Diabetes and everolimus eluting bioresorbable poly‐L‐lactide vascular scaffolds for coronary artery disease: Dead‐end or some path forward?

Key Points Bioresorbable vascular scaffolds (BVS) intend to overcome long‐term limitations of permanent metallic coronary stent implants, particularly in the pro‐inflammatory, prothrombotic diabetic milieu. The Amsterdam Investigator‐Initiated Absorb Strategy All‐Comers (AIDA) trial demonstrates worse 3‐year outcomes with everolimus‐eluting poly‐L‐lactide BVS than everolimus‐eluting stents (EES) in both diabetics and non‐diabetics. A larger sample‐size patient‐level meta‐analysis finds significantly increased risk of early and very late BVS thrombosis in diabetics. While no current clinical evidence supports the BVS hypothesis of improving outcomes in diabetics compared to EES, follow‐up beyond the 3‐year device resorption phase and current generation device and implantation technique improvements provide the unlikely possibility of a useful niche for the everolimus‐eluting poly‐L‐lactide BVS.