(CCSP018) LONG-TERM ANGIOGRAPHIC PATTERNS OF BIORESORBABLE VASCULAR SCAFFOLDS (BVS) RESTENOSIS

Background: The angiographic patterns of restenosis are well known for BMS and DES. The treatment of diffuse intra-stent restenosis is relatively complex with a high recurrence rate after balloon angioplasty. Data about long-term in-BVS restenosis patterns in the literature remains scarce. We hypothesized that the in-scaffold pattern of restenosis would be more diffuse 12 months after deployment.

METHODS AND RESULTS: Between April 2013 and May 2017, 616 patients underwent PCI in our Heart Institute with deployment of at least one BVS. As of July 2020, 139 patients underwent a subsequent coronary angiogram. After a follow-up of 959±702 days, 41 patients (52 lesions) experienced a clinical restenosis (≥ 50% and angina symptoms or ≥70% stenosis) which resulted in a target lesion revascularization (TLR). The in-BVS restenosis group had fewer smokers (9.76% vs. 32.65%, p=0.0094) and more prior CABG surgery (21.95% vs. 7.14%, p=0.0276). 6 lesions (11.5%) showed early restenosis ( < 6 months), 8 lesions (15.4%) presented late restenosis (between 6 and 12 months) and 38 lesions (73.1%) had very late restenosis (>12 months). 31 lesions (59.6%) showed focal restenosis (36.54% had a Mehran's focal body pattern) and 21 had a diffuse pattern (mainly intra-scaffold pattern). Previous CABG [OR=3.485 (95% CI: 1.05-11.561), p=0.041] and scaffold length ≥30 mm [OR=2.903 (95% CI: 1.227- 6.871), p=0.015] were independent predictors of in-BVS restenosis. Within the first year of deployment, the in-BVS angiographic pattern of restenosis was mainly focal (12 of 14 lesions; 86%). After 12 months, the prevalence of focal and diffuse angiographic restenosis patterns was similar, i.e. 19 focal (50%) and 19 (50%) diffuse lesions.

Conclusion: In this cohort of BVS patients with angiographic follow-up, the most frequently observed angiographic pattern of in-BVS restenosis was focal. After 12 months of follow-up, the pattern of very-late restenosis was focal in only 50% of cases. Longer length of scaffolds and prior bypass surgery independently predicted the risk of in-BVS restenosis in this cohort.