ORIGINAL RESEARCH article
Front. Med. Technol.
Sec. Cardiovascular Medtech
Optimizing BVS Morphology: The Promise of Sequential Intermediate Kissing Balloon Dilation for Culotte Techniques: A Bench Study
Provisionally accepted
- 1Department of Cardiology, Union Hospital, Fujian Medical University, Fujian, PR China,Provincial Institute of Coronary Artery Disease, Fujian, PR China., Fuzhou, China
- 2The People's Hospital of Bozhou, Bozhou, China
- 3The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Background: Bioresorbable vascular scaffolds (BVS) present specific challenges in coronary bifurcation lesions, including risks of scaffold thrombosis, side branch (SB) ostial malapposition, and restenosis due to strut overlap. We hypothesized that sequential intermediate kissing balloon dilation (SIKBD) would improve strut apposition and optimize BVS morphology. This bench study compared three culotte-based BVS implantation strategies. Methods:Silicone bifurcation phantoms (n=30, 10 per group) were used to evaluate: Conventional culotte stenting (CCS) with routine intermediate solo balloon dilation (rISBD); Double-kissing mini-culotte stenting (DKMCS); Double-kissing single-ring culotte stenting (DKSRCS) with SIKBD. Quantitative micro-CT and OCT analyses assessed SB ostial stenosis rate, neocarina length (LNC), strut malapposition rate (SMR), and scaffold coverage indices. Results: Compared to CCS, DKMCS and DKSRCS demonstrated: Improved SB ostial expansion: effective area increased by 14% (6.29±0.36 mm² vs. 6.71±0.37/6.78±0.26 mm², P=0.05).Reduced SB ostial stenosis decreased by 43% (0.14±0.04% vs. 0.08±0.04/0.08±0.03%, P<0.05).Shorter neocarina length: LNC reduced by 39% (0.49±0.10 mm vs. 0.30±0.08/0.28±0.06 mm, P<0.05).Lower malapposition rates: PMV malapposition decreased by 56–67% (11.82±1.57% vs. 5.19±0.55/3.84±1.12%, P<0.05). Conclusions: The double-kissing strategy (DKMCS/DKSRCS) optimizes BVS scaffolding by reducing SB ostial stenosis and improving strut apposition. These morphological
Keywords: Bioresorbable vascular scaffolds, Coronary bifurcation lesions, Culotte Techniques, SB ostial stenosis, sequential intermediate kissing balloon dilation
Received: 31 Oct 2025; Accepted: 09 Dec 2025.
Copyright: © 2025 Chen, Tu, Zhang, Wang and Hu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Lianglong Chen
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