Bioresorbierbare Scaffolds: Rationale, aktueller Entwicklungsstand und Herausforderungen bei der Behandlung der koronaren Herzerkrankung

Zusammenfassung

Drug-Eluting Stents (DES) der neuesten Generation gelten als Goldstandard der interventionellen Behandlung von Koronarstenosen und sind in den aktuellen Leitlinien der Fachgesellschaften Therapie der Wahl für die interventionelle Revaskularisation von Koronarstenosen. Obwohl aktuelle DES einige Probleme und Nachteile der reinen Ballonangioplastie bzw. der Bare Metal Stents (BMS) gelöst haben, bleiben Limitationen, insbesondere die einer chronischen lokalen Entzündungsreaktion als Folge der permanenten Implantation eines Fremdkörpers, das Risiko einer späten und sehr späten Stentthrombose und eine Einschränkung der vaskulären Vasomotion durch das permanente Metallgerüst. Der Einsatz von bioresorbierbaren Scaffolds (BRS) könnte diese Limitationen überwinden, da sie lediglich temporär im Gefäß verbleiben und sich nach ca. 1–2 Jahren auflösen. Derzeit stehen 2 Devices zur klinischen Anwendung zu Verfügung. Darüber hinaus befinden sich einige in der Erprobung. Dieser Artikel gibt einen Überblick über den aktuellen Stand.

Abstract

New generation drug-eluting metal stents (DES) are the golden standard for percutaneous coronary intervention and the treatment of choice for revascularization of coronary artery stenosis in the current guidelines of the cardiac societies. Although modern DES have solved some of the problems and disadvantages of plain balloon angioplasty and bare-metal stents (BMS) some limitations remain, especially a chronical local inflammatory response as a result of permanent implantation of a foreign body, the risk of late and very late stent thrombosis and a missing vasomotion due to a permanent metal framework. The development of bioresorbable scaffolds is an approach that aims to overcome the limitations of drug-eluting metal stents. These devices provide temporary scaffolding of the vessel and then disappear, liberating the vessel from its cage. Currently, two devices are available for clinical use and various types of bioresorbable scaffolds are under development. This article provides an overview of the current state of development.

Schlüsselwörter

bioresorbierbare Scaffolds - koronare Herzerkrankung - perkutane Koronarintervention - Drug-Eluting Stents

Key words

bioresorbable vascular scaffolds - coronary artery disease - percutaneous coronary intervention - drug-eluting stents

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