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BackgroundEarly studies evaluating the performance of bioresorbable scaffold (BRS) Absorb in in-stent restenosis (ISR) lesions indicated promising short-term to mid-term outcomes.AimsTo evaluate long-term outcomes (up to 5 years) of patients with ISR treated with the Absorb BRS.MethodsWe did an observational analysis of long-term outcomes of patients treated for ISR using the Absorb BRS (Abbott Vascular, Santa Clara, California, USA) between 2013 and 2016 at the Heart Centre Luzern. The main outcomes included a device-oriented composite endpoint (DOCE), defined as composite of cardiac death, target vessel (TV) myocardial infarction and TV revascularisation, target lesion revascularisation and scaffold thrombosis (ScT).ResultsOverall, 118 ISR lesions were treated using totally 131 BRS among 89 patients and 31 (35%) presented with an acute coronary syndrome. The median follow-up time was 66.3 (IQR 52.3–77) months. A DOCE had occurred in 17% at 1 year, 27% at 2 years and 40% at 5 years of all patients treated for ISR using Absorb. ScTs were observed in six (8.4%) of the cohort at 5 years.ConclusionsTreatment of ISR using the everolimus-eluting BRS Absorb resulted in high rates of DOCE at 5 years. Interestingly, while event rates were low in the first year, there was a massive increase of DOCE between 1 and 5 years after scaffold implantation. With respect to its complexity, involving also a more unpredictable vascular healing process, current and future BRS should be used very restrictively for the treatment of ISR.

CONTEXT The role of percutaneous closure of patent foramen oval (PFO) in patients with cryptogenic stroke has been very controversial for years due to a lack of clear evidence. OBJECTIVE Systematic review and meta analysis of the effect of percutaneous PFO closure for secondary prevention of cryptogenic strokes as compared to best medical therapy (BMT). DATA SOURCES Trials were identified through a literature search until 28 May 2013. STUDY SELECTION Controlled clinical trials (randomised and non randomised) comparing percutaneous PFO closure with BMT. DATA EXTRACTION AND SYNTHESIS Main end point of interest was stroke. A random effects model was used to calculate the pooled relative risks (RR) with 95 CIs. RESULTS A total of 14 studies (three randomised controlled trials (RCT) and 11 non randomised observational studies (non RCT)) and a total of 4335 patients were included for this analysis. There was no significant treatment effect of PFO closure regarding stroke among the RCT (RR 0.66 95 CI 0.37 to 1.19 p=0.171). However among non RCT stroke was reduced (RR 0.37 95 CI 0.20 to 0.67 p

Aim Restoration of effective myocardial reperfusion by primary percutaneous coronary intervention (PPCI) in patients with STEMI is not predictable. A method to assess the likelihood of a suboptimal response to conventional pharmaco-mechanical therapies could be beneficial. We aimed to derive and validate a scoring system that can be used acutely at the time of coronary reopening to predict the likelihood of downstream microvascular impairment in patients with STEMI. Methods and Results A score estimating the risk of post-procedural microvascular injury defined by an index of microcirculatory resistance (IMR) > 40, was initially derived in a cohort of 85 STEMI patients (Derivation cohort). This score was then tested and validated in three further cohorts of patients (Retrospective (30 patients), Prospective (42 patients) and External (29 patients). The ATI score [Age ( > 50 = 1); pre-stenting IMR (> 40 and 40 in all the four cohorts (AUC:0.87; p 40, while no cases of final IMR >40 occurred in the presence of an ATI score Conclusions The ATI score appears to be a promising tool capable of identifying patients during PPCI that are at the highest risk of an adverse outcome following revascularisation.

We thank Dr Ammirati and his colleagues for their very valuable comments on our paper.1 We agree with their interpretation, the low incidence of non-fatal strokes in the medical arm (