Optical Coherence Tomography to Assess Proximal Side Optimization Technique in Crush Stenting

Abstract

AimThe aim of this study was to explore the potential intraprocedural benefits of the Proximal Side Optimization (PSO) technique by Optical Coherence Tomography (OCT).MethodsA case series of 10 consecutive true bifurcation lesions, with severe long pathology of long side branch (SB), were randomly assigned to be treated by standard DK Crush procedure (non-PSO group) as compared to DK Crush in PSO modification (PSO group). The data from OCT investigation before crushing of the SB Drug-Eluting Stent (DES), after crushing, after first kissing balloon inflation (KBI), and after final angiography were compared between the two groups (Public trials registry ISRCTN23355755).ResultsAll 10 cases were successfully treated by the assigned technique. The two groups were similar in terms of indications for the procedure, bifurcation angle, and stent dimensions. As compared to the non-PSO, the PSO group showed larger proximal SB stent areas (5.8 ± 1.8 vs. 4.5 ± 0.5 mm2; p = 0.02), the larger delta between distal and proximal stent areas before crush (1.5 ± 0.7 vs. 0.6 ± 0.5 mm2; p = 0.004), and the larger Space of Optimal Wiring (SOW) after Crush (5.3 ± 1.8 vs. 2.5 ± 1.1 mm2; p = 0.02). The gaps in scaffolding within the ostial segment of the Side Branch DES were found in two patients from the non-PSO group.ConclusionThe DK Crush in PSO modification results in larger SB DES and SOW areas with better apposition to the vessel wall. As result, the SB DES acquires a funnel shape, which reduces the risk of passage outside the SB stent struts during re-wiring, thus, allowing predictable and secure results.

Optical Coherence Tomography Predictors of SIde Branch REstenosis after unprotected Left Main bifurcation angioplasty using double kissing crush technique (OP‐SIBRE LM Study)

“…Based on the findings of this study, we would like to put forward an optimized DK crush technique that we anticipate will help minimize the length of new metallic carina and the incidence of SB ISR (Figure 5). It includes double kissing, double crush, double proximal SB stent optimization (PSO) 24,25…”

“…Based on the findings of this study, we would like to put forward an optimized DK crush technique that we anticipate will help minimize the length of new metallic carina and the incidence of SB ISR (Figure 5). It includes double kissing, double crush, double proximal SB stent optimization (PSO) 24,25 and double POT with first proximal and second middle to distal rewiring as well as use of appropriately sized SB balloon for FKBD. We also recommend >90% SB stent expansion for optimal long‐term results.…”