Effect of proximal balloon edge dilation technique for opening a side branch ostium in repetitive‐proximal optimizing technique sequence

Abstract

Objective: The purpose of this experimental bench test was to compare stent deformation, obstruction of stent struts at a jailed side branch (SB) ostium, and stent strut malapposition between SB inflation using proximal balloon edge dilation (PBED) technique and SB inflation using conventional balloon dilation in repetitive-proximal optimizing technique (re-POT) sequence. Background: The second proximal optimizing technique (POT) procedure in the re-POT sequence might increase obstruction of stent struts at a jailed SB ostium, because deformation of stent cells at the main branch (MB) occurred during SB inflation for opening the SB ostium. Methods: A fractal coronary bifurcation bench model made of flexible urethane was used, and crossover single-stent implantation (Xience Sierra, Abbott Vascular, Santa Clara, CA, n = 12) was performed from the MB with the re-POT sequence. During the re-POT sequence, the jailing rate at the SB ostium assessed by videoscopy was compared between SB inflation using PBED technique (PBED group, n = 6) and SB inflation using conventional balloon dilation (conventional group, n = 6). Results: The jailing rate after the second POT procedure tended to be lower in the PBED group than in the conventional group (26 ± 12% vs. 34 ± 8%, p = .211), and the change in the jailing rate during the second POT procedure was significantly smaller in the PBED group than in the conventional group (4.8 ± 5.3% vs. 11.6 ± 3.5%, p = .026). Conclusions: In the re-POT sequence, the PBED technique with a short balloon for SB inflation might minimize worsening of the jailing rate at the SB ostium during the second POT procedure.

Impact of Coronary Stent Design in Proximal Balloon Edge Dilation Technique for Bifurcation Percutaneous Coronary Intervention

“…5,6) However, the second POT procedure might reform the stent back to its original shape and pull well-deployed stent struts at the SB vessel wall toward the MB, thus, increasing obstruction by stent struts at a jailed SB ostium even when the PBED technique is used. 7,11) In the present study, a wide bifurcation angle would be associated with a higher rate of malapposed struts of the bifurcation segment after the PBED procedure. This negative phenomenon was observed more frequently with 2-link stents.…”

“…In addition, link location at the SB ostium is an important factor for stent deformation in bifurcation PCI. [7][8][9] To avoid any influence of link location, we intentionally set the absence (linkfree) of stent links in the distal semicircle of the SB ostium under videoscopic observation in the present study. The differences in the rate of malapposed struts identified in our study might thus, be based on stent design, but not the location of wire re-cross or stent link.…”

“…5,6) We have previously reported an experimental bifurcation bench model study that showed good effects on obstruction by stent struts at a jailed SB ostium using a proximal balloon edge dilation (PBED) technique in the re-POT sequence compared with conventional SB balloon dilation. 7) In this experimental study, SB dilation with the PBED technique prevented stent deformation induced by SB dilation and eliminated the need for the second POT procedure in the re-POT sequence. This new sequence (POT-PBED sequence) might thus, reduce procedure time and the risk of stent deformation following insertion of the second POT balloon.…”

Bifurcation percutaneous coronary intervention of left main trunk treated using a proximal optimizing technique and proximal balloon edge dilation technique

“…However, we have previously reported that the second POT procedure in the re-POT sequence increased obstruction of stent struts at a jailed SB ostium, because deformation of stent cells at the main branch occurred during SB inflation to open the SB ostium in our experimental bifurcation bench model study [ 5 ]. More recently, to prevent stent deformation during SB dilatation, our experimental bifurcation bench model study introduced the utility of SB inflation using the PBED technique and showed improved final results of cross-over single-stent implantation in bifurcation lesions using the POT-PBED procedures [ 2 ]. In the present case, OCT demonstrated well-apposed stent struts at both the proximal stent edge of the LMT and opposite the LCx after POT-PBED procedures, and a second POT (re-POT) procedure was not needed.…”

“…The default approach in bifurcation percutaneous coronary intervention (PCI) generally involves simple strategies with a single stent or provisional side branch (SB) stenting [ 1 ]. We previously reported an experimental bifurcation bench model study that showed good effects on obstruction by stent struts at a jailed SB ostium using a proximal balloon edge dilation (PBED) technique in the repetitive proximal optimizing technique (re-POT) sequence compared with conventional SB balloon dilation[ 2 ]. SB dilation with the PBED technique prevented stent deformation induced by SB dilation and eliminated the need for the second POT procedure in the re-POT sequence.…”