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Bifurcation stenting with BVS
Maciej Lesiak Department of Cardiology
University Hospital in Poznan, Poland
Breaking the limits or just breaking the struts?
Disclosure
Speaker’s name: Maciej Lesiak
I have the following potential conflicts of interest to this
presentation:
Research contracts
Consulting: Abbott Vascular
Employment in industry
Stockholder of a healthcare company
Owner of a healthcare company
Other(s)
Background
• BVS is a promising technology (vessel reparative therapy)
• Scaffolds have not been tested in bifurcation lesions so far
• Is coronary artery bifurcation an important limitation in the use of BVS?
Kissing with two NC balloons (3.0 & 2.5 mm) @ 8 ATM
BVS 3.0x18 mm Silicone tube, lumen 3.0 mm
No ruptured links
3.0
NC 2.5
BVS 3.0 x 18 mm NC 3.0 BVS 3.0 x 18 mm
3.52 mm
Poznan Bifurcation BVS Registry
• Consecutive bifurcation cases treated with BVS
• Informed consent
• Any indication to PCI (stable or ACS)
• Any Medina type
• No excessive calcium & tortuosity
Inclusion / exclusion criteria
Prospective, single-centre clinical registry
Baseline characteristics N = 43
Age (years) 62± 11
Male gender 33 (77%)
Diabetes mellitus 14 (32.6%)
Hypertension 33 (76.7%)
Smoking 20 (46.5%)
Previous MI 22 (52.4%)
LV Ejection Fraction (%) 51 ± 11
Previous revascularization 24 (55,8%)
Peripheral vascular disease 4 (9.3%)
Chronic Kidney Disease (eGFR<60) 6 (14.0%)
Indication for PCI
Stable angina 33 (76.7%)
Unstable angina / NSTEMI 7 (16.5%)
STEMI 3 (7.0%)
Total population
Vessel / Lesion characteristics N = 43
Bifurcation location
LM/LAD, LM/LCx 7 (16.3%)
LAD/DIA 25 (58.1%)
LCX/OM 9 (20.9%)
RCA (PL/PDA) 2 (4.7%)
True bifurcation lesion: 1,1,1 / 1,0,1 / 0,1,1 20 (46.5%)
Ostial SB only (0,0,1) 8 (18.6%)
Type B2+C 36 (83.7%)
Calcification (moderate/heavy) 10 (27%)
Thrombus (angio) 4 (9.3%)
CTO 7 (16.3%)
Vessel / lesion
Procedure characteristics N = 43
Radial approach 30 (70%)
6 F Guiding catheter 43 (100%)
Simple technique (one stent) 37 (86%)
Provisional T stenting 30 (70%)
Systematic T stenting 4 (9%)
TAP technique 1 (3%)
SB ostial stenting 8 (19%)
Pre dilatation 42(98%)
Strut opening 13 (35%)
Final Kissing / snuggle 13 (30%)
FK MB balloon diameter 3.0 ± 0.2 mm
FK SB balloon diameter 2.4 ± 0.2 mm
Results
Vessel / Lesion characteristics N = 43
Main Vessel
Reference vessel diameter prox. 3.2 ± 0.7 mm
Reference vessel diameter dist. 2.7 ± 1.0 mm
Lesion length (mm) 11.8 ± 8.8 mm
Diameter stenosis (%) 72 ± 27 %
Side Branch
Reference vessel diameter 2.4 ± 0.5 mm
Lesion length 5.1 ± 5.4 mm
Diameter stenosis 39.6 ± 31.4 %
Angles
Proximal bifurcation angle (angle A) 140 ± 40 degrees
Distal bifurcation angle (angle B) 54± 30 degrees
Bifurcation angle < 50 degrees 26 (60.5%)
Results
Procedure characteristics N = 43
MB Stent diameter 3.1 ± 0.2 mm
MB Stent length 21 ± 4.6 mm
SB Stent diameter 2.8 ± 0.4 mm
SB Stent length 21 ± 4.4 mm
Additional stenting
MB / SB 3 / 0
Scaffold/procedure success 43 / 42*
Fluoroscopy time 10.9 ± 6.7 min
Contrast use 145 ± 57 ml
IVUS / OCT 13 (30%)
Results
*One case of SB dissection during wire re-cross, slow flow, CKMB
In hospital Discharge-30 days
Death 0 1 (fatal stroke)
Cardiac death 0 0
Myocardial infarction 2 0
Q MI 0 0
Non-Q MI 2* 0
Stroke 0 1
Stent thrombosis (any as of ARC) 0 0
Target vessel failure 0 0
Clinical outcomes
*One case of SB dissection during wire re-cross, slow flow, CKMB
One case of septal branch closure with CKMB
n=43 Discharge – end of FU
All cause death 1
Cardiac death 0
Myocardial infarction 0
Target lesion revascularization 0
Target vessel revascularization 0
Stent thrombosis (any as of ARC) 0
Target vessel failure 0
Follow-up
Median observation time 134 days (3 – 366)
Mean observation time 140 ± 98 days
Baseline characteristics and angiography
49YO man, stable angina class 3. Anterior MI & PCI of LAD in 2013
6 F Guide, femoral approach
Target vessel
Baseline characteristics and angiography
60 YO woman, stable angina class 2
6 F Guide, femoral approach
Target vessel