title: The absorb bioresorbable vascular scaffold in coronary bifurcations: insights from bench testing.
abstract: OBJECTIVE
  This study sought to evaluate the feasibility of performing contemporary bifurcation techniques with the Absorb everolimus-eluting bioresorbable vascular scaffold (Abbott Vascular, Santa Clara, California) (BVS).
  
  
  BACKGROUND
  The feasibility of using the BVS in bifurcation lesions is unknown.
  
  
  METHODS
  We performed bifurcation stenting procedures including main-vessel stenting with ballooning of the side branch through the BVS struts, T-stenting and crush and culotte procedures, in a synthetic arterial model. Low-pressure final kissing balloon (FKB) inflation was performed to complete the procedures.
  
  
  RESULTS
  Single-stent procedures optimally opened the side-branch ostium without deforming the main vessel BVS. T-stenting completely covered the side-branch ostium. In crush cases, we could easily re-cross the crushed BVS with the wire and balloon and achieve good results after deployment of the main-vessel BVS and FKB inflation. A 2-BVS culotte resulted in good paving of the main vessel. Disruption of 1 BVS strut was observed after FKB inflation with the 2 balloons inflated beyond the recommended limit of the BVS, as calculated by Finet's law.
  
  
  CONCLUSIONS
  Intervention of bifurcation lesions using the Absorb BVS using modern bifurcation techniques appears feasible in a coronary bifurcation model. Provisional stenting is recommended in the majority, with sequential balloon inflations and FKB inflation only when necessary. T or T-stenting and small protrusion stenting with a metal drug-eluting stent is preferable in case of crossover. A2-BVS, T-stent technique can be performed in a high-angle bifurcation; otherwise, crush or culotte should be considered, using metal DES in the side branch. Two-BVS crush and culotte require careful evaluation, and should only be considered in patients with large-caliber main vessels.
authors: Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada. Electronic address: vlad.dzavik@uhn.ca.
authors: Vladimír
authors: V
authors: Džavík
authors: San Raffaele Scientific Institute and EMO-GVM Centro Cuore Columbus, Milan, Italy.
authors: Antonio
authors: A
authors: Colombo
mesh_terms: D020341:Absorbable Implants; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation*; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D054855:Drug-Eluting Stents; D000068338:Everolimus; D005240:Feasibility Studies; D008422:Materials Testing; D008955:Models, Cardiovascular; D011474:Prosthesis Design; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives*; D054457:Tissue Scaffolds
chemical_list: D002317:Cardiovascular Agents; D000068338:Everolimus; D020123:Sirolimus
keywords: BVS; CT; DES; FKB; OCT; PCI; bifurcation; bioresorbable vascular scaffold; bioresorbable vascular scaffold(s); computed tomography; drug-eluting stent(s); final kissing balloon(s); kissing balloon inflation; optical coherence tomography; percutaneous coronary intervention; stenting