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

Vladimír Džavík, Antonio Colombo

Research output: Contribution to journalArticle

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. A 2-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.

Original languageEnglish
Pages (from-to)81-88
Number of pages8
JournalJACC: Cardiovascular Interventions
Volume7
Issue number1
DOIs
Publication statusPublished - Jan 2014

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Keywords

  • bifurcation
  • bioresorbable vascular scaffold
  • kissing balloon inflation
  • stenting

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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