Author + information
- Bernardo Cortese1,
- Azeem Latib2,
- Davide Piraino3,
- LUCA TESTA4,
- Alfonso Ielasi5,
- Salvatore Geraci6,
- Akihito Tanaka2,
- Dario Buccheri7,
- Roberto Adriano Latini8,
- Pedro Leon Silva Orrego9 and
- Antonio Colombo2
- 1ASST Fatebenefratelli-Sacco Milano, Milano, Milan, Italy
- 2Interventional Cardiology Institute San Raffaele Hospital, Milan, Italy
- 3Interventional Cardiology Unit, University of Palermo, Palermo, Italy
- 4IRCCS POLICLINICO SAN DONATO- SAN DONATO MILANESE, roma, Rome, Italy
- 5Cardiology Division, A.O. Bolognini, Seriate, Italy
- 6San Giovanni di Dio Hospital, Agrigento, Italy
- 7Interventional Cardiology Unit, University of Palermo
- 8Interventional Cardiology, Hospital Fatebenefratelli - ASST Fatebenefratelli Sacco., Milano, Milan, Italy
- 9Fatebenefratelli Hospital, Milano, Milan, Italy
Despite the improvement in techniques and tools, coronary lesions involving a bifurcation are still challenging and the outcome with drug-eluting stents not always optimal, including very late adverse events. The role of bio-vascular scaffolds (BVS) and drug-coated balloons (DCB) in this setting has not been investigated adequately yet.
From the databases of 6 italian centres with high proficiencies in newer technologies, we retrospectively collected all consecutive cases of coronary bifurcations managed or attempted with the implantation of at least one BVS (Absorb, Abbott Vascular, CA) in the main vessel and the use of one DCB (Elutax SV, Aachen Resonance, Germany; In.Pact Falcon, Medtronic, CA; Restore, Germany; Sequent Please, BBraun, Germany; Pantera Lux, Biotronik, Switzerland) in the side branch (SB). Primary study endpont was the occurrence of major adverse cardiovascular events (MACE) at the longest-available follow up.
Thirty-four patients fulfilled the enrollment criterion, 21% had diabetes and 47% an acute coronary syndrome. Average Syntax score was 14.3, all lesions were de novo and 23 patients (68%) had a type 1,1,1 Medina lesion. Twenty lesions (59%) involved the proximal left anterior-descending artery/first diagonal branch. Only 32.4% of patients underwent an intravascular imaging-guided angioplasty. Average lesion length was 22.3 mm in the main vessel and 10.1 mm in the SB. MV was always predilated and BVS received a postdilation in 88% of the cases. In 44% of the cases the DCB was used during final kissing balloon inflation, and in no cases a stent/BVS was required in the SB. Procedural success was achieved in 100% of the cases. After an average follow up of 15.5 (±11.5) months, we observed one case of MACE cause by target-lesion revascularization (2.9%) with no deaths, no myocardial infarctions or scaffold thromboses.
In conclusion, management of coronary bifurcation lesions with the use of newer technologies including BVS and DCB seems feasible and effective at mid-term clinical follow up.
CORONARY: Bioresorbable Vascular Scaffolds