Restenosis patterns after bioresorbable vascular scaffold implantation: Angiographic substudy of the GHOST-EU registry

Objectives: To evaluate pattern of in-BVS-restenosis after bioresorbable vascular scaffold (BVS) implantation. Background: In-stent restenosis morphology impacts target lesion revascularization (TLR) rates and clinical outcomes. Although several trials report on outcomes after BVS implantation, information about in-BVS restenosis pattern is still lacking. Methods: Between November 2011 and January 2014, in 7 of 10 European centers participating in the GHOST-EU registry, 668 patients underwent BVS implantation. Of them 164 patients (200 lesions) underwent an additional angiogram 3 to 12 months after index PCI. Results: Binary in-BVS restenosis (IBR) (in-segment diameter stenosis ≥50%) was observed in 12.7% (21 of 164) of patients (30 lesions), with a TLR rate of 16.5%. The IBR morphology was classified as focal margin in 50.0%, focal body in 26.7%, multifocal in 10.0%, and diffuse in 13.3% of these cases. Treatment of small vessels (OR 5.49, 95% CI 1.6–18.8, P < 0.01) was identified as independent predictor of IBR. Performing predilatation (OR 0.13, 95% CI 0.02–1.04, P = 0.06), high-pressure postdilatation (OR 3.16, 95% CI 0.90–11.18, P = 0.07) as well as treatment of acute coronary syndrome (OR 0.18, 95% CI 0.03–1.12, P = 0.07) seem to strongly influence this risk. Conclusions: The IBR morphology is mostly focal involving particularly the BVS margins suggesting association with procedural aspects in this early experience with BVS. Treatment of small vessels is the strongest predictor of higher IBR risk.