Mechanism of Drug-Eluting Absorbable Metal Scaffold Restenosis: A Serial Optical Coherence Tomography Study.

Ueki, Yasushi; Räber, Lorenz; Otsuka, Tatsuhiko; Rai, Himanshu; Losdat, Sylvain; Windecker, Stephan; Garcia-Garcia, Hector M; Landmesser, Ulf; Koolen, Jacques; Byrne, Robert; Haude, Michael; Joner, Michael (2020). Mechanism of Drug-Eluting Absorbable Metal Scaffold Restenosis: A Serial Optical Coherence Tomography Study. Circulation. Cardiovascular interventions, 13(3), e008657. American Heart Association 10.1161/CIRCINTERVENTIONS.119.008657

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The pathomechanisms underlying restenosis of the bioabsorbable sirolimus-eluting metallic scaffold (Magmaris) remain unknown. Using serial optical coherence tomography, we investigated causes of restenosis, including the contribution of late scaffold recoil versus neointimal hyperplasia.


Patients enrolled in BIOSOLVE-II undergoing serial angiography and optical coherence tomography (post-intervention and follow-up: 6 months and/or 1 year) were analyzed. Patients were divided into 2 groups according to angiographic in-scaffold late lumen loss (LLL) <0.5 or ≥0.5 mm. End points were late absolute scaffold recoil and neointimal hyperplasia area as assessed by optical coherence tomography.


Serial data were available for analysis from 70 patients (LLL <0.5 mm: n=41; LLL ≥0.5 mm: n=29). Patient and lesion characteristics were comparable, and there was no significant difference in mean and minimal scaffold area between groups at post-intervention. Late absolute scaffold recoil was less among patients with LLL <0.5 mm (0.53±0.68 mm2) compared with those with LLL ≥0.5 mm (1.48±1.20 mm2; P<0.001). Neointimal hyperplasia area was smaller among patients with LLL <0.5 mm at follow-up (1.47±0.33 mm2) compared with patients with LLL ≥0.5 mm (1.68±0.34 mm2; P=0.013). In a matched-frame analysis (post-intervention and follow-up), late absolute scaffold recoil varied according to the underlying plaque type (lipid: 0.63±1.23 mm2; calcified: 0.81±1.44 mm2; and fibrous: 1.20±1.52 mm2; P <0.001), while there was no difference with regards to neointimal hyperplasia area (P=0.132).


In addition to neointimal hyperplasia, late scaffold recoil contributed significantly to LLL of sirolimus-eluting absorbable metal scaffolds. The extent of late scaffold recoil was dependent on the underlying plaque morphology and was the highest among fibrotic lesions. Registration: URL: Unique identifier: NCT01960504.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Pre-clinic Human Medicine > Department of Clinical Research (DCR)
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Ueki, Yasushi, Räber, Lorenz, Otsuka, Tatsuhiko, Losdat, Sylvain Pierre, Windecker, Stephan


600 Technology > 610 Medicine & health




American Heart Association




Andrea Flükiger-Flückiger

Date Deposited:

13 Mar 2020 18:02

Last Modified:

20 Feb 2024 14:16

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

angiography follow-up hyperplasia sirolimus tomography, optical coherence




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