Free Dissolve Stents —
The Bioresorbable Scaffold That Disappears

What if a stent could do its job — hold an artery open, deliver a drug, prevent restenosis — and then simply disappear? That is the promise of the bioresorbable vascular scaffold (BVS), also known as the dissolving stent or free dissolve stent. It is one of the most ambitious ideas in coronary intervention, and its story so far is a fascinating lesson in medical innovation.

The permanent metallic stent has been transformational. But it also has well-recognised limitations: it cannot respond to vessel movement, it can cause late complications years after implantation, and it permanently alters the architecture of the artery. The bioresorbable scaffold was designed to eliminate these problems — by providing temporary structural support and drug delivery, then dissolving completely, leaving behind a vessel that looks and behaves like a native artery again.

How Does a Dissolving Stent Work?

The most widely studied bioresorbable scaffold — the Absorb BVS by Abbott — was made from polylactic acid (PLLA), a biodegradable polymer also used in dissolvable sutures. Like a drug-eluting stent, it was coated with an antiproliferative drug (everolimus) to prevent the artery from narrowing again after the procedure. But unlike a metallic stent, it was designed to slowly break down through hydrolysis — a natural chemical process driven by water — over a period of approximately two to three years.

In theory, by the time the scaffold has fully resorbed, the artery has been stabilised by new tissue, the drug has been delivered, and the vessel is free again — able to dilate, constrict, and respond to the body's needs like any natural artery.

The Promise — Why This Matters

The theoretical advantages of a bioresorbable scaffold over a permanent metallic stent are significant. Once resorbed, the artery can vasodilate normally again — something a metal stent permanently prevents. Imaging with CT or MRI is no longer obscured by metallic artefact. The vessel wall is no longer a site of chronic inflammation from a permanent foreign body. And future interventions — should they ever be needed — are not complicated by the presence of permanent hardware.

For younger patients who may live for decades after their PCI, the idea of leaving nothing behind is particularly compelling. A 40-year-old who receives a permanent stent today carries it for life. A bioresorbable scaffold, in theory, gives that patient their artery back.

The Reality — What Went Wrong with the First Generation

The Absorb BVS was CE-marked in Europe in 2011 and FDA-approved in the United States in 2016. Early results were promising, and the technology was adopted with considerable enthusiasm. But randomised trial data from the ABSORB III and ABSORB IV trials told a more complicated story.

At three years, the Absorb BVS showed higher rates of target lesion failure and — most concerning — a significantly higher rate of scaffold thrombosis compared with the Xience drug-eluting stent. Scaffold thrombosis is a serious complication in which a clot forms inside the implant, often causing a heart attack. The mechanism appeared related to the much thicker struts of the bioresorbable scaffold (150–200 microns) compared with modern thin-strut metallic stents (60–80 microns), incomplete resorption timelines, and the critical importance of optimal implantation technique.

Abbott withdrew the Absorb BVS from the global market in 2017. It was a significant setback — but not necessarily the end of the concept.

The Next Generation — Where Are We Now?

The lessons from the first generation have been applied to a new wave of bioresorbable scaffold development. Several platforms are now in clinical use or late-stage trials, with key improvements: thinner struts (improving flow dynamics and reducing thrombosis risk), faster resorption timelines, better deliverability, and more rigorous implantation protocols.

Devices such as the Fantom (REVA Medical), DESolve (Elixir Medical), MagMaris (Biotronik — a magnesium-based scaffold), and the Firesorb (MicroPort) represent a new generation of designs. The MagMaris in particular has shown promising early results, with its magnesium backbone resorbing in approximately 12 months — considerably faster than the polymer-based first generation. Sirolimus-eluting bioresorbable scaffolds from Chinese manufacturers are generating substantial real-world data in Asia.

Should Patients Ask for a Dissolving Stent Today?

At this time, bioresorbable scaffolds are not yet a routine alternative to drug-eluting stents for most patients. The evidence base for second-generation devices is still maturing, and the long-term data needed to confirm superiority — or even non-inferiority — to modern thin-strut DES are not yet available in sufficient volume.

That said, several centres of excellence in Europe and Asia are using next-generation scaffolds selectively in specific patient profiles: younger patients with favourable anatomy (larger vessels, focal lesions, no heavy calcification), where the long-term benefit of a metal-free artery is most meaningful.

If you are a younger patient interested in this technology, the right question to ask your interventional cardiologist is not "can I have a dissolving stent?" but rather "am I a good candidate for a bioresorbable scaffold, and which platform would you recommend?" The answer depends on your specific anatomy, the lesion characteristics, and the experience of your centre with the available devices.

Dr. Zaidoun Hajali

MD · FSCAI · FRCP — Consultant Interventional Cardiologist, Dubai & UAE

German-trained interventional cardiologist with 16+ years of experience across complex PCI, including experience with next-generation bioresorbable scaffold platforms during his tenure at leading European cardiac centres.