Medically treated patients with ischemic cardiomyopathy and large areas of viable myocardium on PET are at high risk for cardiac death.

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T reatment of in-stent restenosis (ISR) is still a technical challenge for interventional cardiologists. Several studies have demonstrated that treating drug-eluting stent (DES) ISR is even more challenging because of the unfavorable substrate of DES ISR because of the presence of resistant stent underexpansion or neoatherosclerosis that have been shown to be associated with poorer clinical and angiographic outcomes than treating bare-metal stent (BMS) ISR.1-4 Despite this, current recommended options for ISR treatment are DES or drug-eluting balloon (DEB), regardless of the type of ISR lesion (within BMS or DES).5 However, both these technologies present some drawbacks and recently the bioresorbable vascular scaffold (BVS, ABSORB; Abbott Vascular, Santa Clara, CA) has emerged as an attractive alternative strategy for ISR. No in-hospital death, myocardial infarction, or revascularization occurred. At 15 months of follow-up, the incidence of the device-oriented composite end point estimated with the Kaplan-Meier method was 9.1%. No significant differences were reported between drug-eluting stent and bare-metal stent ISR groups in terms of device-oriented composite end point (10.9% versus 6.4%; hazard ratio, 1.7; 95% confidence interval, 0.5-6.5; P=0.425) and its singular components (cardiac death: 2.8% versus 2.0%, hazard ratio, 1.3; 95% confidence interval, 0.1-14.1, P=0.843; target vessel myocardial infarction: 1.5% versus 0%, P=0.421; ischemia-driven target lesion revascularization: 9.6% versus 4.4%, hazard ratio, 2.3; 95% confidence interval, 0.5-10.8, P=0.309). Conclusions-Our registry suggests that the use of BVS implantation for the treatment of complex drug-eluting stent and bare-metal stent ISR lesions might be associated with acceptable long-term clinical outcomes.(Circ Cardiovasc Interv. 2016;9:e003148.