Elsevier

Atherosclerosis

Volume 238, Issue 1, January 2015, Pages 22-25
Atherosclerosis

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

https://doi.org/10.1016/j.atherosclerosis.2014.11.013Get rights and content
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Highlights

  • Bioresorbable scaffold implantation in ostial lesions leads to ‘neo-carina’ formation.

  • ‘Neo-carinas’ can cause hemodynamic disturbances of variable extent in the main branch.

  • These hemodynamic disturbances can be associated with atherosclerosis progression.

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.

Keywords

Optical coherence tomography
Bioresorbable vascular scaffold
Primary percutaneous coronary intervention
Computational fluid dynamics
Bifurcation intervention
Atherosclerosis progression

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These authors contributed equally to this work.