Treatment of in-stent restenosis with bioresorbable vascular scaffolds: optical coherence tomography insights.

The role of the bioresorbable vascular scaffold (BVS) in patients with in-stent restenosis (ISR) remains unsettled. We present optical coherence tomography (OCT) findings in a series of 15 consecutive patients undergoing treatment of ISR with a BVS under systematic OCT guidance. OCT disclosed severe ISR in all patients (minimal lumen area [MLA], 1.3 ± 0.6 mm(2); stent obstruction 80% ± 10%). After the procedure, OCT MLA was 6.4 ± 2 mm(2) with a final BVS expansion of 79% ± 19%. "Angiographically silent" edge dissections (n = 6), intradevice dissections (n = 3), tissue prolapse (n = 3), and malapposition (n = 3) were also readily visualized. These findings underscore the diagnostic value of OCT in patients undergoing BVS implantation for ISR.