Absorb BRS for in-stent restenosis: the final bow before (scaffold) collapse?

Correspondence to Dr Diego Arroyo; diego.arroyo@h-fr.ch Restenosis in drug-eluting stents (DES) complicates 3%–8% of procedures at 1 year, 8%–15% at 2 years and 8%–31% at 10 years. 1 2 Restenosis after plain-old balloon angioplasty (POBA) is due to negative remodelling, while restenosis after bare metal stent (BMS) is mostly related to neointimal hyperplasia. In a combined analysis from the ABSORB trials with 3-year follow-up, significant increases in the risk of target vessel myocardial infarction and target lesion revascularisation (TLR), as well as early and late scaffold thrombosis (ST), were observed compared with contemporary DES.5 Dedicated implantation protocols improved the risk of TLR,6 7 but ST remained a concern, and no benefit, such as restored vasoreactivity, could be demonstrated.8 Although BRS did not survive these disappointing results, long-term outcomes are paramount and still need to be analysed as potential positive effects would be expected once the platform is completely resorbed. Ten-year clinical outcomes after sirolimus-eluting stent implantation: impact of an in-stent restenosis target lesion.