Rather Thick, Yet Antithrombogenic
Is the Magmaris Scaffold a New Hope for Bioresorbable Coronary Scaffold?
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The concept of a fully bioresorbable coronary scaffold (BRS), a device that do its job and disappears, fits the physiological need to restore the coronary artery structure without implanting a permanent device, and the technology has, therefore, attracted interest of inventors, interventional community, and patients.1 BRS offers transient scaffolding of the vessel to prevent acute recoil and closure with an elution of antiproliferative drug to prevent constrictive remodeling and excessive neointimal hyperplasia. At long term, the disappearance of the device may allow the restoration of vasomotion and the mechanotransduction of cyclic strain to the coronary artery, which may influence the vessel wall metabolism and subsequent vascular remodeling.2 By eliminating the foreign body via bioresorption process, BRS maintains long-term suitability for future possible revascularization options (percutaneous or surgical), enables assessment of noninvasive imaging,3and potentially reduces long-term adverse events stemming from permanent materials.4
See Article by Waksman et al
As of July 2017, 5 products—Absorb, Desolve, ART Pure, Magmaris, and Fantom scaffolds—acquired a Conformité Européene mark in Europe. The Absorb scaffold was the first device approved by Food and Drug Administration in the United States and by Pharmaceuticals and Medical Devices Agency in Japan.5 Three scaffolds (Absorb, Desolve, and ART Pure) were made of poly-lactide, whereas the Magmaris scaffold and the Fantom scaffold consisted of magnesium and thyrosine polycarbonate, respectively. To compensate inherent mechanical limitations of bioresorbable materials (lower tensile strength and shorter elongation-at-break), the struts of BRS are in general thicker (125–150 μm) and wider than those of permanent drug-eluting metallic stents.5
Recent Setback of the Absorb Scaffold
Despite the initial expectation, the enthusiasm toward BRS has recently been ebbed away because of the worrisome signal of a higher thrombotic risk of the polymeric Absorb scaffold than the metallic Xience stent in both early and late/very late phase. Recent meta-analyses …