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22-06-2017 | Original Article | Uitgave 7-8/2017 Open Access

Netherlands Heart Journal 7-8/2017

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

2017 revision

Tijdschrift:
Netherlands Heart Journal > Uitgave 7-8/2017
Auteurs:
B. Everaert, J. J. Wykrzykowska, 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, P. Smits, R. J. van Geuns

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.

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Netherlands Heart Journal

Het Netherlands Heart Journal wordt uitgegeven in samenwerking met de Nederlandse Vereniging voor Cardiologie en de Nederlandse Hartstichting. Het tijdschrift is Engelstalig en wordt gratis beschikbaa ...

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