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PCI treatment of coronary bifurcation lesions (CBL) is technically challenging. Bioresorbable vascular scaffold (BVS) provides temporary vessel scaffolding with drug-elution; restores normal vessel architecture and physiology upon resorption. There are limited data on the feasibility and safety of using ABSORB BVS (Abbott Vascular) for treatment of CBL.
A retrospective analysis of CBL treated with ABSORB-BVS at a tertiary PCI center from Sep-12 to May-14. All PCIs were performed under OCT guidance.
A total 41 CBL were treated in 37 patients undergoing non-urgent PCIs. Mean age of the patients was 60 years. Radial access was used in treatment of 34 CBL. As per 'Medina' classification, 25 (61%) CBL were (1,1,1), 9 (22%) were (1,1,0), 4 (10%) were (0,1,1) and 1 (2.4%) each (1,0,1), (1,0,0) and (0,1,0). Side branch (SB) were wired in 30 (73%) CBL; treated with DES in 5 (12.2%) lesions (T-stent in 2, balloon-crush in 3) and balloon angioplasty only in 20 (48.8%) CBL. Main vessel stenting was performed with proximal optimization technique (POT) in 20 (48.8%) CBL. Final kissing balloon (FKB) inflation was performed in 10 (24.4%). BVS used per case were 2.0±0.2, and mean diameter and length were 2.9±0.1and 22.3±0.9 mm respectively. Thirty-one lesions (76%) involved LAD/diagonal vessel.
BVS treatment of CBL was successful in 40 of 41 (98%) CBL with only 1 patient in whom delivering the BVS was difficult. Failure to wire SB occurred in 3 patients, of whom SB flow compromised in 2 patients. One patient had intra-procedural left main stem dissection treated with a drug-eluting stent. Three (7%) had biochemical but not clinical evidence of peri-procedural MI. Mean follow-up was of 110 ± 15 days. One patient died with suspected sub-acute BVS thrombosis and 1 underwent drug-eluting balloon treatment of in-scaffold restenosis.
1. A wide range of CBLs can be safely and effectively treated with ABSORB BVS.
2. Intravascular imaging is mandatory to guide BVS sizing and for assessment of strut apposition and integrity.
3. Wire crossing of BVS struts and dilating through them into the SB appears safe.
4. Sequential balloon post-dilatation and FKB inflation appear safe and feasible.