The first generation ABSORB BVS scaffold; to be or not to be?

In the routine treatment of coronary artery disease, balloon angioplasty has been replaced by stents. The use of bare-metal stents resulted in lower rates of restenosis and repeat revascularisations. Drug-eluting stents (DES), designed with thinner struts and anti-proliferative drugs, have further enhanced the efficacy and safety of percutaneous coronary intervention. Nevertheless, the new generation of metallic DES are also limited by risks of neoatherosclerosis with late and very late stent thrombosis and a rigid metallic cage impairing vasomotion [1]. Bioabsorbable ‘stents’ were developed to restore coronary flow and temporary support the vessel with the advantage of dissolving completely over time, possibly overcoming abovementioned short-comings of metallic DES. The ABSORB (Abbot Vascular, Santa Clara, California, USA) bioabsorbable vascular scaffold (BVS), consisting of a poly-L-lactide backbone coated with a mixture of polyD,L-lactide and an everolimus-eluting drug, was the first bioresorbable device to receive CE (Conformité Européene) approval in 2010 and approval by the Food and Drug Administration in the United States in 2016. Studies performed in relative simple coronary lesions have shown reasonable short-term to mid-term results. Conversely, world-wide registries from clinical practice raised concerns regarding increased rates of scaffold thrombosis. Recently, longer-term follow-up randomised clinical data have become available. The ABSORB II trial is the first randomised trial reporting 3 years’ follow-up. This trial did not meet the co-primary endpoints: BVS compared with Xience