Netherlands Heart Journal | 2019
Absorbing the Absorb experience—don’t let the concept fade away
Abstract
Coronary artery disease is a major cause of morbidity and mortality in patients with diabetes mellitus. In our daily catheterisation laboratory practice, patients with diabetes mellitus represent more than 25% of those who undergo revascularisation. Patients with diabetes are not only more likely to have coronary artery disease, but also to have a more complex and diffuse illness. Atherosclerosis also tends to be more rapidly progressive. Moreover, the long-term results after revascularisation with percutaneous coronary intervention or coronary artery bypass graft surgery are worse in diabetic patients [1, 2]. Coronary revascularisation with contemporary drug-eluting stents (DES) is associated with better clinical outcomes compared with early-generation DES and bare-metal stents. However, there are ongoing risks of in-stent restenosis and thrombosis. It is hypothesised that this is due to persistent inflammation, impaired vasomotion and ongoing tissue growth within the stent frame. Other concerns regarding DES in the long term include permanent side branch occlusion and the lack of ability to place a bypass graft at the stented location. Fully biodegradable stents, also referred to as bioresorbable scaffolds, have been developed in an effort to overcome these disadvantages of traditional stenting. The concept is that with these devices, the stent is in place long enough to protect against subacute thrombosis, recoil and early restenosis, but not long enough to experience the long-term shortcomings. Therefore, the use of these scaffolds is hoped to improve outcomes in high-risk patients who may need repeat percutaneous coronary intervention or coronary artery