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Bioresorbable scaffolds (BRS) represent the latest revolution in interventional cardiology. Thanks to their reabsorptive properties, they provide temporary scaffolding that helps stabilizing the plaque and promotes healing, and then disappear, thus restoring a functional endothelium and vasomotion. Several devices have been tested at the preclinical and clinical stage. Here we review the rationale, development, design and clinical data of the BRS platforms, providing a comprehensive review of the literature.

Long corrosion period and slow resorption in vivo remain major limitations for iron-based bioresorbable scaffolds. This work focused on the design and characterization of a novel iron-based drug-eluting coronary scaffold (IBS scaffold) made of nitrided iron materials. The 53 μm IBS scaffold shows good device performance comparable to a current mainstream drug-eluting coronary stent (Xience Prime™) due to the good comprehensive mechanical performance of nitrided iron materials. The novel design of a zinc barrier layer makes it possible for the IBS scaffold to have ultrathin struts and thick PDLLA coating of 12 μm to maintain adequate scaffolding (125 kPa) after 3 months implantation while having a significantly shortened corrosion period (13 months). The biocorrosion and bioresorption of the IBS scaffold could be effectively evaluated using Micro-CT, OCT and MRI methods. Although complete bioresorption of the corrosion products has not been observed yet, there are no identified biological problems for the IBS scaffold after implantation in rabbit abdominal aorta up to 13 months. This study demonstrates that the IBS scaffold with novel design has significantly shortened corrosion period and less amount of corrosion products without causing any biological problems after implantation up to 13 months, therefore is promising for coronary application. Keywords: Nitrided iron, Coating design, Effective scaffolding, Shortened corrosion period, Biosafety

Objectives We aim to perform a systematic literature review on all studies reporting the clinical outcomes of the use of bioresorbable scaffolds (BRS) in different settings of coronary artery disease (CAD). Background BRS are designed to provide early support of the vessel wall postangioplasty, deliver antiproliferative agents to prevent excessive hyperplastic healing responses and finally “disappear” when no longer required. Emerging data have provided evidence of their use in specific clinical scenarios. Methods A comprehensive literature search was performed by 2 independent reviewers utilizing MEDLINE, EMBASE, and Cochrane Library databases. The only 2 CE marked BRS: everolimus-eluting Bioresorbable vascular scaffold ABSORB BVS and the myolimus-eluting DESolve Bioresorbable Coronary Scaffold (BCS) System were included. Results The studies were categorized into: ST elevation myocardial infarction (STEMI), stable CAD, and “all-comers” group. Thirty-one studies were included; 8 in STEMI patients (all ABSORB), 15 in stable CAD patients. In the STEMI group (n = 606), acute procedural success ranged from 96% to 100%, cardiac mortality 0–9.1%, recurrent MI and stent thrombosis rates were 0–4.3%. In the stable CAD group, the 13 ABSORB studies (n = 3259) demonstrated cardiac mortality rate of 0–0.6%, recurrent MI rate 0–4.5%, and stent thrombosis rate 0–4.3% Conclusions Current clinical data suggest the BRS, especially the ABSORB BVS, may represent a reasonable alternative to DES in uncomplicated coronary anatomy. (J Interven Cardiol 2016;29:57–69)

__Background:__ The optimal implantation technique for the bioresorbable scaffold (Absorb, Abbott Vascular) is still a matter of debate. The purpose of the present study was to evaluate the effect of implantation technique on strut embedment and scaffold expansion. __Methods and Results:__ Strut embedment depth and scaffold expansion index assessed by optical coherence tomography (OCT) (minimum scaffold area/reference vessel area) were evaluated in the ABSORB Japan trial (OCT subgroup: 87 lesions) with respect to implantation technique using either quantitative coronary angiography (QCA) or OCT. Strut embedment was assessed at the strut level (n=667), while scaffold expansion was assessed at the lesion level (n=81). The mean embedment depth was 63±59 µm. Balloon sizing and inflation pressure had no direct effect on strut embedment. Plaque morphology affected strut embedment [nonatherosclerotic (58.9±54.3 µm), fibroatheroma (73.3±59.6 µm), fibrous plaque (59.7±51.1 µm), and fibrocalcific plaque (–3.1±61.6 µm, negative value means malapposition), P

The quest to manufacture a safe and effective bioresorbable scaffold (BRS) has been ongoing for nearly 2 decades. Polymers based on poly-l-lactide (PLLA) or poly-d,l-lactide were introduced as the base material for BRS technology. The core polymer technology has distinct differences compared with

Background Device underexpansion is associated with late adverse outcomes after bioresorbable vascular scaffold (BVS) implantation. This study, representing official IVUS results of the ABSORB Japan trial, aimed to characterize IVUS findings, focusing specifically on acute device expansion, and to investigate its impact on late lumen loss (LLL) with Absorb-BVS compared with cobalt-chromium everolimus-eluting stents (CoCr-EES). Methods ABSORB Japan enrolled 148 patients (2:1 randomization) in the IVUS cohort. Serial IVUS was prescheduled at post-procedure and 3 years. Acute device expansion was evaluated with respect to the degree and uniformity of the implanted device. Results Overall, Absorb-BVS showed smaller and more nonuniform device expansion at post-procedure, compared with CoCr-EES, which was particularly prominent in small-vessel lesions. In serial analysis, Absorb-BVS showed unique associations of smaller device expansion (r = 0.40, p = 0.001) and more nonuniformity (r = 0.29, p = 0.007) at post-procedure with greater LLL at 3 years, primarily attributable to greater negative remodeling (r = 0.39, p = 0.006). In contrast, acute device expansion showed no relation with subsequent lumen change in CoCr-EES. In Absorb-BVS, ischemic-driven target lesion or vessel revascularization (ID-TLR or ID-TVR) at 3 years occurred more frequently in small- versus large-vessel lesions (12.5% vs. 0%, p = 0.04 for ID-TLR and 15.6% vs. 2.3%, p = 0.08 for ID-TVR). Conversely, Absorb BVS had no target lesion nor vessel failure, even in small-vessel lesions, when adequate device expansion was achieved at post-procedure. Conclusions Unlike CoCr-EES, underexpansion was associated with greater negative remodeling and LLL in Absorb-BVS. This may in part account for the poorer outcomes of Absorb-BVS than CoCr-EES when under-expanded.

First generation bioresorbable scaffolds (BRS) made from poli-L-lactide acid (PLLA) have failed to overcome limitations of current generation metallic drug eluting stents. Therefore, the need for improvement of bioresorbable platforms has intensified. Herein we present preclinical outcome of a novel

The technique used at the time of implantation has a central role in determining the risk of thrombosis in bioresorbable vascular scaffolds (BRS). Different definitions of the &ldquo, optimal&rdquo, implantation technique exist, however. The impact of individual procedural characteristics on the risk of scaffold thrombosis (ScT) was evaluated in a single-center observational study that enrolled 657 patients (79% males, mean age 63 &plusmn, 12 years) with 763 lesions who received a total of 925 BRS for de novo lesions. During a median 1076 (762&ndash, 1206) days&rsquo, follow-up there were 28 cases of thrombosis. Independent predictors of ScT included the use of predilatation balloons bigger than the nominal BRS diameter (hazard ratio (HR) = 0.4 (0.16&ndash, 0.98), p = 0.04), sizing (implantation in vessels with reference vessel diameter &gt, 3.5 mm or &lt, 2.5 mm: HR = 5.71 (2.32&ndash, 14.05), p = 0.0002) and the degree of vessel expansion (ratio of minimum lumen to reference vessel diameter, HR: 0.005 (0.0001&ndash, 0.23), p = 0.007). In addition, a mild BRS oversizing (final BRS diameter to vessel diameter 1.14&ndash, 1.28) was associated with a lower thrombosis risk, whereas undersizing and more severe oversizing (final BRS diameter to vessel diameter &lt, 1.04 and &gt, 1.35, respectively) were associated with an increased risk of ScT (HR = 0.13 (0.02&ndash, 0.59), p = 0.0007). In conclusion, different components of the &ldquo, technique have different impacts on the risk of BRS thrombosis. Besides predilatation with a balloon larger than the BRS diameter, correct vessel size selection and a mild to moderate oversizing appear to be protective.

Aims The aim of the study was to evaluate the impact of bioresorbable vascular scaffold (BRS) implantation technique on post-procedural quantitative coronary angiography (QCA) parameters in ST-elevation myocardial infarction (STEMI). Methods and results We assessed 442 STEMI patients who underwent BRS implantation in the BVS STEMI STRATEGY-IT study. Optimal BRS implantation was assessed using the PSP score, developed and validated in the GHOST-EU registry. We analysed post-implantation QCA parameters, including minimum lumen diameter (MLD) and maximum footprint, in patients with and without optimal BRS implantation, coded as maximum PSP score. Patients with optimal BRS implantation had higher post-procedural MLD and lower maximum footprint than those without. Multivariate analysis demonstrated that optimal BRS implantation was an independent predictor of high post-procedural MLD, defined as ≥2.4 mm for 2.5 or 3.0 mm BRS and ≥2.8 mm for 3.5 mm BRS. Thrombectomy before optimal BRS implantation showed a trend towards higher post-procedural MLD and lower maximum footprint. There was no relationship between optimal BRS implantation and device-oriented composite events at one year. Conclusions Optimal BRS implantation, as assessed by PSP score, was associated with better post-procedural QCA parameters in STEMI. Thrombectomy before optimal BRS implantation might improve angiographic results in STEMI. Long-term follow-up is needed to analyse the relationship between QCA parameters and clinical outcomes after BRS implantation in STEMI patients.

Aims: The aim of the study was to evaluate the effect of strut protrusion (SP) on wall shear stress (WSS) and neointimal growth (NG) one and five years after implantation of an Absorb bioresorbable vascular scaffold. Methods and results: Eight patients were selected from a first-in-man study. Following three-dimensional (3D) reconstruction of coronaries, WSS was quantified using Newtonian steady-flow simulation in each cross-section at 5° subunits (sectors) of the circumferential luminal surface. At one year, neointimal thickness (NT) was measured by optical coherence tomography (OCT) and correlated to WSS and SP post procedure. Median SP was 112.9 (90.8, 133.1) µm post implantation. Post procedure, a logarithmic inverse relationship between SP and post-implantation WSS (r=–0.425, p

The aim of this study was to investigate the operability, 6-month efficacy, and safety of the novel sirolimus-eluting iron bioresorbable coronary scaffold (IBS) system compared with a cobalt-chromium everolimus-eluting stent (EES) (XIENCE Prime stent) in porcine coronary arteries.Bioresorbable scaffolds have been considered the fourth revolution in percutaneous coronary intervention. However, the first-generation bioresorbable scaffold showed suboptimal results.Forty-eight IBS and 48 EES were randomly implanted into nonatherosclerotic swine. The operability, efficacy, and safety of the IBS and EES were evaluated using coronary angiography, optical coherence tomography, micro-computed tomography, scanning electron microscopy, and histopathologic evaluation at 7, 14, 28, 90, and 180 days after implantation.The operability of the ultrathin IBS (∼70 μm) was comparable with that of the EES, except for its visibility. There was no statistically significant difference in area stenosis between the IBS and EES from 28 to 180 days. The IBS maintained its integrity up to 90 days without corrosion, while corrosion was observed in a few struts in 2 of 10 IBS at 180 days. The percentage of endothelialization of IBS was higher than that of XIENCE Prime stents within 14 days after implantation. The fibrin score was higher in the IBS group at 28 days but comparable with the EES group at 90 and 180 days. No scaffold or stent thrombosis was seen in either group. No abnormal histopathologic changes in scaffolded or stented vessel segments and 5 main remote organs were observed in either group.Preclinical results suggest that the novel IBS has comparable operability, mid-term efficacy, and safety with the EES, and its corrosion profile in porcine coronary arteries is reasonable, which could support initial clinical study of the IBS.

Venous outflow obstruction is a dominant contributor to chronic venous disease. Treatment of venous disease has historically been limited by available vascular stent technology not specifically designed for the venous system. The ideal venous stent must provide requisite flexibility, strength, and accurate deployment for the anatomical and pathophysiological conditions of chronic venous disease. Venous stent technology is advancing with multiple dedicated venous stents currently available in Europe and with investigational device exemption studies ongoing in the United States. These technological advancements are promising for patients suffering from chronic venous disease. This article discusses the current status and future directions of venous stents.

The advent of the fully bioresorbable vascular scaffold (BVS) is the latest step in a series of advancements in the design of intracoronary stents over the past few decades. The novelty of this technology is in providing temporary vessel scaffolding and local antiproliferative therapy to prevent neointimal hyperplasia after percutaneous coronary intervention followed by gradual resorption of the scaffold to restore the native vessel anatomy and physiology - a process termed vascular reparative therapy. Areas covered: The first generation of BVS has not been able to fully match the high benchmark in safety and efficacy set by contemporary metallic drug-eluting stents. These shortcomings of BVS may be due to factors related to the device itself, the complexity of the underlying lesion, or the implantation technique. Expert commentary: Here, how intravascular imaging may be used to minimize these shortcomings is described and moreover, an imaging-guided step-by-step approach for BVS implantation that integrates the recently described pre-dilatation, stenting, post-dilatation (PSP) strategy is explained.

This review presents the radial strength of bioresorbable scaffolds (BRS) with respect to clinical significances, the recent advances, current inadequacies, and future enhancement measures. To evaluate the radial strength of BRS, the related imaging results from clinical trials assessing several typical devices are summarized, including Absorb bioresorbable vascular scaffold (BVS), DESolve scaffold, and Mg-based BRS. These findings show that the radial strength of BRS has been enhanced greatly in recent years. However, as compared with the leading drug-eluting stent (DES), none of these latest approved BRS can always maintain sufficient radial strength within the required time even if they have thicker strut. To improve the radial strength of BRS fundamentally, we propose that biodegradable materials be mixed with some reinforcing agents and plasticizers of the optimum contents and processed targetedly like annealing. The best combination of these material modifications is expected to achieve high molecular weight and increased crystallinity, making BRS have optimal mechanical properties on premise of sufficient radial strength without introducing new problems. We hope that this review of the radial strength of BRS will provide insights for researchers to manufacture BRS that can eliminate restenosis.

BACKGROUND Optimal implantation results of bioresorbable scaffolds (BRS) are typically assumed to require postdilatation with non-compliant (NC) balloons to achieve full scaffold apposition and minimize event rates. We systematically evaluated the mechanical effect of NC balloon postdilatation on magnesium-based BRS (Magmaris®, Biotronik AG, Bulach, Switzerland) in vivo. METHODS In 35 patients, 40 Magmaris® BRS were implanted to treat 37 de novo coronary artery stenoses. A systematic implantation protocol was followed. After appropriately sized NC balloon predilatation (1:1:1 vessel:balloon:scaffold ratio), Magmaris® BRS were implanted with a pressure of 10 atm, followed by NC balloon postdilatation at nominal BRS size (standardized at 16 atm). OCT was performed before and after postdilatation and OCT images were analyzed at a spacing of 0.2 mm to measure BRS dimensions and determine apposition as well as to detect strut fractures. RESULTS PCI with Magmaris® BRS (mean diameter: 3.21 ± 0.32 mm; mean length: 20 ± 4 mm) was successful in all cases, in one case a non-flow-limiting distal edge dissection occurred after implantation and before postdilatation. NC balloon postdilatation led to significantly larger mean scaffold diameter (3.21 ± 0.32 mm vs. 2.80 ± 0.39 mm, P

Bioresorbable scaffolds represent a promising new technology in the field of percutaneous coronary interventions. The concept of the eventual resorption of the scaffold pertains to multiple theoretical advantages that may hold true particularly in bifurcation lesions – no permanent caging of the coronary artery, avoidance of acquired device malapposition and delayed hypersensitivity reactions, no permanent metallic stent protrusion in the main branch, etc. The worldwide experience with the use of bioresorbable scaffolds is limited. In our experience of selected bifurcation lesions, a provisional approach using one-scaffold has excellent results. Two-scaffold techniques appeared feasible. Our data support the exploration of the use of bioresorbable scaffolds in more challenging coronary substrates like bifurcations. Prospective registries and ideally randomised trials should assess whether the theoretical benefits of bioresorbable vascular scaffolds (BVS) in bifurcation lesions can produce sustainable good clinical outcomes.

Bioresorbable scaffolds (BRS) have been introduced to clinical practice to avoid some limitations associated with the presence of permanent metal prostheses in coronary arteries. Due to elimination of the natural vasomotion of the vessel and flow disturbance, stents impair endothelial function, increasing the risk of adverse events such as late and very late thrombosis or accelerated neoatherosclerosis. Additionally, the presence of metallic stents hinders non-invasive imaging of coronaries and may exclude the possibility of bypass graft anastomosis within the stented segment. The use of fully bioresorbable scaffolds would allow for an effective treatment of coronary lesions while overcoming the limitations related to the prolonged presence of metal prostheses in coronary vessels. After early positive clinical results of BRS implanted in simple lesions in small number of patients, large randomised trials revealed numerous limitations of this technology, with unacceptably high incidence of scaffold thrombosis and myocardial infarction. Nevertheless, the negative results of the studies render the learning curve of interventional cardiologists introducing into clinical practice this novel technology. Optimal stenting technique combined with extensive use of intravascular imaging may contribute to obtaining promising results also in patients with complex stenosis, like thrombotic lesions, bifurcations, chronic total occlusions, long and calcified lesions.

Rationale: Bioresorbable scaffolds may confer clinical benefit in long-term studies; early mechanistic studies using intravascular imaging have provided insightful information about the immediate and mid-term local serial effects of BRS on the coronary vessel wall. Objectives: We assessed baseline, 6- and 12-month imaging data of the drug-eluting absorbable metal scaffold (DREAMS 2G). Methods and results: The international, first-in-man BIOSOLVE-II trial enrolled 123 patients with up to 2 de novo lesions (in vessels of 2.2 to 3.7 mm). Angiographic based vasomotion, curvature and angulation were assessed; intravascular ultrasound (IVUS) derived radiofrequency (RF) data analysis and echogenicity were evaluated; optical coherence tomography (OCT) attenuation and backscattering analysis were also performed. There was hardly any difference in curvature between pre-procedure and 12 months (− 0.0019; p = 0.48). The change in angulation from pre- to 12 months was negligible (− 3.58°; 95% CI [− 5.97, − 1.20]), but statistically significant. At 6 months, the change in QCA based minimum lumen diameter in response to high dose of acetylcholine and IVUS-RF necrotic core percentage showed an inverse relationship (estimate of − 0.489; p = 0.055) and with fibrous volume a positive relationship (estimate of 0.53, p = 0.035). Bioresorption analysis by OCT showed that the maximum attenuation values decreased significantly from post-procedure at 6 months (Δ 6 months vs. post-proc. is − 13.5 [95% CI − 14.6, − 12.4]) and at 12 months (Δ 12 months vs. post-proc. is − 14.0 [95% CI − 15.4, − 12.6]). By radiofrequency data, the percentage of dense calcium decreased significantly from post-procedure at 6 months and at 12 months. Likewise, by echogenicity, hyperechogenic structures decreased significantly from post-procedure at 6 months; thereafter, they remained unchanged. Conclusion: Following implantation of DREAMS 2G, restoration of the vessel geometry, vasomotion and bioresorption signs were observed at up to 12 months; importantly, these changes occurred with preservation of the lumen size between 6 and 12 months. NCT01960504

AIMS No randomised comparison data are available beyond the resorption of the everolimus-eluting bioresorbable scaffold. Absorb is expected to be completely resorbed by 3 years. The purpose of this report is to provide the 4 year results of a randomised, single blind, multicentre evaluation of Absorb versus the metallic stent Xience (Abbott Vascular, Santa Clara, CA, USA). METHODS AND RESULTS Three-year follow-up has been previously published. Patients re-consented for additional follow-up up through to 5 years; 86% (N=289) and 84% (N=139) of whom underwent a 4 year follow-up visit. TLF was noted in 11.5% in the Absorb arm and 6.0% in the Xience arm (p=0.063) at 4 years, with 1.0% and 0.7% absolute difference respectively between 3 and 4 years. No new very late definite/probable scaffold/stent thrombosis was reported between 3 and 4 years, with a 4-year rate of 3.0% versus 0.0% (p=0.035) and a slight decrease in DAPT prescription in both arms at 4 years (25.9% versus 21.1%, p=NS). CONCLUSIONS A downturn of events was recorded beyond the expected resorption time. Further long-term evaluation in larger randomised studies is necessary to confirm this observation.

New-generation drug-eluting stents are recommended as the default option in all clinical conditions and lesion subsets in patients undergoing percutaneous coronary intervention (PCI). On the other hand, despite achieving very good results in the rate of restenosis, permanent delivery of a metallic platform is affected by several drawbacks, such as caging of the vessel, side branch jailing, impairment of vasomotion, and the impossibility of lumen enlargement. Also, the presence of residual foreign material may increase the risk of late and very late stent thrombosis and support the need for long-term dual antiplatelet therapy after PCI. These pending limitations of metallic stents can be addressed by the implantation of bioresorbable scaf-folds (BRSs). At present, there are numerous devices available for preclinical or clinical evaluation. This review discusses the evidence for BRS in the management of patients with coronary artery disease.

BACKGROUND: Development of methods for accurate reconstruction of bioresorbable scaffolds (BRS) and assessing local hemodynamics is crucial for investigation of vascular healing after BRS implantation.Methods and Results:Patients with BRS that crossed over in a coronary bifurcation were included for analysis. Reconstructions of the coronary lumen and BRS were performed by fusion of optical coherence tomography and coronary angiography generating a tree model (TM) and a hybrid model with BRS (TM-BRS). A virtual BRS model with thinner struts was created and all 3 models were analyzed using computational fluid dynamics to derive: (1) time-average shear stress (TASS), (2) TASS gradient (TASSG), which represents SS heterogeneity, and (3) fractional flow reserve (FFR). Reconstruction of the BRS was successful in all 10 patients. TASS and TASSG were both higher by TM-BRS than by TM in main vessels (difference 0.27±4.30 Pa and 10.18±27.28 Pa/mm, PCONCLUSIONS: Neglecting BRS reconstruction leads to significantly lower SS and SS heterogeneity, which is most pronounced at side branch ostia. Thinner struts can marginally reduce SS heterogeneity.

A previous Task Force of the European Society of Cardiology (ESC) and European Association of Percutaneous Cardiovascular Interventions (EAPCI) provided a report on recommendations for the non-clinical and clinical evaluation of coronary stents. Following dialogue with the European Commission, the Task Force was asked to prepare an additional report on the class of devices known as bioresorbable scaffolds (BRS). Five BRS have CE-mark approval for use in Europe. Only one device -the Absorb bioresorbable vascular scaffold- has published randomized clinical trial data and this data show inferior outcomes to conventional drug-eluting stents (DES) at 2-3 years. For this reason, at present BRS should not be preferred to conventional DES in clinical practice. The Task Force recommends that new BRS devices should undergo systematic non-clinical testing according to standardized criteria prior to evaluation in clinical studies. A clinical evaluation plan should include data from a medium sized, randomized trial against DES powered for a surrogate end point of clinical efficacy. Manufacturers of successful devices receive CE- mark approval for use and must have an approved plan for a large-scale randomized clinical trial with planned long-term follow-up.

The use of bioresorbable stents in interventional cardiology presents a novel approach in the treatment of coronary artery disease. The bioresorbable technology was introduced to overcome limitations of current metallic drug-eluting stents such as late in-stent restenosis and permanently caging the vessel. The concept of a bioresorbable stent is to provide temporal support to the vessel before being degraded and resorbed by the body, promoting vessel healing and restoration of vasomotion. Although the bioresorbable stents have many promising advantages over metallic stents, drawbacks such as insufficient radial strength of the bioresorbable material and large strut profile of the stent need to be addressed in order to enhance the performance of the bioresorbable stents. Currently, there are several bioresorbable scaffolds that are under development with some already commercially available. In this chapter, the concept of bioresorbable stents together with its advantages and limitations will be examined. An overview of the current bioresorbable platforms which include bioresorbable scaffolds made from polymers and biodegradable metallic stents will also be discussed.

We present an application of a validated reconstruction methodology for the comparison between patient-specific hemodynamics and neo-intimal thickening at nine months from the intervention. (1) Background: Coronary bifurcation stenting alters the vessel geometry, influencing the local hemodynamics. The evaluation of wall shear stress (WSS) relies on the application of computational fluid dynamics to model its distribution along the coronary tree. The endothelium actively responds to WSS, which triggers eventual cell proliferation to cover the stent struts. (2) Methods: Baseline optical coherence tomography and angiographic data were combined to reconstruct a patient-specific coronary bifurcation with an implanted bioresorbable scaffold and to simulate the hemodynamics. Results were linked with the neo-intimal thickening after nine months from the intervention. (3) Results: Blood velocity patterns were disrupted at the bifurcation due to the presence of the stent. It was observed that 55.6% of the scaffolded lumen surface was exposed to values of time-averaged WSS lower than 0.4 Pa. Follow-up images showed a luminal narrowing of 19% in the main branch. There was also a complete coverage in 99% of struts. (4) Conclusions: This approach provided valuable complementary information that might improve the clinical outcomes in this subset of coronary diseases.

The aim of this study is to follow morphological imaging characteristics and osteointegration of TruFit® bone graft substitute (BGS) plugs in cases of chondral and osteochondral defects of the articular surface of the knee joint, using high-quality cartilage-sensitive 3-T magnetic resonance imaging (MRI), linked to clinical outcomes. The MRI was used to assess osteointegration and biological evolution of the TruFit® BGS plugs in cases with minimum 5-year follow-up: The TruFit® plug was used in 46 patients for a total of 47 cases with mean age of 57.89 (range 32–80). In this study, we reviewed only the cases with minimum follow-up of 5 years: 5 patients with mean age 64.4 years (minimum 38, maximum 80). The mean follow-up was 71 months (range 63–77). Patients were evaluated clinically, with Lysholm Knee Scoring Scale and MOCART Scale. 3-T MRI, which is preferable to 1.5 T for the better signal-to-noise ratio, contrast and the ability to acquire morphological images at higher spatial resolution, shows a satisfactory integration of bone scaffolds in studied cases for more than 5 years and a satisfactory restoration of the articular cartilage, with the exception of a case of which we still have to consider the factors age, type of lesion and the relationship between the plugs implanted. Clinical and radiological results significantly improve in a longer follow-up time.

Since Tamai were the first to launch the fascinating bioresorbable scaffold in 1999, Abbott took the leadership of the proof of concept in human with Absorb bioresorbable vascular scaffold (BVS; Abbott Vascular, Santa Clara), a 100% poly-l-lactic acid everolimus-eluting bioresorbable scaffold.1,2 Despite encouraging noninferiority randomized trials during the first 2-year follow-up, these studies showed an increase in-scaffold thrombosis compared with the drug-eluting stent (DES; Xience; Abbott). Unfortunately, the 3-year outcome of ABSORB II (A Clinical Evaluation to Compare the Safety, Efficacy and Performance of ABSORB Everolimus Eluting Bioresorbable Vascular Scaffold System Against XIENCE Everolimus Eluting Coronary Stent System in the Treatment of Subjects With Ischemic Heart Disease Caused by de Novo Native Coronary Artery Lesions) confirmed by meta-analyses resulted in the end of Absorb BVS use in Europe and the United States.3,4 In September 2017, Absorb BVS was withdrawn from the market, although higher rates of scaffold thrombosis did not result in increased mortality.5 Moreover, 4 other scaffolds with European Conformity …

Patient Initials or Identifier Number Mr FR ### Relevant Clinical History and Physical Exam A 60-year-old male with a background of diabetes, obesity, hyperlipidemia has a history of ischemic heart disease. A myocardial perfusion scan done 1 year ago indicated ischemia in the left anterior

Resorbable magnesium scaffolds (RMS) represent a conceptually attractive alternative to polymeric scaffolds for the treatment of significant coronary artery lesions. Promising outcomes at 24 months...