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Background: Many operators are hesitant to use Absorb Bioresorbable vascular Scaffold (A-BSV) in coronary bifurcation lesions because of its larger profile, thicker struts and limited expansion characteristics. Our objectives were to study the technical aspects and outcomes of treating coronary bifurcation lesions with A-BRS by comparing ‘one scaffold strategy’ (OSS) with ‘two scaffold strategy’ (TSS).
Methods: Patients who underwent coronary bifurcation stenting, either OSS or TSS, with A-BVS over a period of 3 years were prospectively included. Lesion bed was pre-dilated with non-complaint balloon, scaffold was deployed gradually at nominal pressure. Side branch was recrossed with wire and then scaffold was post-dilated at high pressure. Finally snuggle balloon dilatation was performed. Patients were followed-up periodically with stress testing and CT coronary angiography.
Results: Out of 122 bifurcation lesions in 117 patients, 87 lesions were treated with OSS while 35 lesions with TSS. The mean number of A-BRS implanted per lesion was 1.3±0.6 (OSS group:1.3±0.6 and TSS group:1.2±0.5). In TSS group, bail out stenting of side branch was performed in 5 (14.3%) lesions while elective stenting in 30 (85.7%) lesions; ‘T’, ‘TAP’ and ‘V’ stenting techniques were performed in 14 (40%), 16 (45.7%) and 5 (14.3%) lesions respectively; hybrid stenting with A-BVS and metallic stent was performed in 5 (14.3%) lesions. In OSS group, side branch was protected, predilated and recrossed in 87 (63.9%), 21 (57.7%) and 24 (49.5%) lesions respectively. Final snuggle balloon dilatation was performed in 23 (26.4%) and 35 (100%) lesions in OSS and TSS groups respectively (p<0.0001). The mean duration of follow-up was 26.4±7.9months with 98.3% follow-up. There was no scaffold thrombosis (0%). One patient in both OSS group and TSS group developed restenosis and underwent bypass surgery subsequently (TLR rate: 1.2% vs 2.9%, p=0.49; overall 1.6%). The rest were doing fine without any major adverse clinical events.
Conclusions: Coronary bifurcation stenting with A-BVS, both one scaffold strategy and two scaffold strategy, is technically feasible producing excellent results at short-term and long-term follow-up.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Complex Coronary Intervention: Left Main/Bifurcations and Multivessel Disease
Abstract Category: 22. Interventional Cardiology: Coronary Intervention: Left Main, Multivessel, Bifurcation
Presentation Number: 1157-193
- 2017 American College of Cardiology Foundation