The Arrival of the Organic Stent

When I was a cardiology fellow in Philadelphia in 2003 I was fortunate to be one of the first physicians in the country to implant a first of its kind CYPHER drug coated stent. Prior to the advent of drug coated stents, patients received bare metal stents that were mired with the achilles heel of interventional cardiology: restenosis. This is when scar tissue formed inside of the stent infra-structure and resulted in fairly frequent repeat procedures to open the same treatment area as before. The drug coated stents appeared to resolve much of this issue but restenosis and even stents clotting off remained an important issue.

Absorb in handEnter 2016 and the FDA approval of the first fully bioresorbable scaffold approved for use in the United States, the ABSORB stent (image 1).  The stent has a polymer that serves as the scaffold and it also has a coating polymer that carries the “drug” everolimus that serves as the drug that inhibits the scar tissue formation similar to drug coated metallic stents.

These polymers are now used in a wide range of bioresorbable implants, including: orthopedic devices such as plates, pins and screws; drug delivery systems such as solid implants and gel based systems; suture anchors; peripheral bioresorbable stents (organic stents); and surgical mesh and clips.  As a sub-investigator in the Absorb III clinical trial and having enrolled patients into the study it was exciting to recently implant these approved stents in patients in the real world setting. It truly is a revolution in the stenting arena.

Absorb resorption OCTsThe ability to implant a non-metallic scaffold that ultimately gets metabolized via the Krebs cycle to H2O and CO2 is an exciting proposition. The stent literally disappears over time (image 2). This first generation technology in this arena stands to change the landscape of what we do and how we approach our patients now and in the future. New trials are already underway as are new stent designs in this area and the future of interventional cardiology and our ability to help patients seems more hopeful than ever. Stay tuned!