title: Skirt followed by trouser stenting technique: True anatomical preservation of coronary Y-shaped bifurcation lesions while using "vanishing" bioresorbable scaffolds: A report of two cases.
abstract: We report on two cases in which Y-shaped coronary bifurcations were treated with the use of Bioresorbable scaffolds. The first case was of a 50-year-old man with NSTEMI. Coronary angiography showed stenosis involving a Y-shaped bifurcation of proximal to mid LAD and diagonal. The lesion was wired using two 0.14 BMW guide wires, followed by serial pre-dilatation of LAD and Diagonal branch. The stent into proximal LAD was deployed first as a skirt (3.5 × 12 BVS). Stent was post-dilated. A second 2.5 × 28 BVS was deployed into diagonal branch, protruding backwards; along with a 2.0 × 15 SC balloon continuing into the mid LAD. Both balloons where pulled back proximally and re-inflated. The technique was repeated in reversed order for stenting the mid LAD using the third BVS (3.0 × 18 BVS). Finally two NC balloons where used to post-dilate both legs of the newly-formed trouser. The result was checked by OCT. The second case was that of a 62-year-old man with chest pain and NSTEMI. He had a history of previous PCI to LCx using bare metal stent. Coronary angiogram showed severe in-stent restenosis in mid LCX, extending into two large obtuse marginal branches. After wiring both OMs, serial pre-dilatation was done with two NC 2.5 × 20 balloons, followed by initial stenting of mid LCx inside old stent, as the proximal segment of bifurcation, using a 3.5 × 12 BVS, followed by implanting a 2.5 × 28 BVS into OM2 and 2.5 × 18 into OM1. At 6 months a clinical follow up via telephone contact revealed no recurrence of chest pain in both cases and no further intervention required.
authors.affiliation: Al Qassimi Hospital, Sharjah, United Arab Emirates. Electronic address: welabbassi@yahoo.com.
authors.forename: Wael
authors.initials: W
authors.lastname: Elabbassi
authors.affiliation: Al Qassimi Hospital, Sharjah, United Arab Emirates. Electronic address: Arif345@yahoo.com.
authors.forename: Arif
authors.initials: A
authors.lastname: Al Nooryani
mesh_terms: D020341:Absorbable Implants; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation* / Q000379:methods*; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000072658:Non-ST Elevated Myocardial Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D011474:Prosthesis Design; D015607:Stents; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome
keywords: Bifurcation stenting; Bioresorbable scaffolds; Percutaneous intervention