Serial intracoronary imaging to predict efficacy and safety of magnesium-based resorbable scaffolds

So far, bioresorbable scaffold (BRS) technology has failed in achieving non-inferiority compared to metallic drug-eluting stents (DES). While the polymeric Absorb (Abbott) bioresorbable vascular scaffold was rigorously tested against metallic DES and showed inferior efficacy and safety, any other BRS technology has undergone no or very limited assessment in powered randomised trials, including the previous two generations of resorbable magnesium scaffold (RMS). In the only randomised controlled trial (RCT), the small MAGSTEMI trial, the second-generation drug-eluting absorbable magnesium scaffold (DREAMS 2G, commercial name Magmaris [Biotronik]) showed a lower clinical and angiographic efficacy as compared to DES, yet a better vasomotor function at follow-up1. This trial and the results of the BIOSOLVE observational studies reportedly identified stent recoil due to limited radial strength as the leading reason for inferior efficacy. The latest iteration, the third-generation DREAMS (DREAMS 3G, commercial name Freesolve [Biotronik]), was developed to address this limitation. Compared to Magmaris, DREAMS 3G improved radial strength despite reduced strut thickness. In the first-in-human study (BIOMAG-I) assessing the DREAMS 3G, target lesion revascularisation at 12 months rarely occurred (2.6%) and no...