Inflation Pressure in Side Branch during Modified Jailed Balloon Technique Does Not Affect Side Branch Outcomes

Abstract

Objectives. This study aimed to investigate the optimal jailed balloon inflation in the side branch during the modified jailed balloon technique for bifurcated lesions. Background. The modified jailed balloon technique is one of the effective techniques to minimize the emergence of side branch (SB) compromise by preventing plaque or carina shifting during a single stent strategy in the main vessel with provisional SB treatment. However, there are no detailed studies on the method of optimal jailed balloon inflation. Methods. We analyzed 51 consecutive patients who underwent percutaneous coronary intervention (PCI) for bifurcated lesions with a modified jailed balloon technique between September 2018 and December 2020. These 51 patients were divided into two groups according to the magnitude of inflation pressure of the jailed balloon: a higher pressure (HP) group and lower pressure (LP) group. Results. No significant differences in procedural outcomes were observed between the two groups. The findings of SB compromise were relatively common with our procedure (30.0% in the HP group; 33.3% in the LP group). The patterns of SB compromise such as dissection or stenosis increase were observed at similar frequencies between them. In particular, SB dissection was noted in the SB lesion with some plaque burden, irrespective of the magnitude of the jailed balloon inflation pressure. Univariate analysis showed that calcification in the main vessel and SB lesion length was significantly associated with SB compromise. Finally, all PCI procedures were successfully completed without any provisional stent deployment in SB. Conclusions. We speculate that lesion characteristics rather than the PCI procedural factors may be critical determinants to cause SB compromise.

Comparison of Jailed Wire and Jailed Balloon for Prevention of Side Branch Occlusion in Provisional Stenting: Evidence from a Systematic Review and Meta-Analysis

“…However, JWT is favored for its lower rates of dissection in clinical practice. In the literature, JBT has been shown to increase the risk of dissection, especially when the jailed balloon is inflated [ 19 , 20 ]. Since these reports were single-arm studies, they were not enrolled in this review.…”

Protective ballooning technique for prevention of side branch occlusion in coronary nonleft main true bifurcation lesions: A single‐center study

“…A retrospective study in Japan also demonstrated that the inflation pressure of the jailed balloon did not affect SB outcomes. However, the balloon size used in MB is larger than that used in SB and the sample size was small, which would not be appropriate for all bifurcation lesions 18 …”

“…However, the balloon size used in MB is larger than that used in SB and the sample size was small, which would not be appropriate for all bifurcation lesions. 18 Kumsars et al reported that the final kissing balloon inflation had no benefit in reducing the incidence of SB stenosis-related ischemia after MB stent implantation. 19 There are also studies showing that ostial stenosis of the SB determined by quantitative coronary angiography could not predict the functional significance of the SB (flow fraction reserve value) after MB stent deployment.…”

Review of Techniques for Protecting Side Branch from Occlusion during Provisional Stenting in Coronary Bifurcation Lesions

“…Nomura et al . [ 56 ] showed that SB balloon pressure, or stent balloon nominal pressure did not affect procedural outcomes. However, SB dissection occurred in 14 of the 51 patients, SB flow less than TIMI 3 occurred in 3 lesions, and SB ostial stenosis increased in 5 patients [ 56 ].…”