Author + information
- Received January 21, 2014
- Accepted January 30, 2014
- Published online August 1, 2014.
- Nicolas Van Mieghem, MD∗ (, )
- Jeroen J. Wilschut, MD,
- Jurgen Ligthart, MSc,
- Karen Witberg, MSc,
- Robert-Jan M. van Geuns, MD, PhD and
- Evelyn Regar, MD, PhD
- Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
- ↵∗Reprint requests and correspondence:
Dr. Nicolas Van Mieghem, Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Room Bd 171, ‘s Gravendijkwal 230, 3015 CE Rotterdam, the Netherlands.
A 43-year-old patient undergoes a transradial percutaneous coronary intervention for a bifurcation lesion of the left proximal circumflex artery and the first obtuse marginal branch (Medina 1,1,1) (Fig. 1). A 3.5 × 12-mm bioresorbable vascular scaffold (BVS) (Abbott Vascular, Santa Clara, California) is positioned in the obtuse marginal branch (OM) with a 3.0-mm (noninflated) balloon parked in the main branch as a bumper to help mark the carina of the bifurcation. Of note, the proximal scaffold ring of a 3.5-mm BVS protrudes 1.4 mm and 1 mm from the edge of the proximal radiopaque platinum marker beads in its crimped and deployed constellation, respectively. The proximal marker is set at the lower shoulder of the carina. This ensures enough protrusion into the main branch to allow for complete coverage of the carina including its proximal shoulder yet avoiding excessive protrusion that would convert the technique into a mini-crush implicating 3 layers of scaffold.
A 3.5 × 18-mm BVS is implanted in the main branch across the bifurcation. The OM is rewired, and sequential postdilation is performed. An optical coherence tomography study from the OM confirmed complete coverage of the carina, appropriate scaffold apposition, and preserved BVS integrity (Fig. 2). Specific features of the BVS can help execute a modified T and protrusion technique with complete carina coverage, precluding more aggressive crush maneuvers and obviating the need for final kissing-balloon inflation.
Dr. Van Mieghem is on the speakers’ bureau of Abbott Vascular. Dr. van Geuns is on the speakers’ bureau and advisory board of Abbott Vascular Dr. Ligthart owns a consultancy company. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Abbott Vascular is providing an institution research grant for the Erasmus Medical Center.
- Received January 21, 2014.
- Accepted January 30, 2014.
- American College of Cardiology Foundation