Introduction on How to Select the Most Appropriate Patient and Lesion to be Treated with a Coronary Bioresorbable Vascular Scaffold
Although the introduction of metallic stents has revolutionised the percutaneous treatment of coronary artery disease (CAD) and has been demonstrated to improve clinical outcomes as compared with plain old balloon angioplasty (POBA), the permanent presence of a metallic cage that stays on the vessel wall beyond its intended purpose of preventing acute recoil, is associated with a number of drawbacks. The recent introduction of bioresorbable vascular scaffolds (BVS) offers the potential of dealing with these drawbacks as these devices allow positive remodelling and restoration of normal vasomotor vessel function.1,2 They also offer the potential of reducing restenosis and stent thrombosis rates because they tend to be more biocompatible as compared with conventional metallic drug-eluting stents (DES), whilst also maintaining access for coronary bypass grafting in the future if required. Until recently, the use of BVS has largely been in the context of clinical trials, but an increasing number of real-world patients are being treated with these scaffolds. Despite the fact that most, if not all, patients can be treated with these devices, it is clear that certain patient cohorts have more to gain than others from BVS use, especially if these innovative devices fulfil their expected potential. In view of their higher cost and challenges in implantation technique as compared with conventional DES, the selective use of BVS is appropriate especially in the current climate.