metal stent to increase blood flow to the heart. Coronary angioplasty, also known as percutaneous coronary intervention (PCI), is the most commonly used nonsurgical technique for managing obstructive coronary artery disease. Examples of some of these include unstable angina, acute myocardial infarction (MI), and coronary artery disease (CAD). This procedure is minimally invasive and patients usually are discharged the following day. Coronary angioplasty is commonly performed via the femoral artery; however, use of the radial artery has recently produced better outcomes in patients with ST-segment elevation myocardial infarction (STEMI). A catheter with a small balloon mounted on the end is inserted into a blood vessel in the femoral or radial artery and advanced into a coronary artery. The catheter is then positioned at the narrowed portion of the affected artery and the balloon is inflated as needed. As the balloon inflates, it stretches the coronary artery wall (also known as balloon angioplasty). The balloon is then deflated and the catheter is removed from the artery. The balloon inflation expands the stent and presses it against the coronary artery wall. Inflation may be repeated within the stent to achieve the desired width. The implantation of metal stents used to widen the artery has been common for many years. Once the metal stent is in place, it remains there to keep the artery widened to prevent ischemia from reoccurring. The metal stent may cause scar tissue to form over time within the stent causing the arterial restenosis it was placed there to prevent. There are stents that temporarily release a drug for a few months after stent placement, to prevent the formation of scar tissue; however, this is not a permanent solution for the risk of restenosis. On July 5th, 2016, The U.S. Food and Drug Administration (FDA) approved the first fully absorbable stent to treat coronary artery disease. According to the FDA, The Absorb GT1 Bioresorbable Vascular Scaffold System (BVS), releases the drug everolimus to limit the growth of scar tissue. It is then gradually absorbed by the body in approximately two to three years. The absorption of the stent removes the foreign body from the artery once it is no longer needed, in the same manner as dissolvable sutures. Once the stent is absorbed, the only thing that remains are four platinum markers embedded in the walls of the artery so cardiologists can track where the stent was originally placed. The same balloon angioplasty procedure used to place the metallic stents is also used to place the BVS stent with minimal alterations. There are several other alternatives for the treatment of patients with coronary artery disease including exercise, diet, drug therapy, percutaneous coronary interventions (ex.
balloon angioplasty, atherectomy, bare metal stents, and drug-eluting stents), and coronary artery bypass graft (CABG) surgery. Each procedure has its own advantages and disadvantages. A patient should fully discuss these alternatives and side effects with his physician to select the method before choosing. Patients must speak to their physicians to see if they meet all qualifications for a procedure using the new BVS stent. Patients who cannot tolerate or have an allergy to anticoagulation agents used in this procedure or post-procedural antiplatelet medications, as well as (poly (L-lactide), poly (D, L-lactide), platinum) or with contrast sensitivity should not use this product. Complications may include: catheter site infection, bleeding, and coronary artery complications that may require additional interventions such as: arteriovenous fistula, pseudoaneurysm, aneurysm, dissection, perforation or rupture, embolism, peripheral nerve injury, peripheral
ischemia. Even with all possible complications, the BVS stents have shown remarkable improvements in prevention of post stent restenosis and post stent thrombus formation. A randomized, single blind, controlled trial performed by Lorenz Räber, MD; Henning Kelbæk, MD; Miodrag Ostojic, MD; resulted in “Major adverse cardiac events occurring after approximately 1 year in 24 patients (4.3%) receiving biolimus-eluting stents with biodegradable polymer and 49 patients (8.7%) receiving bare-metal stents. The difference was driven by a lower risk of target vessel–related reinfarction and ischemia-driven target-lesion revascularization in patients receiving biolimus-eluting stents compared with those receiving bare-metal stents. Rates of cardiac death were not significantly different. Definite stent thrombosis occurred in 5 patients (0.9%) treated with biolimus-eluting stents and 12 patients (2.1%) treated with bare-metal stents.” In conclusion, there are many options to consider when evaluating a patient’s risk for surgical intervention and postoperative complications; however, using the device that will ultimately cause the least damage to a patient’s quality of life is the gold standard. Compared with a bare-metal stent, the use of biolimus-eluting (BVS) stents with a biodegradable polymer resulted in a lower rate of postoperative arterial complications.