Author + information
- Ivan Gomez-Blazquez1,
- Victor Jimenez Diaz2,
- Saleta Fernandez-Barbeira3,
- Guillermo Bastos Fernández4,
- Antonio De Miguel Castro5,
- Jose Antonio Baz Alonso4,
- Alberto Ortiz Saez6 and
- Andres Iñiguez4
Treatment of patients with in-stent restenosis (ISR) remains a clinical and technical challenge. ISR lesions treated with new-generation drug-eluting stent (DES) implantation have worse results than treatment of de novo lesions. Everolimus-eluting bioresorbable scaffold (BRS) represent an attractive alternative for ISR treatment since long-term accumulation of several layers of metal within the vessel wall is avoided. Our aim is to determine the safety and efficacy of everolimus-eluting BRS for ISR treatment.
Prospective observational study. Consecutive patients with ISR coronary lesions treated with BRS implantation were included.
A total of 56 ISR lesions in 53 patients were treated with BRS implantation between June 2013 and December 2015. Mean age of patients was 64 ± 10 years, 74% were male, 38% were diabetic and 28% presented as acute coronary syndrome. Among all lesions, 43% were DES ISR and 18% were recalcitrant ISR. Diffuse ISR pattern was present in 48% lesions and 70% lesions were B2/C. Predilatation was performed in 100% cases and cutting balloon was used in 52% lesions. Successful scaffold delivery was achieved in all lesions. Among all BRS deployed, 23% had 2.5 mm nominal diameter. Postdilatation with non-compliant balloon was performed in 86% lesions at 21±5 atmospheres. One patient suffered periprocedural non-Q wave myocardial infarction due to side branch artery caged. All patients had clinical follow-up at 12 months. After 1 year, 2 patients (3.8%) had cardiac death and 4 patients (7.5%) underwent target lesion revascularization for binary restenosis. Scaffold thrombosis rate was 1.9% (late probable thrombosis). Use of dual antiplatelet therapy was 100% and 90% at 6 and 12 months, respectively.
In our study, treatment of ISR with everolimus-eluting BRS implantation was feasible and safe, with a mid-term rate of cardiac events comparable to conventional treatment in this setting. Adequate patient selection and optimal implant technique are essential for appropriate results.
CORONARY: Stents: Bioresorbable Vascular Scaffolds