Author + information
- Received April 21, 2013
- Revision received July 25, 2013
- Accepted July 29, 2013
- Published online January 1, 2014.
- ∗Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- †San Raffaele Scientific Institute and EMO-GVM Centro Cuore Columbus, Milan, Italy
- ↵∗Reprint requests and correspondence:
Dr. Vladimír Džavík, Interventional Cardiology Program, Peter Munk Cardiac Centre, University Health Network, 6-246 EN Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada.
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.
Dr. Džavík has received unrestricted research grants, speaker honoraria, and travel grants from Abbott Vascular. Dr. Colombo has reported that he has no relationships relevant to the contents of this paper to disclose.
- Received April 21, 2013.
- Revision received July 25, 2013.
- Accepted July 29, 2013.
- American College of Cardiology Foundation