title: Sequential Proximal Optimizing Technique in Provisional Bifurcation Stenting With Everolimus-Eluting Bioresorbable Vascular Scaffold: Fractal Coronary Bifurcation Bench for Comparative Test Between Absorb and XIENCE Xpedition.
abstract: The aim of this fractal bifurcation bench study was to compare provisional bifurcation stenting with a "re-POT" sequence, comprising a proximal optimizing technique (POT), side branch inflation, and final POT, between a bioresorbable vascular scaffold (BVS) and a metallic stent.
  
  
  
  Re-POT proved significantly better than kissing balloon inflation in maintaining circular geometry without overstretch in metal stents, while significantly reducing side branch ostium strut obstruction and global strut malapposition. This should be useful for BVSs, which are more easily breakable.
  
  
  
  Twenty left main-like and 20 left anterior descending-like fractal coronary bifurcation bench models used 10 each 2.5 × 24 mm and 3.5 × 24 mm Absorb (Ab) BVSs and 10 each 2.5 × 24 mm and 3.5 × 24 mm XIENCE Xpedition (XX) metal stents, implanted by re-POT, with optical coherence tomographic analysis at each step and micro-computed tomographic analysis of Ab devices to detect strut fracture.
  
  
  
  With Ab devices, re-POT reduced percentage strut malapposition close to XX rates (0.8 ± 0.7% vs. 0.0 ± 0.0%, p < 0.05; 3.5 ± 1.7% vs. 0.3 ± 0.6%, p < 0.05), conserving proximal circularity (elliptical ratio, 1.04 vs. 1.03 and 1.04 vs. 1.04; p = NS). Mean post-re-POT proximal expansion was 0.6 ± 0.1 mm (+21.6 ± 2.1%) for 2.5-mm and 1.0 ± 0.1 mm (+23.6 ± 2.2%) for 3.5-mm Ab devices, with only 1 strut fracture (left anterior descending-like bench). Side branch ostium strut obstruction was greater with Ab scaffolds than XX stents: 41.1 ± 9.4% versus 16.4 ± 8.1% (p < 0.05) and 31.8 ± 3.2% versus 10.0 ± 5.3% (p < 0.05), respectively, for 2.5- and 3.5-mm scaffolds and stents. Ab scaffolds showed 2 ± 1% moderate but significant late recoil as of 1 h, reaching 4 ± 2% by 24 h (p < 0.05).
  
  
  
  Re-POT optimized most Ab provisional bifurcation treatments, without fracture, respecting fractal geometry, and without exceeding 1.0-mm proximal differential diameter.
authors.affiliation: Department of Interventional Cardiology, Cardiovascular Hospital and Claude Bernard University and INSERM Unit 1060 CARMEN, Lyon, France.
authors.forename: François
authors.initials: F
authors.lastname: Derimay
authors.affiliation: Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France.
authors.forename: Géraud
authors.initials: G
authors.lastname: Souteyrand
authors.affiliation: Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Motreff
authors.affiliation: Cardiology, UMR 915, Institut du Thorax, Nantes, France.
authors.forename: Patrice
authors.initials: P
authors.lastname: Guerin
authors.affiliation: Cardiology, UMR 915, Institut du Thorax, Nantes, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Pilet
authors.affiliation: Laboratory TIMC-IMAG, DynaCell, CNRS UMR 5525, Institut de l'Ingénierie et de l'Information de Santé, Grenoble, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Ohayon
authors.affiliation: Clinique Saint Augustin, Bordeaux, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Darremont
authors.affiliation: Department of Interventional Cardiology, Cardiovascular Hospital and Claude Bernard University and INSERM Unit 1060 CARMEN, Lyon, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Rioufol
authors.affiliation: Department of Interventional Cardiology, Cardiovascular Hospital and Claude Bernard University and INSERM Unit 1060 CARMEN, Lyon, France. Electronic address: gerard.finet@univ-lyon1.fr.
authors.forename: Gérard
authors.initials: G
authors.lastname: Finet
mesh_terms: D020341:Absorbable Implants; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D054855:Drug-Eluting Stents; D000068338:Everolimus / Q000008:administration & dosage*; D017709:Fractals; D006801:Humans; D008422:Materials Testing; D008670:Metals; D008953:Models, Anatomic; D008955:Models, Cardiovascular; D011474:Prosthesis Design; D011475:Prosthesis Failure; D015607:Stents; D041623:Tomography, Optical Coherence; D055114:X-Ray Microtomography
chemical_list: D002317:Cardiovascular Agents; D008670:Metals; D000068338:Everolimus
keywords: bioresorbable vascular scaffold; coronary bifurcation; polymeric stent; provisional stenting