Author + information
- Johan Bennett1,
- Maarten Vanhaverbeke2,
- Nick Hiltrop1,
- Nina Vanden Driessche2,
- Peter Sinnaeve1,
- Keir McCutcheon1,
- Tom Adriaenssens1,
- Walter Desmet1 and
- Christophe Dubois3
Metal absorbable scaffolds constitute a conceptually attractive alternative to metallic stents or polymeric scaffolds in complex bifurcation lesions. This acute animal study sought to provide insights regarding the feasibility of performing complex bifurcation stenting with Magmaris bioresorbable magnesium-alloy scaffold (Biotronik AG, Bülach, Switzerland).
Twenty-five New Zealand White rabbits underwent stenting of non-diseased aorto-iliac bifurcations with Magmaris using provisional (PS,n=5), culotte (n=6), modified-T (n=6), or T-and-protrusion (TAP,n=8) stenting techniques. Angiography, optical coherence tomography and micro-computed tomography were performed to assess the result.
45 Magmaris were successfully delivered and implanted in 25 rabbits without complication, and with procedural success of 100%. In all bifurcation procedures (n=25), the angiographic results were excellent. In 7/25 stenting procedures single strut fractures were identified, whilst following 2 procedures multiple strut fractures were identified. The majority of strut fractures occurred at the bifurcation affecting the main vessel scaffold (n=3), SB scaffold (n=3), or both (n=1) with connectors (n=4) and rings (n=4) equally affected. PS optimally opened the SB without scaffold compromise. Culotte resulted in complete bifurcation coverage and good scaffold expansion; single strut fractures were present in 3/6 and double fractures in 1/6 procedures. Mod-T and TAP resulted in complete bifurcation coverage, minimal neocarina double-strut layers and good expansion. In 2/6 Mod-T procedures single strut fractures were present with SB scaffold deformity present in additional 2/6 procedures. In 2/8 TAP procedures single strut fractures were present at the bifurcation without compromising overall scaffold integrity. This non-diseased model may not accurately predict scaffold behavior in humans and long-term outcomes following scaffold degradation are unknown.
Bifurcation stenting using Magmaris appears feasible. PS with additional TAP if needed seems reasonable. When a 2-stent technique is required from outset, TAP appears favorable whilst Mod-T and culotte stenting should probably be avoided.
CORONARY: Bioresorbable Vascular Scaffolds