Author + information
- Pedro Martin Lorenzo1,
- Medina Alfonso1,
- SuàRez De Lezo Javier2,
- Jose Novoa Medina1,
- Mazuelos Francisco2,
- Manuel Pan2,
- Ojeda Soledad2 and
- Suàrez De Lezo Josè2
In vitro and in vivo geometry of metallic single stent implantation in coronary bifurcated lesions after kissing balloon (KB) intervention, has been well studied. The same analysis of bioabsorbable vascular scaffolding (BVS) had not yet been reported. Our own in vitro observations with BVS showed integrity and no device fracture after KB inflation when a ≤2.5 mm balloon diameter was inflated through the struts.
In our series, 80 coronary bifurcated lesions were treated with provisional BVS strategy. In 21 out of 80 lesions, we performed final KB inflation after BVS implantation. The reason for side branch (SB) intervention was ostial angiographic stenosis (present before BVS implantation in 14 lesions, and appearing after it in 7). IVUS studies were performed in 3 conditions: before treatment, immediately after BVS and after KB inflation. Measurements were performed at the proximal scaffold segment, before SB origin, under SB origin and at the distal segment. This study analyzes the ultrasonographic (IVUS) findings after BVS implantation and after KB inflation. For KB technique, the balloon diameter inflated in the MV was always 0.5 mm minor than BVS diameter and the SB balloon diameter was 2 or 2.5 mm.
BVS diameter was 3.10 ± 0.39 mm and the mean inflation pressure was 15±1 atm. The MV balloon diameter was 2.8±0.3 mm (0.5 mm minor than BVS diameter in all cases). The SB balloon diameter was 2.3±0.2 mm and the inflation pressure of both balloons was 7-8 atm. Integrity of the device was always observed after KB. Good aposition of the proximal BVS and angiographic improvement of the SB origin was always obtained. Geometry of the BVS may be modified after KB technique, but nor distorted. The table summarizes the findings.
|After BVS||After KB inflation||p|
|Proximal BVS area||7.48±1.73||7.95±1.99||0.03|
|AI at proximal stent||0.85±0.06||0.86±0.05||0.93|
|Before SB origin area (mm2)||6.70±1.99||7.53±2.04||<0.01|
|AI before SB origin||0.81±0.08||0.80±0.07||0.88|
|After SB origin BVS area (mm2)||6.03±1,76||5.89±1.67||0.77|
|AI after SB origin||0,85±0,06||0,82±0,07||0.04|
|Distal BVS area (mm2)||6.99±2,03||7,01±1,72||0.98|
|AI at distal BVS||0,84±0,06||0,84±0,05||0.71|
Final KB inflation in bifurcated coronary lesions treated with BVS is feasible, without inducing fracture or important distortion of the scaffold.