Will the dream of "leave nothing behind" remain a utopia if we forget to optimise the systemic medical therapy?

Bioresorbable scaffolds (BRS) were designed to “leave nothing behind” by providing temporary scaffolding, thereby overcoming the limitations of permanent metallic stents in the treatment of coronary artery disease at long-term follow-up. These limitations include ongoing triggers for neoatherosclerosis, resulting in in-stent restenosis rates of 2-3% per year and in-stent thrombosis rates of 0.1-0.2% per year at long-term follow-up. Furthermore, permanent caging with metallic stents hampers vasomotion and vessel pulsatility, and can also make future coronary bypass grafting difficult123.

The Absorb bioresorbable vascular scaffold (BVS; Abbott) was the first BRS to obtain the European Conformity (CE) mark and U.S. Food and Drug Administration approval. In September 2017, as a result of disappointing outcomes, especially increased risk of scaffold thrombosis, the device was withdrawn from the market.

However, long-term follow-up, (i.e., when the scaffold is fully resorbed after approximately 3-4 years) of these ABSORB trials could provide us with insights as to whether the "leave nothing behind" is the 4th rosy prophecy or a utopian idea4.

In this issue of EuroIntervention, Smits and his colleagues report on the results of the...