Bioresorbable scaffolds in acute coronary syndrome: A promising alternative to drug-eluting stents or a step too soon?

Abstract

Bioresorbable scaffolds (BRS) represent a promising innovation in interventional cardiology, offering the potential to restore native arterial physiology while delivering drug-elution benefits. However, their role in acute coronary syndrome remains uncertain, given the higher thrombotic risk and lesion complexity in this population. This editorial reviews the current evidence surrounding bioresorbable scaffold use in acute coronary syndrome, particularly considering recent findings from Li et al in the World Journal of Cardiology, which suggest that contemporary bioresorbable scaffold platforms may provide mid-term outcomes comparable to drug-eluting stents under optimal procedural conditions. Despite these encouraging signals, this editorial emphasizes that the early experience with first-generation BRS was associated with increased thrombosis and target-lesion failure, particularly during the resorption phase. Newer-generation bioresorbable scaffold designs, coupled with refined implantation techniques and imaging guidance, have shown promising results, however, large, randomized controlled trials and long-term follow-up are essential to substantiate their clinical efficacy and safety. We advocate for a selective, evidence-driven approach to bioresorbable scaffold use in acute coronary syndrome, confined to low-complexity lesions in well-equipped centers with experienced operators. Robust randomized controlled trials, comprehensive imaging data, and transparent reporting are crucial to define the role of BRS in acute coronary syndrome and guide future clinical practice.

Keywords: Bioresorbable vascular scaffold; NeoVasc; Magnesium-based scaffold; Thrombosis; Pre-dilation; Sizing; Post-dilation

Core Tip: Bioresorbable scaffolds aim to provide temporary coronary support with drug delivery while ultimately restoring a device-free artery. In acute coronary syndrome, evidence remains cautious: First-generation polymeric scaffolds showed increased thrombosis during the resorption phase, and newer platforms require rigorous implantation discipline. The study by Li et al discussed here used the NeoVas sirolimus-eluting poly-L-lactic acid scaffold and reported comparable mid-term outcomes to drug-eluting stents, with reduced inflammatory biomarkers at 1 month. These signals are hypothesis-generating; definitive adoption requires randomized trials with imaging and long-term follow-up.