Salvage of side branch by provisional “TAP technique” using absorb™ bioresorbable vascular scaffolds for bifurcation lesions: First case reports with technical considerations

Abstract

Recent technological developments have led to the development of Absorb™ bioresorbable vascular scaffold (BVS) [Abbott Vascular, Santa Clara, USA] for percutaneous treatment of coronary artery disease by percutaneous coronary intervention (PCI). The BVS is now approved for use in many countries but experience in bifurcation lesions is limited and largely unreported and concerns still exist about its use across major side branches. We report for the first time, the successful use of the “T and Protrusion” (TAP) technique of deploying BVS into the side branch (SB) through the struts of main branch (MB) BVS to salvage a suboptimal result and threatened closure of a SB in three cases when treating bifurcation lesions with a planned single BVS strategy. The TAP technique was successful in all cases and there were no complications. All patients continue to do well at short-term follow-up. This case report provides information regarding the feasibility as well as technical and procedural insights when using BVS for bifurcation lesions. © 2014 Wiley Periodicals, Inc.

Absorb bioresorbable stents for the treatment of coronary artery disease

“…Bench testing has defined safe margins of balloon sizes and pressures for postdilatation and strut opening in a laboratory setting [83,84]. Different techniques have been successfully used with the Absorb device-culotte [85], provisional stenting [47], TAP technique [86] and T-stenting [87]. For larger side branches, strut cell opening into a side branch without compromising the main branch was visualized with the use of three-dimensional online reconstructed OCT imaging [88].…”

A review of bioresorbable scaffolds: hype or hope?

“…(28) Although the majority of studies on the BVS have been on stable patients and simple lesions, with better understanding of the BVS and improved operator expertise, it is now being used in complex lesion subsets. There is data on the application of the BVS in acute coronary syndrome, (21,26,28,29) bifurcation lesions, (30,31) left main disease, (32,33) chronic total occlusion, (34) calcific lesions, (35) in-stent restenosis (36) and multi-vessel disease.…”

Progress in interventional cardiology: challenges for the future

“…Today, the most promising material for biodegradable stents still is chemically modified poly-lactic acid (57); although the first clinical trial with the so-called bioresorbable vascular scaffold (BVS) stent had to be aborted because of an elevated late lumen loss that has been attributed to some inflammatory reactions and the mechanical properties of the stent (58), after an adaptation of the stent geometry, the second BVS generation yielded improved clinical results in a recent pilot trial (54,59) and, having been CE (Conformité Européene) approved in Europe in 2011, has nowadays gained considerable clinical relevance. However, the experience for the use of BVS in bifurcation lesions as well as across major side branches or calcified vessels is still limited (60,61).…”