Bifurcation Percutaneous Coronary Intervention With Bio-resorbable Scaffold: Pushing the Boundary

Abstract

Introduction: The development of bio-resorbable scaffold (BRS) has introduced a new paradigm in the field of interventional cardiology, although the clinical experience to date been largely confined to simple coronary lesions. Detailed reports in its use for other indications are currently lacking. Methods: We present three patients who successfully underwent bifurcation angioplasty with three different strategies using the everolimus eluting bioresorbable vascular scaffold (ABSORBTM; Abbott, Illinois, USA). The aim of this case series is to provide insight into the operational issues relating to and early procedural results of bifurcation PCI with BRS Results: Patient 1 underwent staged PCI to the LAD and D1 bifurcation (Medina: 0,1,1). A modified double-kissing crush was performed using a DES in the side branch and BRS in the main vessel. The second patient underwent successful bifurcation PCI to his OM1 with a two scaffold strategy (Medina 0,1,1). Case 3 was a patient with CTO to his LAD/D1 bifurcation (Medina 1,1,1), who received 2 BRS in the LAD in a provisional strategy with high pressure kissing inflation at the end. Good final angiographic and OCT results were achieved for all three patients. None had recurrent symptoms or MACE (including scaffold thrombosis) at clinical follow-up at 20, 21 and 18 months, respectively. Conclusion: This case series demonstrates that BRS is able to withstand the deforming forces from kissing balloon inflation and the crushing technique, and that bifurcation PCI can be performed safely and successfully with BRS particularly under OCT guidance.