title: First optical coherence tomography follow-up of coronary bifurcation lesions treated by drug-eluting balloons.
abstract: BACKGROUND
  A strategy of percutaneous bifurcation intervention with provisional bare-metal stent (BMS) implantation followed by drug-eluting balloon (DEB) treatment represents a valuable opportunity in patients not compliant with long-duration dual-antiplatelet therapy. We used optical coherence tomography (OCT) to assess coronary bifurcation lesions treated by BMS and DEB, and secondarily, to better explore the association between stent geometry and tissue coverage.
  
  
  METHODS
  Twelve patients underwent frequency-domain OCT 6 months after undergoing percutaneous bifurcation intervention with BMS implantation followed by kissing DEB. The same type of BMS was correspondingly implanted in silicone bifurcation models and scanned by microcomputed tomography.
  
  
  RESULTS
  Overall, a total 2914 struts were analyzed, revealing 0.6% malapposed struts and 3.1% uncovered struts, with neointimal thickness of covered struts measured at 0.19 ± 0.13 mm. Findings were homogeneous among patients with the exception of one outlier who presented a significant distortion of the stent geometry, suggesting proximal cell rewiring prior to kissing DEB, as supported by the microcomputed tomography model. This pattern was not present in the other cases, which showed struts optimally apposed and nicely scaffolding the side-branch ostium.
  
  
  CONCLUSIONS
  This is the first study describing the effects of DEB in percutaneous bifurcation interventions according to OCT parameters. The results show that a strategy of kissing DEB following BMS is associated with low neointimal thickness and high rate of covered stent struts. Moreover, these results appear to be dependent on the quality of bifurcation intervention, with distal cell rewiring more favorable than proximal cell rewiring.
authors.affiliation: UOC Cardiologia, Piazzale dell'Umanesimo, 10, 00144 Rome, Italy. g.a.sgueglia@gmail.com.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Sgueglia
authors.forename: Nicolas
authors.initials: N
authors.lastname: Foin
authors.forename: Daniel
authors.initials: D
authors.lastname: Todaro
authors.forename: Antonino
authors.initials: A
authors.lastname: Stipo
authors.forename: Justin E
authors.initials: JE
authors.lastname: Davies
authors.forename: Achille
authors.initials: A
authors.lastname: Gaspardone
authors.forename: Carlo
authors.initials: C
authors.lastname: Di Mario
authors.forename: Edoardo
authors.initials: E
authors.lastname: Pucci
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D003198:Computer Simulation; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D023903:Coronary Restenosis / Q000628:therapy*; D003331:Coronary Vessels / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D041623:Tomography, Optical Coherence