Long-Term Clinical Outcomes After Bioresorbable Vascular Scaffold Implantation for the Treatment of Coronary In-Stent Restenosis

Abstract

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.

Bioresorbable Vascular Scaffold Korean Expert Panel Report

“… 17) 18) 19) 20) 21) In addition, BRS was evaluated in the complex patients and lesions subset including diabetes, 22) ACS, 23) 24) 25) MI, 26) 27) 28) 29) 30) 31) 32) 33) small vessel, 34) and in-stent restenosis. 35) 36) 37) However, the interpretation of such studies should be careful considering the biased nature of registry studies. Table 2 summarized currently available registry studies.…”

Comparison of new-generation drug-eluting stents versus drug-coated balloon for in-stent restenosis: a meta-analysis of randomised controlled trials

“…Bioresorbable scaffold (BRS) may be an alternative treatment choice in the future. 32 33 The ongoing AbsorbISR (Absorb Bioresorbable Scaffold vs Drug Coated Balloon for Treatment of In-Stent-Restenosis, NCT02474485) trial comparing bioresorbable vascular scaffold with DCB to treat ISR will shed light in terms of clinical utility of BRS for coronary ISR. Finally, further refinements in DCB technology and auxiliary strategies, 34 35 such as use of scoring balloon before DCB, 30 are warranted.…”

Challenging treatment of in-stent restenosis in a coronary bifurcation by implantation of a bioresorbable scaffold under optical coherence tomography guidance

“…Some scientific reports however, focus on dedicating interventional techniques to minimize these risks [10,11]. ISR is also a challenging scenario for BRS, because the expansion of the scaffold is sensibly inferior than in on-label indications [12] and reported clinical outcomes are inconsistent to date [13,14]. The current case reports the successful treatment of a lesion combining both bifurcation and ISR challenges, by implanting a BRS.…”