered revolutionary in coronary devices, but several trials were disappointing; thus, the challenge in this field remains. DESolve is a novolimus-eluting poly-L lactide-based polymer scaffold that dissolves through a bio-reabsorption mechanism, vanishing completely in 2 years. Its ability to supply the necessary radial strength to support the vessel for the critical early months after delivery is an important feature showing a unique self-correction property, which reduces incomplete stent apposition. Overexpansion has a good, safe margin with DESolve. This review aims to provide an overview of this controversial topic.