The drug-eluting resorbable magnesium vascular scaffold in complex coronary bifurcations: insights from an in vivo multimodality imaging study

AIMS: This acute in vivo study sought to provide insights regarding the feasibility of performing complex bifurcation stenting with Magmaris magnesium alloy bioresorbable scaffolds (Biotronik, Bulach, Switzerland). METHODS AND RESULTS: Twenty-five New Zealand White rabbits underwent stenting of non-diseased aorto-iliac bifurcations with the Magmaris using provisional (PS; n=5), culotte (n=6), modified T (n=6), or T and protrusion (TAP, n=8) stenting techniques. Angiography, optical coherence tomography and micro-computed tomography were performed. Angiographic results were good without evidence of side branch (SB) compromise. In 9/25 procedures, strut fractures were identified with minimal luminal compromise in two cases. PS opened the SB optimally without evidence of scaffold compromise. Culotte resulted in complete bifurcation coverage and good scaffold expansion; single strut fractures were present in three out of six and double fractures in one out of six procedures. Modified T and TAP resulted in complete bifurcation coverage, minimal neocarina double-strut layers and good expansion. In two out of six modified T procedures, strut fractures were present with SB scaffold deformity present in an additional two out of six procedures. In three out of eight TAP procedures, strut fractures were present without compromising overall scaffold integrity. CONCLUSIONS: Bifurcation stenting using Magmaris appears feasible. PS with additional TAP whenever needed seems a reasonable approach. Whenever a two-stent technique is planned, TAP appears most favourable whilst modified T and culotte stenting should probably be avoided.