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 invivo.

Atherosclerosis progression, Bifurcation intervention, Bioresorbable vascular scaffold, Computational fluid dynamics, Optical coherence tomography, Primary percutaneous coronary intervention
dx.doi.org/10.1016/j.atherosclerosis.2014.11.013, hdl.handle.net/1765/84923
Atherosclerosis
Department of Cardio-Thoracic Surgery

Karanasos, A, Li, Y, Tu, S, Wentzel, J.J, Reiber, J.H.C, van Geuns, R.J.M, & Regar, E.S. (2015). 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. Atherosclerosis, 238(1), 22–25. doi:10.1016/j.atherosclerosis.2014.11.013