Improving vessel healing with fully bioresorbable drug-eluting stents: more than a pipe dream?

This editorial refers to ‘Everolimus-eluting bioresorbable stent vs. durable polymer everolimus-eluting metallic stent in patients with ST-segment elevation myocardial infarction: results of the randomized ABSORB ST-segment elevation myocardial infarction—TROFI II trial’[†][1], by M. Sabate et al ., on page 229. Bioresorbable stents (BRS) represent a disruptive technology with potential for improving long-term outcomes after percutaneous intervention.1 The principal advantage of BRS compared with conventional metallic stent technology is that the device is broken down by the body after its useful function has been served, potentially restoring normal vessel anatomy over the long term and ameliorating the risk of late adverse events in the treated arterial segment.2 Two such devices have received CE mark approval for use; both are based on polylactic acid stent backbones: the everolimus-eluting Absorb stent (Abbott Vascular, Abbott Park, IL, USA) in 2011 and the novolimus-eluting DESolve stent (Elixir Medical, Sunnyvale, CA, USA) in 2013. However, current approval processes leading to CE mark are based on conformity testing (i.e. performance as intended) and assessment of safety, and generally do not require comparative efficacy assessment against existing devices.3 In fact, BRS are generally more challenging to implant in comparison with metallic stents, and careful patient and lesion selection is crucial to ensuring good results with this technology.4 Moreover, clinical experience with these devices remains rather limited, and further comparative efficacy data are required before we can be sure of the place of these devices in day-to-day practice. Encouraging results have been reported with the Absorb BRS compared with conventional metallic drug-eluting stents (DES) in small randomized trials enrolling patients presenting with stable or unstable angina.5, … [1]: #fn-2