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Bioresorbable scaffold (BRS) are an attractive option in percutaneous coronary interventions (PCI) due to potential advantages associated with its complete absorption within several years of implantation [1]. However, current generation BRS have thicker struts compared to contemporarymetallic stents. Furthermore, a small stent/vessel diameter is considered to be an important risk factor for adverse events including target lesion revascularization (TLR) and stent thrombosis [2]. As a consequence, there are concerns that the treatment of small vessels with current generation BRS may result in a greater number of adverse events when compared to second-generation metallic stents. Whilst a previous study demonstrated similar clinical and angiographic outcomes following BRS in small vessels when compared to large vessels [3], this was in the context of simple lesions that is not fully representative of contemporary clinical practice. The purpose of this study was therefore to investigate clinical outcomes following BRS implantation in small vessels. BetweenMay 2012 and April 2015, 350 consecutive lesions (248 patients) were treatedwith BRS Absorb (Abbott Vascular, Santa Clara, CA) in 2 high volume centers in Milan, Italy. All patients provided informed

⁎ Corresponding author at: EMO-GVM Centro Cuore Co E-mail address: info@emocolumbus.it (A. Colombo). Fig. 1. Coronary angiogramand intracoronary image of initia Two bioresorbable scaffoldswere implanted on the proxima luminal diameter, VD: vessel diameter. B. Angiogram at 16 midportion of the LCx and the ectatic lesion (yellow asteris enlargement of the vessel with the maximum scaffold lum figure, the reader is referred to the web version of this artic

Objectives We evaluated the angiographic patterns and predictors of in-stent restenosis (ISR) for ostial lesions of the right coronary artery (RCA) to clarify the mechanism of insoluble restenosis. Background Although ISR of the RCA still occurs, limited data is available regarding the associated angiographic findings. Methods Between January 2005 and September 2013, we recruited consecutive patients undergoing routine angiography 6–18months after implantation of a drug-eluting stent (DES). Multiple logistic regression analysis was used to determine the independent predictors of ISR, and the adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) were calculated. Results Routine angiography revealed that 45 of 131 patients (34.3%) had RCA-ISR, which were classifiable by occlusion type into ostial (24 cases), proximal (17 cases), diffuse (3 cases), and total (1 case). By multivariable analysis, early generation DES was the only independent predictor of overall ISR (aOR, 3.54; 95% CI, 1.59–7.87; p =0.002). In a subgroup analysis of each focal ISR pattern, early generation DES (aOR, 7.76; 95% CI, 2.15–28.0; p =0.002) was associated with increased risk of ostial ISR. On the contrary, larger stent (aOR, 0.21; 95% CI, 0.05–0.84; p =0.027) was associated with decreased risk of ostial ISR. Furthermore, a ratio of the stent to post-balloon size >1.10 (aOR, 3.93; 95% CI, 1.30–11.8; p =0.002) and good left ventricular contractility (ejection fraction >60%) (aOR, 8.27; 95% CI, 1.76–39.0; p =0.008) were associated with increased risk of proximal ISR when stent fracture was observed. Conclusion The focal pattern of RCA-ISR was mostly observed after DES implantation, and the mechanisms of proximal and ostial ISR differed.

Kissing-balloon technique (KBT) is commonly performed during percutaneous coronary intervention of distal unprotected left main coronary artery (ULM) aiming at obtaining optimal opening of the side branch (left circumflex artery; LCX) ostium. Nonetheless, detailed evaluation of vascular response to stents in LCX ostium is lacking. We therefore evaluated the vascular response to different drug-eluting stents (DES) in ostial LCX after ULM by means of optical coherence tomography (OCT).We prospectively enrolled 38 consecutive patients with ULM disease, who were treated with single-stent procedure using DES, crossover the ULM-left anterior descending artery (LAD) followed by KBT. Twelve patients were treated with sirolimus-eluting stents (SES) and 26 patients were treated with everolimus-eluting stents (EES). OCT was conducted at post-PCI and 9-month follow-up. We evaluated the DES-vessel interactions and number of stent struts at the side branch (LCX) ostium (SO) at post-PCI, and compared the narrowing of ostial area at LCX between SES and EES.Post-procedure, the number of stent struts at SO was significantly higher in SES compared to EES (median 14.47% vs 0.19%, p0.001). The narrowing of LCX ostial area at follow-up was more pronounced in SES compared with EES (29.16% vs 2.46%, respectively, p0.001). Linear regression analysis showed a high correlation between the number of stent struts in LCX ostium and ostial area narrowing (r=0.771, p0.001).OCT showed differences between EES- and SES-vessel interactions at ULM bifurcation PCI. Number of LCX ostium struts at post-PCI impacted the narrowing of ostial area at 9-month follow-up.

Aims There is uncertainty on which stenting approach confers the best long-term outlook for unprotected left main (ULM) bifurcation disease. Methods and results This is a non-randomized, retrospective study including all consecutive patients with 50% stenosis of the left main involving at least 1 of the arteries stemming from the left main treated with drug-eluting stents (DES) in 9 European centers between 2002 and 2004. Patients were divided into two groups: those treated with provisional stentings vs. those treated with two stent strategy. The outcomes of interest were 10-year rates of target lesion revascularization (TLR), major adverse cardiac events (MACE), and their components (cardiovascular death, myocardial infarction [MI], or repeat revascularization), along with stent thrombosis (ST). A total of 285 patients were included, 178 (62.5%) in the provisional stenting group and 87 (37.5%) in the two stent group. After 10years, no differences in TLR were found at unadjusted analysis (19% vs 25%, p>0.05) nor after propensity score matching (25% vs 28%, p>0.05). Similar rates of MACE (60% vs 66%, p>0.05), death (34% vs 43%, p>0.05), MI (9% vs 14%, p>0.05) and ST were also disclosed at propensity-based analysis. Conclusion Even after 10year follow-up, patients treated with provisional stenting on left main showed comparable rates of target lesion revascularization compared to two stent strategy.

The advent of drug-eluting stents (DES) improved the rates ofrestenosis [1]. In cases of percutaneous coronary intervention (PCI) forlong-diffuse lesions, operators often face the dilemma of whether tofully cover most of the vessel length. Incomplete lesion coverage is anindependent risk factor of restenosis [2], while on the other hand,a “full-metal jacket (FMJ)” remains associated with higher rates of in-stent restenosis and stent thrombosis [3–5]. In addition, a FMJ oftenprecludes future surgical revascularization. The use of bioresorbablescaffolds (BRS) appears very attractive due to their full reabsorption 2to 3 years after implantation. However, very little is known about theperformanceofBRSwhenusedforthetreatmentoflong-diffuselesions.Onthisbasis,wesoughttoinvestigatethefeasibilityandtheshort-termclinical outcomes following BRS implantation for very long lesions(“full-plastic jacket”).A retrospective analysis in 2 high volume centers in Milan was per-formedonconsecutivepatientswhounderwentPCIwithBRS(ABSORB;Abbott Vascular, Santa Clara, California) between May 2012 and May2014. Exclusion criteria were PCI for ST-segment elevation myocardialinfarction, non-ST-segment elevation myocardial infarction and bypassgraft. During the study period, a total of 142 patients (191 lesions)underwent BRS implantation. Procedural “full-plastic jacket” (FPJ) was