Bioresorbierbare Scaffolds – Therapiekonzept mit Zukunft?

Zusammenfassung

Drug eluting Stents (DES) sind aufgrund ihrer hohen Effektivität und Sicherheit die Standardtherapie im Rahmen der perkutanen Koronarintervention. Bioresorbierbare Scaffolds (BRS) bestehen aus einem resorbierbaren Grundgerüst und einer antiproliferativen Beschichtung. Sie wurden mit dem Ziel der Wiederherstellung der Gefäßintegrität und Vasomotion konzipiert. Die aktuellen Daten zum Absorb-BRS weisen jedoch auf vermehrte Sicherheits- (Thrombosen) und Effizienzlimitationen (Revaskularisationen) im Vergleich zu DES hin. Ein routinemäßiger Einsatz von BRS im Rahmen der PCI kann aktuell nicht empfohlen werden. Eine individuelle Indikationsstellung unter Abwägung der potenziellen Vorteile und Risiken sollte vor Implantation eines BRS erfolgen. Eine Weiterentwicklung der Technologie mit dünneren Streben und besseren mechanischen Eigenschaften könnten diese Limitationen allerdings überwinden und den Stellenwert der BRS neu definieren.

Abstract

Drug eluting stents remain the standard therapy in percutaneous coronary intervention (PCI) due to their high efficacy and good safety profile. Bioresorbable scaffolds (BRS) are made of a bioresorbable backbone coated with an antiproliferative drug. They were designed to restore vasomotion and vascular integrity after PCI. Due to safety and efficacy issues the Absorb BRS is no longer commercially available outside of clinical trials or registries in Europe. A routine usage of BRS in PCI is currently not indicated based on scientific data. Further improvement of this technology with reduced strut thickness, better mechanical properties and shorter duration of absorption could overcome these limitations. The future role of BRS has to be determined by randomized clinical trials with next generation BRS technology.

Schlüsselwörter

koronare Herzkrankheit - Myokardinfarkt - perkutane Koronarintervention - bioresorbierbare Scaffolds

Key words

coronary artery disease - myocardial infarction - percutaneous coronary intervention - bioresorbable scaffolds

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