Challenges of the newer generation of resorbable magnesium scaffolds: Lessons from failure mechanisms of the past generation

Bioresorbable scaffolds (BRS) were developed to overcome the obstacles of metallic stents, mostly related to sustained presence of metallic foreign body in the coronary vessel. Following earlier success of single-arm BRS studies, randomized controlled trials of Absorb bioresorbable vascular scaffold...

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Bibliographic Details
Published in:Journal of cardiology 2023-02, Vol.81 (2), p.179-188
Main Authors: Seguchi, Masaru, Aytekin, Alp, Lenz, Tobias, Nicol, Philipp, Alvarez-Covarrubias, Hector A., Xhepa, Erion, Klosterman, Grace R., Beele, Alicia, Sabic, Emina, Utsch, Léa, Alyaqoob, Aseel, Joner, Michael
Format: Article
Language:English
Subjects:
Absorbable Implants
Bioresorbable scaffold
Coronary artery disease
Coronary Artery Disease - surgery
Drug-Eluting Stents
Humans
Magnesium
Magnesium alloy
Percutaneous coronary intervention
Percutaneous Coronary Intervention - methods
Prosthesis Design
Stent thrombosis
Thrombosis
Treatment Outcome
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Summary:Bioresorbable scaffolds (BRS) were developed to overcome the obstacles of metallic stents, mostly related to sustained presence of metallic foreign body in the coronary vessel. Following earlier success of single-arm BRS studies, randomized controlled trials of Absorb bioresorbable vascular scaffold (Abbott Vascular, Santa Clara, CA, USA) showed poor long-term clinical outcomes, particularly in terms of scaffold thrombosis. BRS made from magnesium alloy provide a promising alternative in terms of radial force, strut thickness and, potentially lower thrombogenicity. A recent clinical study demonstrated that magnesium-based BRS seems to be promising with regards to the risk of scaffold thrombosis. In this review, our aim is to describe the issues that prevented Absorb BVS from achieving favorable outcomes, provide current status of existing BRS technologies and the challenges that newer generation BRSs need to overcome, and the results of clinical studies for commercially available magnesium-based BRS, which remain the only BRS actively studied in clinical practice. [Display omitted] •Bioresorbable scaffolds (BRS) using magnesium alloy are still under development.•Current magnesium BRS seems to be promising regarding the risk of thrombosis.•Remaining issue is if the BRSs can provide sufficient radial force over a long time.
ISSN:0914-5087
1876-4738
DOI:10.1016/j.jjcc.2022.09.003