title: Is it safe to implant bioresorbable scaffolds in ostial side-branch lesions? Impact of 'neo-carina' formation on main-branch flow pattern. Longitudinal clinical observations.
abstract: Formation of a 'neo-carina' has been reported after bioresorbable vascular scaffolds (BVS) implantation over side-branches. However, as this 'neo-carina' could protrude into the main-branch, its hemodynamic impact remains unknown. We present two cases of BVS implantation for ostial side-branch lesions, and investigate the flow patterns at follow-up and their potential impact. Computational fluid dynamics analysis was performed, using a 3D mesh created by fusion of 3-dimensional angiogram with optical coherence tomography images. In our first case, mild disturbances were seen when 'neo-carina' did not protrude perpendicularly into the main branch. In the second case, extensive flow re-distribution was observed due to a more pronounced protrusion of the 'neo-carina'. Importantly, these areas of hemodynamic disturbance were observed together with lumen narrowing in a non-stenotic vessel segment. Our case observations highlight the importance of investigating the hemodynamic consequences of BVS implantation in bifurcation lesions and illustrate a novel method to do so in vivo.
authors.affiliation: Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, Netherlands.
authors.forename: Antonios
authors.initials: A
authors.lastname: Karanasos
authors.affiliation: Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, Netherlands.
authors.forename: Yingguang
authors.initials: Y
authors.lastname: Li
authors.affiliation: Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, PR China; Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, Netherlands. Electronic address: sxtu@sjtu.edu.cn.
authors.forename: Shengxian
authors.initials: S
authors.lastname: Tu
authors.affiliation: Department of Biomedical Engineering, Thoraxcenter, Erasmus University Medical Center, Rotterdam, Netherlands.
authors.forename: Jolanda J
authors.initials: JJ
authors.lastname: Wentzel
authors.affiliation: Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, Netherlands.
authors.forename: Johan H C
authors.initials: JH
authors.lastname: Reiber
authors.affiliation: Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, Netherlands.
authors.forename: Robert-Jan
authors.initials: RJ
authors.lastname: van Geuns
authors.affiliation: Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, Netherlands.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Regar
mesh_terms: D020341:Absorbable Implants; D000368:Aged; D000465:Algorithms; D050197:Atherosclerosis / Q000175:diagnosis / Q000503:physiopathology*; D001672:Biocompatible Materials / Q000737:chemistry*; D003198:Computer Simulation; D017023:Coronary Angiography; D018450:Disease Progression; D054855:Drug-Eluting Stents; D006439:Hemodynamics; D006801:Humans; D057446:Hydrodynamics; D021621:Imaging, Three-Dimensional; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D033081:Shear Strength; D013314:Stress, Mechanical; D054457:Tissue Scaffolds
chemical_list: D001672:Biocompatible Materials
keywords: Atherosclerosis progression; Bifurcation intervention; Bioresorbable vascular scaffold; Computational fluid dynamics; Optical coherence tomography; Primary percutaneous coronary intervention