الفهرس 
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Abstract
Despite the advances in the field of interventional cardiology, coronary bifurcations lesions, which represent approximately 15-25% of percutaneous coronary interventions (PCI) cases, are still a challenge .
Our aim in this study was to evaluate the performance of BVS and DCB in bifurcation lesions at mid-term follow up in order to gain a better understanding of their efficacy and safety at this clinical setting.
Forty patients fulfilled the enrollment criteria were from 6 Italian centers over the period from July 2013 to July 2017.The follow up period extended to July 2019 with a mean of 1095 days. The study included all consecutive cases of coronary bifurcations managed or attempted with:
a) The implantation of at least one Absorb BVS in the main vessel.
b) The use of one or more DCB in the side branch.
Follow up at the maximum available timing with a minimum of
6 months was done for major adverse cardiovascular events including death, non-fatal MI, scaffold thrombosis and cerebrovascular stroke.
In our study males represented 85% of the study population. 35% of our patients were smokers. Their age ranged from 36.3 to 77.5 years. The average weight was 7912 kg and the average height was 170.96.1 cm.
Hypertension represented 57.5% of the study population .22.5% of the patients were diabetics . 11 patients (27.5%) had a history of prior PCI and
7 patients (17.5%) had a history of prvious MI. No patients suffered from
a previous cerebrovascular stroke. Percutaneous coronary intervention was indicated secondary to stable angina in 20 patients (50%), unstable angina in 6 patients (15%),NSTEMI in 8 patients (20%), STEMI in 6 patients (15%). The ejection fraction of the patients enrolled ranged from 46.4 to 66.4%.
The serum creatinine level ranged from 0.6 to 1.24. The hemoglobin level ranged from 11.04 to 15.56 g/dl. The LDL cholesterol level ranged from 180 to 200 mg/dl.
Radial access was the access of choice in 80% of the patients while the femoral access was used in only 20% of the patients.
The bifurcation lesion involved the LM in 1 patient (2.5%), the LAD in 23 patients (57.5%), the LCX in 11 patients in (27.5%) and the RCA in
8 patients (20%). The Syntax score was 15.047.18.According to Medina classification 27 patients (67.5%) had Medina( 1,1,1),9 patients (22.5%)had Medina (1,0,1),1 patient (2.5%) had Medina (0,1,0), 1 patient (2.5%) had Medina (1,0,0) and 2 patients (5%) had Medina (0,1,1).
The RVD of the main branch was 3.130.4 mm and the lesion in the main branch ranged from 16.92 to 25.92 mm. The RVD of the SB ranged from 2.02 to 2.59mm.The lesion lengh of the side branch ranged from 10.79 to 12.19mm.The MLD of the MB was 0.510.37mm while the percent dimater stenosis of the MB was 83.213.4%.The MLD of the SB was 0.770.62mm while percent dimater stenosis SB was 2.310.14.%.
Intravascular imaging was used in 32.5 of the patients. IVUS was used in used in 10 patients (25%) while OCT was used in 3 patients (7.5%). Intravscular imaging was used according to opertaor’s dicretion, notably ,the IVUS was used in the CTO cases and the LM lesion.
During the procedure the PSP technique was adopted where predilatation of the lesion and post dilatation of the scaffold was done in 100% of the patients.For the sake of lesion preparation scoring balloon was used in 1 patient (2.5%) and no rotablator was needed.The diameter of the predilatation balloon ranged from 1.91to 3.71mm. The Absorb BVS was the scaffold used in all patients , the length of the scaffold was 22.026.07 mm and it was deployed to 10.921.4 atm. After deployement of the scaffold, postdilatation was done with balloons whose diameters ranged from 2.51 to 4.11 mm inflated up to 20.34.4 atm.
Predilatation of the side branch was done in 32 patients (48%) to inflation pressures of 113 atm.Kissing balloon inlation before stent implantation was done in 5 patients (12.5%) and after stent implantation in 23 patients (57.5 %). The FKB was done using normal balloons in 6 patients (15%) and with DCBs in 17 patients (42.5%).
Paclitaxel eluting balloons (PCBs) were used in 97.5% of the patients while a sirolimus coated balloon (Magic touch) was used in one patient only (2.5%). The following DCBs were used : Pantera LUX in 6 patients, Elutax SV in 11 patients, Restore in 6 patients, Sequent in 4 patients,Inpact Falcon in 10 patients, Danubu in one patient and Agent in one patient.
The diameter of the DCBS ranged from 1.69 to 3.17 mm with a length that ranged from 13.575 to 27.175 mm. The inflation pressure was 9.4251.9 atm and the duration of inflation was 51.7510.02 sec.
Immediate angiographic results showed TIMI III flow in both the MB and side branch with a dissection left in the side branch in 6 patients (15%). The dissection was type A in 5 patients (12.5%) and type C in 1 patient (2.5%) which didnt require stenting .The final percent diamter stenosis of the MB was 5.284% and the MLD was3.01670.3mm. The final percent diameter stenosis of the side branch was 12.992% and the MLD was 1.90.2 mm.
The procedural time ranged from 31.75 to 101.75 min. The total fluoroscopy time ranged fom 8.3 to 15.7 min . The total amount of contrast used ranged from112 to 312 ml.
Acetylsalicylic acid was prescribed in all patients after the procedure. All the patients received P2Y12 inhibitors post procedure: clopidogrel was used in 11 patients (27.5%), Prasugrel was used in 4 patients (10%) and Ticagrelor was used in 25 patients (62.5%).
Patients were enrolled from July 2013 to July 2017 with at least 6 months follow up after the index procedure of the last patient. The follow up extended to July 2019 with a mean of 1095 days. Angiographic follow up was indicated in 13 patients (32.5%).The indication varied from stable angina in 8 patients (9%), Unstable angina in 3 patients (7.5%), NSTEMI in 1 patient (2.5%) and STEMI in 1 patient (2.5%).
The angiographic follow up in these 13 patients revealed 2.93.4 % diametr setnosis in the main branch and 1129.49 % diameter stenosis in the side branch. The MLD in the MB was 3.2 0.47 mm while the MLD in the SB was 1.7840.6 mm.There were no cases of MB TLR , SB TLR or scaffold thrombosis. There was only one case (2.5%) of target vessel MI. The patient presented with NSTEMI and was managed with POBA.