Bioresorbable scaffolds for treating coronary artery disease in patients with diabetes mellitus

Coronary artery disease remains the most common cause of mortality and morbidity in the diabetic population due to accelerated atherosclerosis driven by complex pathophysiological effect of hyperglycemia, augmented serum levels of advanced glycation end-products, insulin resistance, and high free fatty acid levels. Advancements in percutaneous coronary intervention (PCI) and advent of newer generation drug eluting stents (DESs) have improved outcomes in patients with diabetes mellitus. However, diabetes is still a strong risk factor for adverse clinical outcomes after PCI due to higher rate of restenosis, stent thrombosis, and lower 1-year survival in diabetic compared to non-diabetic population. Bioresorbable scaffolds (BRSs) are novel devices for coronary revascularization and offer potential to improve long-term outcomes. It remains to be proven whether PCI with BRS may improve the outcomes in diabetic patients. This chapter reviews the revascularization strategy in patients with diabetes mellitus, with particular focus on the role of BRS in this patient group.