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See 1 citation in JACC Cardiovasc Interv 2014:

JACC Cardiovasc Interv. 2014 Jan;7(1):81-8. doi: 10.1016/j.jcin.2013.07.013. Epub 2013 Dec 11.

The absorb bioresorbable vascular scaffold in coronary bifurcations: insights from bench testing.

Author information

1
Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada. Electronic address: vlad.dzavik@uhn.ca.
2
San Raffaele Scientific Institute and EMO-GVM Centro Cuore Columbus, Milan, Italy.

Abstract

OBJECTIVES:

This study sought to evaluate the feasibility of performing contemporary bifurcation techniques with the Absorb everolimus-eluting bioresorbable vascular scaffold (Abbott Vascular, Santa Clara, California) (BVS).

BACKGROUND:

The feasibility of using the BVS in bifurcation lesions is unknown.

METHODS:

We performed bifurcation stenting procedures including main-vessel stenting with ballooning of the side branch through the BVS struts, T-stenting and crush and culotte procedures, in a synthetic arterial model. Low-pressure final kissing balloon (FKB) inflation was performed to complete the procedures.

RESULTS:

Single-stent procedures optimally opened the side-branch ostium without deforming the main vessel BVS. T-stenting completely covered the side-branch ostium. In crush cases, we could easily re-cross the crushed BVS with the wire and balloon and achieve good results after deployment of the main-vessel BVS and FKB inflation. A 2-BVS culotte resulted in good paving of the main vessel. Disruption of 1 BVS strut was observed after FKB inflation with the 2 balloons inflated beyond the recommended limit of the BVS, as calculated by Finet's law.

CONCLUSIONS:

Intervention of bifurcation lesions using the Absorb BVS using modern bifurcation techniques appears feasible in a coronary bifurcation model. Provisional stenting is recommended in the majority, with sequential balloon inflations and FKB inflation only when necessary. T or T-stenting and small protrusion stenting with a metal drug-eluting stent is preferable in case of crossover. A2-BVS, T-stent technique can be performed in a high-angle bifurcation; otherwise, crush or culotte should be considered, using metal DES in the side branch. Two-BVS crush and culotte require careful evaluation, and should only be considered in patients with large-caliber main vessels.

KEYWORDS:

BVS; CT; DES; FKB; OCT; PCI; bifurcation; bioresorbable vascular scaffold; bioresorbable vascular scaffold(s); computed tomography; drug-eluting stent(s); final kissing balloon(s); kissing balloon inflation; optical coherence tomography; percutaneous coronary intervention; stenting

PMID:
24332424
DOI:
10.1016/j.jcin.2013.07.013
[Indexed for MEDLINE]
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