REVIEW   

Italian Journal of Vascular and Endovascular Surgery 2018 March;25(1):25-36

DOI: 10.23736/S1824-4777.17.01314-6

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

The application of biobased polymers to peripheral intravascular stent development

Rym EL KHOURY ¹, Alexander NIKANOROV ², Giuseppe BIONDI-ZOCCAI ^{3, 4}, Lewis B. SCHWARTZ ¹ ✉

¹ Department of Surgery, Advocate Lutheran General Hospital, Park Ridge, IL, USA; ² National Coalition on Health Care, Washington, DC, USA; ³ Department of Medico-Surgical Sciences and Biotechnologies, “Sapienza” University of Rome, Rome, Italy; ⁴ Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Isernia, Italy

Atherosclerotic disease involving the arteries of the lower extremities is the leading worldwide cause of disability and death. Treatment options include invasive surgical bypass, balloon dilation, and endovascular permanent metallic stents. Increased utilization of the endovascular approach has emphasized their physiologic and anatomic limitations. Metallic stents have a tendency towards poor durability and device-related complications. To reduce the chronic force and inflammation on native vessels after device implantation while sustaining adequate radial strength, absorbable stents composed of biopolymers have recently been developed. Successful applications in the field of percutaneous coronary intervention have stimulated the design of devices aimed at the peripheral vasculature; poly-L-lactic-acid has emerged as the biopolymer of choice. With uniform implantation success and variable reported angiographic results, bioresorbable vascular scaffolds (BVS) have demonstrated safety in early clinical trials. They represent a paradigm shift in the management of atherosclerosis focused on native vessel function recovery and avoidance of implantation of permanent foreign bodies. Pending the accrual of additional evidence, BVS may already be used for selected patients with coronary and peripheral artery disease, with the ultimate goal of a more widespread adoption to increase long-term safety in comparison to permanent endoprostheses.

KEY WORDS: Peripheral arterial disease - Stents - Biopolymers