Dmax for sizing, PSP-1, PSP-2, PSP-3 or OCT guidance: interventionalist’s jargon or indispensable implantation techniques for short- and long-term outcomes of Absorb BRS?

Recent reports of randomised trials (ABSORB II, ABSORB Japan and ABSORB China) have raised questions on the “non” non-inferiority of the acute and long-term performance of the Absorb bioresorbable scaffold (BRS) when compared to the XIENCE stent (both Abbott Vascular, Santa Clara, CA, USA). Furthermore, very late scaffold thrombosis has been perceived as a possible new unexpected “enemy” – unexpected because thrombosis occurred at a moment when the scaffold was expected to have disappeared. The three main players in this new debate are: the patient/lesion, the device, and the interventionalist. The selection of the patient/lesion might be inappropriate, the device may have inherent deficiencies and the operator may have used the device inappropriately. If the matter were not of paramount importance for the wellbeing of our patients and were not a topic that demands our utmost medical attention, we would have rephrased the title of a past editorial, “Who was thrombogenic, the device, the doctor…or the patient?”. The format of the present commentary is neither an editorial nor a review, but should be considered as the personal views of two clinical scientists who have been involved in the pioneering investigations of this device and have historical and current insights into the field.