ART: Bucking the Trend in Bioabsorbable Stents

Article preview from IN VIVO - June 2008

Bioabsorbable stents arouse great enthusiasm among both interventionalists and industry executives, because they have one major advantage over current stents, both bare metal and drug-eluting: they obviate the need for a permanent implant when only a temporary scaffolding effect is needed. Many stent companies are hedging their bets, working on stents that incorporate both drug elution and bioabsorbability--but not Paris-based Arterial Remodeling Technologies, which is arguing that natural healing, not drug therapy, is the best approach to therapeutically active stents.

Many industry executives believe bioabsorbable devices may be the next big thing in coronary stents after drug-eluting stents. Most bioabsorbable stent companies are hedging their bets, combining drug elution with stents that disappear. Not ART, who's betting that natural healing beats drug therapy.

• Though research on bioabsorbable stents predates the development of drug-eluting stents, the dramatic success of drug-eluting stents during the middle years of this decade pushed development efforts on bioabsorbable stents to the back burner.
• Advocates of bioabsorbable stents argue that the new stents have one major advantage over current stents, both bare metal and drug-eluting: they obviate the need for a permanent implant when only a temporary scaffolding effect is needed.
• More recently, the safety concerns surrounding drug-eluting stents and their link to late-stent thrombosis have knocked the drug-eluting stent market back, and even though many researchers now question that link, more and more interventionalists are arguing against aggressive adoption of drug-eluting stents.
• Many stent companies are hedging their bets, working on stents that incorporate both drug elution and bioabsorbability—but not Paris-based ART, which is arguing that natural healing, not drug therapy, is the best approach to therapeutically active stents.
• Bioabsorbable stents arouse great enthusiasm among both interventionalists and industry executives, though some say that we're years away from knowing whether a viable stent is even possible.

For years, the development of bioabsorbable coronary stents (BAS) lived in the shadow of drug-eluting stents—this despite the fact that early BAS research actually predates and served as a precursor to the initial work on drug-eluting stents (DES). Some cardiovascular researchers claim that the first work on bioabsorbable stents goes back 20 years, before the first bare-metal stents hit the market and around the same time that the large cardiovascular players first began to conceive of putting a therapeutic agent on a stent. (Technically, there are important differences between materials that are biodegradable and bioabsorbable; for the purposes of this article, the term "bioabsorbable" will be used somewhat generically to describe stents that go away some period of time after implant.)

In fact, many of the companies developing DES saw from the early days a natural connection between BAS and DES. Bioabsorbable devices would, in time, become the way to deliver therapeutic agents, and for most bioabsorbable stent companies, a drug-eluting version of their device has long represented a logical and inevitable development of their technology.

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Companies mentioned in this article:

Abbott Laboratories Inc.
Bioabsorbable Vascular Solutions
Arterial Remodeling Technologies
Biotronik GMBH & Co.
Boston Scientific Corp.
Covidien Ltd.
Johnson & Johnson
Cordis Corp.
Ethicon Inc.
Reva Medical Inc.
SyneCor LLC