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Drug-eluting stents (DES) have significantly improved the outcome of percutaneous coronary intervention (PCI); however, several concerns remain regarding late adverse events associated with the presence of a permanent rigid metallic cage that might impair the natural healing process of the coronary vessel wall. Recently, PCI with bioresorbable vascular scaffolds (BVS) has emerged as an interesting alternative with several potential advantages related to the complete resorption process that occurs within 3-5 years. As a consequence, it reduces the trigger for persistent inflammation, enables restoration of normal vessel reactivity and facilitates positive remodeling. However, current BVS have several limitations, including thicker and wider struts, less radial strength, and limited expansion. A hybrid strategy, combining the use of BVS and DES, is a novel approach that could be useful to avoid the limitations of currently available BVS, particularly in case of PCI for complex coronary lesions.We describe a case of hybrid percutaneous intervention with BVS in combination with DES for managing complex lesions unsuitable for pure scaffolding percutaneous coronary intervention.

Objectives: The aim of this study was to evaluate the long-term clinical outcome of the efficacy and safety of sirolimus-eluting stents (SES) for in-stent restenosis (ISR) in the TRUE (Tuscany Registry of Unselected In-Stent Restenosis) database., Background: The TRUE registry demonstrated that SES in the treatment of bare-metal stent ISR is efficacious (5% of target lesion revascularization [TLR]) and safe (stent thrombosis <1%) at 9 months. Clinical outcome at 4 years is reported., Methods: A total of 244 patients with ISR who were treated with SES implantation represent the study population. The incidence of major adverse cardiac events was collected at 4 years., Results: At 4-year follow-up, overall mortality was 9.8% (24 patients). Cardiac death occurred in 11 (4.5%), nonfatal myocardial infarction in 8 (3.2%), and TLR in 27 (11.1%) patients for a cumulative event-free survival rate of 80.3%. Definite stent thrombosis occurred in 5 (2%) patients and possible stent thrombosis in 2 (0.8%). Diabetes remained an independent negative predictor of freedom from TLR (odds ratio [OR]: 0.38; 95% confidence interval [CI]: 0.20 to 0.71, p = 0.002) and major adverse cardiac events (OR: 0.38; 95% CI: 0.20 to 0.71, p = 0.002)., Conclusions: The clinical benefit of SES implantation for bare-metal stent ISR is maintained at 4 years with a low TLR rate and an overall incidence of stent thrombosis of 0.7% per year.

Aims: Due to the widespread use of drug-eluting stents (DES), in-DES restenosis is increasing. The aim of this study is to evaluate the clinical outcome of patients undergoing repeat percutaneous coronary intervention (PCI) for DES restenosis., Methods and Results: One hundred patients with 108 restenotic lesions using DES were consecutively enrolled in a single-arm 2-centre registry. The repeat-PCI was performed either with balloon angioplasty (POBA) or with DES implantation (homo-stent or hetero-stent). Major adverse cardiac events (MACE) occurrence was assessed long-term. Of the 108 DES restenotic lesions, 34 were treated with balloon angioplasty, 43 with homo-stent and 31 with hetero-stent implantation. Of the patients, 37% had diabetes mellitus, while 30% peripheral or carotid artery disease. Over a mean follow-up of 16.0+/-6.0 months, the rates of death, myocardial infarction (MI), and ischaemic driven target lesion revascularisation (IDTLR) in hetero-stent, homo-stent and POBA groups were respectively 0% vs. 5% vs. 3% (p=NS), 2% vs. 5% vs. 0% (p=NS) and 17% vs. 23% vs. 25% (p=NS). When comparing patients treated with POBA to those receiving hetero-/homo-DES, no significant difference in terms of IDTLR (25% vs. 20%; p=NS), MI (0% vs. 4%; p=NS) and overall MACE (25% vs. 23%, p=NS) appeared. The presence of previous MI (OR 0.05; 95% CI 0.01-0.3), first DES implanted for BMS restenosis (OR 0.16; 95% CI 0.02-0.99) and peripheral or carotid disease (OR 0.09; 95% CI 0.01-0.67) were negative independent predictors of freedom from IDTLR., Conclusions: Repeat balloon angioplasty for DES restenosis showed similar clinical outcome compared to re-DES (homo- or hetero-) implantation and could be considered as first treatment strategy in this setting.