Improving Bifurcated Scaffold Morphologies: The Feasibility of Culotte Techniques with Bioresorbable Vascular Scaffolds 

Abstract

Objectives: This study aimed to assess the bioresorbable vascular scaffold (BVS) performance with culotte stenting techniques and evaluate bifurcated scaffold morphologies. Methods: Conventional culotte stenting (CCS), double kissing mini-culotte stenting (DKMCS), and double kissing single-ring culotte stenting (DKSRCS) were executed in silicone bifurcated models. Procedures concluded with final kissing balloon inflation and proximal optimization technique. Microcomputed tomography assessed morphological parameters like side branch (SB) residual ostial stenosis and neocarina length (LNC) quantitatively. Optical coherence tomography (OCT) measured strut malapposition rates (SMR). Results: Quantitative assessments showed that BVS, in comparison with CCS, had significantly enhanced scaffold expansion at the SB ostium (6.29 ± 0.36 mm2 vs 6.71 ± 0.37 mm2, P = 0.05; 6.29 ± 0.36 mm2 vs 6.78 ± 0.26 mm2, P = 0.05, respectively), and decreased SB ostial stenosis(0.14% ± 0.04% vs 0.08% ± 0.04%, P < 0.05; 0.14% ± 0.04% vs 0.08 ± 0.03%, P < 0.05, respectively), LNC (0.49 ± 0.10 mm vs 0.30 ± 0.08 mm, P < 0.05; 0.49 ± 0.10 mm vs 0. 28 ± 0.06 mm, P < 0.05, respectively) and gap width(1.48 ± 0.06 mm vs 1.21 ± 0.06 mm, P < 0.05; 1.48 ± 0.06 mm vs 1.10 ± 0.04 mm, P < 0.05, respectively) in both DKMCS and DKSRCS. Notably, DKMCS and DKSRCS demonstrated reduced SMR, especially in scaffold overlap areas, as revealed by OCT. Conclusions: DKMCS and DKSRCS offer superior morphological outcomes for BVS models than CCS, suggesting BVS as a viable and effective technique for culotte stenting.