Update on coronary artery bioresorbable vascular scaffolds in percutaneous coronary revascularization.

Coronary angioplasty was first introduced in 1977. From plain old balloon angioplasty to the introduction of bare metal stents in 1986 and dual antiplatelet therapy in 1992 to much more later on. Due to the unacceptable rate of stent restenosis, drug eluting stents (DES) were introduced in 2000. The first generation showed an increase in late stent thrombosis which led to the introduction of the second generation DES with biocompatible or biodegradable polymers and thinner platforms. However very late stent thrombosis and late restenosis might still pose problems in the latter. Furthermore, there has been major debate regarding the impact of long-term vessel caging on normal vasomotricity and long-term positive remodeling. To resolve these issues, the bioresorbable vascular scaffolds (BVS) were launched into the real world in 2011, showing promising initial results. Multiple randomized trials, meta-analyses, and registries were performed, mainly with the Absorb Bioresorbable Vascular Scaffold System (Abbott Vascular, Chicago, IL, USA). This new technology is hindered by certain features, such as the BVS radial strength, its strut thickness, and the inflammatory process related to scaffold degradation. Moreover, there is known data indicating higher thrombosis rate with the Absorb BVS compared with the new generation of DES, despite similar cardiovascular death. In this review, we discuss the clinical procedural and technical evidence on BVS, with emphasis on their clinical impact. We finally tackle the future directions on device and procedural improvement while asking: is the bioresorbable technology still the way to the future?

The radial approach in the cardiac catheterization laboratory: is it meant to become the gold standard?

The transradial approach in interventional cardiology was born twenty years ago. Since then, many studies and meta-analyses have compared it with the former approaches, the transfemoral in particular. The most recent data is reviewed in this article through a double perspective: an anatomical and technical viewpoint in terms of a practical and successful vascular access; and a clinical and economical viewpoint with actual data concerning access site bleeding, access site complications, with a particular emphasis on the radial approach. Its impact on major adverse events, cost-effectiveness and patient comfort are also discussed. New advances and techniques are emerging with the radial approach which is gaining more and more magnitude in the world of interventional cardiology. However, can we actually affirm that this approach is meant to become the gold standard?