DOI: 10.4244/EIJV9I7A145

Complex bifurcation percutaneous coronary intervention with the Absorb bioresorbable vascular scaffold

Vladimír Džavík1*, MD; Takashi Muramatsu2, MD; Noel Crooks1, MD; Shimpei Nakatani2, MD; Yoshinubu Onuma2, MD

A 50-year-old diabetic man underwent percutaneous coronary intervention of an LAD/diagonal bifurcation lesion with deployment of a 3.0×28 mm Absorb bioresorbable vascular scaffold (Abbott Vascular, Santa Clara, CA, USA) in the LAD (Online Figure 1A, Moving image 1). After through-the-strut dilation, a 2.5×38 mm XIENCE PRIME™ stent (Abbott Vascular) was deployed in the side branch with a 3.0×15 mm non-compliant balloon positioned in the LAD. A final kissing balloon inflation (FKB) was then performed at 4 atmospheres (Online Figure 1B, Moving image 2). Optical coherence tomography 3-D reconstruction revealed preserved integrity of the bioresorbable vascular scaffold (BVS) rings and complete opening of the side branch ostium (Figure 1, Online Figures 2-5, Moving image 3-5). Inflation through the struts of the BVS is feasible but must be performed slowly. Aggressive inflation can result in ring fracture, instability of the scaffold, and potentially thrombosis. BVS disruption has been observed clinically, and in bench testing after FKB at or just above the maximal recommended diameter for the BVS, using Finet’s principle. If FKB is necessary, inflation must be performed slowly and to low pressures only, maintaining the combined inflated balloon diameter below the recommended limit of the device. Intravascular imaging of the final result is mandatory.

Figure 1. A) 3-D OCT of the BVS/EES interface at the side branch ostium, B) fly-through view from the side branch. DMV: distal main vessel; GWS: guidewire shadow; PMV: proximal main vessel; SB: side branch. Arrows indicate XIENCE V stent struts

Guest Editor

This paper was Guest Edited by Carlo Di Mario, MD, PhD; NHLI Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom.

Conflict of interest statement

V. Džavík has received educational and travel grants, and speaker honoraria from Abbott Vascular, and educational grants from St. Jude Medical. The other authors have no conflicts of interest to declare.

Online data supplement

Online Figure 1. LAD diagonal bifurcation before (A) and after (B) T-stenting.

Online Figure 2. 2-D OCT images through the side branch showing BVS/EES overlap at the carina (A), the carina (B) and proximal to the carina (C).

Online Figure 3. 3-D OCT reconstruction of the side branch ostium.

Online Figure 4. 3-D OCT details of the BVS/EES interface at the side branch ostium.

Online Figure 5. Fly-through views from the distal main vessel and from the side-branch.

Moving image 1. Pre-PCI angiogram of a Medina 0,1,1 LAD/D1 bifurcation lesion.

Moving image 2. Final post-PCI angiogram.

Moving image 3. An OCT pullback from the diagonal branch to the proximal LAD.

Moving image 4. An OCT pullback from the mid LAD to the proximal LAD.

Supplementary data

To read the full content of this article, please download the PDF.

video1
video2
video3
video4
Volume 9 Number 7
Nov 29, 2013
Volume 9 Number 7
View full issue


Key metrics

On the same subject

Editorial

10.4244/EIJ-E-23-00052 Mar 18, 2024
Comparative preclinical assessment of drug-coated balloons: a blessing and a curse for clinical translation
Joner M and Wild L
free

Debate

10.4244/EIJ-E-24-00005 Mar 18, 2024
Ischaemic and viability testing for guiding PCI are overrated: pros and cons
McEntegart M et al
free

Original Research

10.4244/EIJ-D-23-00725 Mar 18, 2024
A systematic algorithm for large-bore arterial access closure after TAVI: the TAVI-MultiCLOSE study
Rosseel L et al

Original Research

10.4244/EIJ-D-23-00783 Mar 18, 2024
Redo-TAVI with the ACURATE neo2 and Prime XL for balloon-expandable transcatheter heart valve failure
Meier D et al
Trending articles
281.88

State-of-the-Art Review

10.4244/EIJ-D-21-00695 Nov 19, 2021
Transcatheter treatment for tricuspid valve disease
Praz F et al
free
243.2

State of the art

10.4244/EIJ-D-21-01117 Sep 20, 2022
Recanalisation of coronary chronic total occlusions
Di Mario C et al
free
208.35

State-of-the-Art Review

10.4244/EIJ-D-21-01034 Jun 3, 2022
Management of in-stent restenosis
Alfonso F et al
free
168.7

Translational research

10.4244/EIJ-D-21-00824 May 15, 2022
Bench test and in vivo evaluation of longitudinal stent deformation during proximal optimisation
Toth GG et al
free
167.05

Expert review

10.4244/EIJ-D-21-00690 May 15, 2022
Crush techniques for percutaneous coronary intervention of bifurcation lesions
Moroni F et al
free
151.03

State-of-the-Art

10.4244/EIJ-D-22-00776 Apr 3, 2023
Computed tomographic angiography in coronary artery disease
Serruys PW et al
free
118

Translational research

10.4244/EIJ-D-22-00718 Jun 5, 2023
Preclinical evaluation of the degradation kinetics of third-generation resorbable magnesium scaffolds
Seguchi M et al
110.35

Viewpoint

10.4244/EIJ-E-22-00007 May 15, 2022
TAVI at 20: how a crazy idea led to a clinical revolution
Eltchaninoff H et al
free
X

The Official Journal of EuroPCR and the European Association of Percutaneous Cardiovascular Interventions (EAPCI)

EuroPCR EAPCI
PCR ESC
Impact factor: 6.2
2022 Journal Citation Reports®
Science Edition (Clarivate Analytics, 2023)
Online ISSN 1969-6213 - Print ISSN 1774-024X
© 2005-2024 Europa Group - All rights reserved