open access

Vol 29, No 6 (2022)
Original Article
Submitted: 2022-05-24
Accepted: 2022-06-14
Published online: 2022-08-16
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A novel technique of proximal optimization with kissing balloon inflation in bifurcation lesions

Dobrin Vassilev12, Niya Mileva13, Panayot Panayotov1, Despina Georgieva2, Greta Koleva2, Carlos Collet4, Gianluca Rigatelli5, Robert J. Gil6
DOI: 10.5603/CJ.a2022.0078
·
Pubmed: 35997048
·
Cardiol J 2022;29(6):899-905.
Affiliations
  1. Medica Cor Hospital, Ruse, Bulgaria
  2. University of Ruse, “Angel Kanchev”, Ruse, Bulgaria
  3. “Alexandrovska” University Hospital, Cardiology Department, Medical University Sofia, Bulgaria
  4. Cardiovascular Center OLV, Aalst, Belgium
  5. Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy
  6. Department of Invasive Cardiology, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland

open access

Vol 29, No 6 (2022)
Original articles — Interventional cardiology
Submitted: 2022-05-24
Accepted: 2022-06-14
Published online: 2022-08-16

Abstract

Background: Percutaneous coronary interventions (PCI) of bifurcation lesions poses a technical challenge with a high complication rate. Kissing balloon inflation (KBI) and proximal optimization technique (POT) are used to correct bifurcation carina after stenting. However, both may still lead to uncomplete strut apposition to the side branch (SB) lateral wall. Proposed herein, is a new stent-optimization technique following bifurcation stenting consisting of a combination of POT and KBI called proximal optimization with kissing balloon inflation (POKI).
Methods: Bench and in-vivo evaluations were performed. For the bench visualization bifurcated silicone mock vessel was used. The POKI technique was simulated using a 3.5 mm POT balloon. For the in-vivo evaluation patients with angiographic bifurcation lesions in a native coronary artery with diameter ≥ 2.5 mm and ≤ 4.5 mm, SB diameter ≥ 2.0 mm, and percentage diameter stenosis (%DS) more than 50% in the main vessel (MV) were included. Provisional stenting was the default strategy.
Results: In total 41 vessels were evaluated. The target vessel was left main in 9 (22.0%) patients, left anterior descending artery — in 26 (63.4%), left circumflex artery — in 4 (9.8%) and right coronary artery — in 2 (4.9%). The predominant type of bifurcation was Medina 1-1-1 (61.8%). Baseline proximal MV DS% was 60.0 ± 23.7%, distal MV DS% — 58.8 ± 28.9% and SB DS% 53.0 ± 32.0%. The application of POKI was feasible in 41 (100%) of the vessels. Post-PCI residual DS at proximal MV was 11.5 ± 15.4%, distal MV — 6.6 ± 9.3%, and SB — 22.9 ± 28.5%. Both procedural and angiographic success was 100%.
Conclusions: POKI is a novel stent-optimization technique for bifurcation lesions. It showed excellent feasibility and success rate both in bench and in-vivo evaluation.

Abstract

Background: Percutaneous coronary interventions (PCI) of bifurcation lesions poses a technical challenge with a high complication rate. Kissing balloon inflation (KBI) and proximal optimization technique (POT) are used to correct bifurcation carina after stenting. However, both may still lead to uncomplete strut apposition to the side branch (SB) lateral wall. Proposed herein, is a new stent-optimization technique following bifurcation stenting consisting of a combination of POT and KBI called proximal optimization with kissing balloon inflation (POKI).
Methods: Bench and in-vivo evaluations were performed. For the bench visualization bifurcated silicone mock vessel was used. The POKI technique was simulated using a 3.5 mm POT balloon. For the in-vivo evaluation patients with angiographic bifurcation lesions in a native coronary artery with diameter ≥ 2.5 mm and ≤ 4.5 mm, SB diameter ≥ 2.0 mm, and percentage diameter stenosis (%DS) more than 50% in the main vessel (MV) were included. Provisional stenting was the default strategy.
Results: In total 41 vessels were evaluated. The target vessel was left main in 9 (22.0%) patients, left anterior descending artery — in 26 (63.4%), left circumflex artery — in 4 (9.8%) and right coronary artery — in 2 (4.9%). The predominant type of bifurcation was Medina 1-1-1 (61.8%). Baseline proximal MV DS% was 60.0 ± 23.7%, distal MV DS% — 58.8 ± 28.9% and SB DS% 53.0 ± 32.0%. The application of POKI was feasible in 41 (100%) of the vessels. Post-PCI residual DS at proximal MV was 11.5 ± 15.4%, distal MV — 6.6 ± 9.3%, and SB — 22.9 ± 28.5%. Both procedural and angiographic success was 100%.
Conclusions: POKI is a novel stent-optimization technique for bifurcation lesions. It showed excellent feasibility and success rate both in bench and in-vivo evaluation.

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Keywords

coronary bifurcations, stent optimization, procedural outcome

About this article
Title

A novel technique of proximal optimization with kissing balloon inflation in bifurcation lesions

Journal

Cardiology Journal

Issue

Vol 29, No 6 (2022)

Article type

Original Article

Pages

899-905

Published online

2022-08-16

Page views

4005

Article views/downloads

730

DOI

10.5603/CJ.a2022.0078

Pubmed

35997048

Bibliographic record

Cardiol J 2022;29(6):899-905.

Keywords

coronary bifurcations
stent optimization
procedural outcome

Authors

Dobrin Vassilev
Niya Mileva
Panayot Panayotov
Despina Georgieva
Greta Koleva
Carlos Collet
Gianluca Rigatelli
Robert J. Gil

References (23)
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