Proximal optimisation technique versus final kissing balloon inflation in coronary bifurcation lesions: the randomised, multicentre PROPOT trial

Watanabe, Yusuke; Murasato, Yoshinobu; Yamawaki, Masahiro; Kinoshita, Yoshihisa; Okubo, Munenori; Yumoto, Kazuhiko; Masuda, Naoki; Otake, Hiromasa; Aoki, Jiro; Nakazawa, Gaku; Numasawa, Yohei; Itô, Tatsuya; Shite, Junya; Okamura, Takayuki; Takagi, Kensuke; Kozuma, Kayoko; Lefèvre, Thierry; Chevalier, Bernard; Louvard, Yves; Suzuki, Nobuaki; Kozuma, Ken

doi:10.4244/eij-d-20-01386

Cited by 19 publications

(21 citation statements)

References 25 publications

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“…To avoid fatal adverse events, additional treatment procedures, including re‐POT or additional KBT, were allowed only after SBD or KBT in cases of high‐risk stent failure with a stent malapposition of >400 µm from the vessel wall in any part of the stent, or serious lumen narrowing (>30% or <2.5 mm 2 ) of the stent area in the distal MV ostium. In this study, recurrent KBT for proximal stent failure in the KBT group was counted as an additional procedure, which was not in the main study 12 …”

Section: Methodsmentioning

confidence: 99%

“…In another study with OCT examination, POT-induced dilation varied with an average proximalto-distal bifurcation expansion ratio of 1.2-1.5 among the attending institutes, wherein incomplete strut apposition was more likely to occur in the institute presenting with a lower value (inappropriate POT). 9 Although the POT balloon was encouraged to be located accurately in this study, 12 difficulty in the identification of the carina due to overlapping of the branches or foreshortening in the angiography and inadequate balloon size selection under angiography might have affected the results.…”

Section: Stent Expansion Induced By Pot and Kbtmentioning

confidence: 98%

“…12 Detailed descriptions on study population, study design, PCI protocol can be found in the main study. 12 In brief, a total of 120 patients from 15 institutes were enrolled between April 2016 and July 2018. After the exclusion of 11 patients, the data of 109 patients (POT group: 52 patients; KBT group: 57 patients) were analyzed (Figure 1).…”

Section: Study Population and Designmentioning

confidence: 99%

“…In this study, recurrent KBT for proximal stent failure in the KBT group was counted as an additional procedure, which was not in the main study. 12…”

Section: Other Technical Considerationsmentioning

confidence: 99%

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Effect of proximal optimization technique on coronary bifurcation stent failure: Insights from the multicenter randomized PROPOT trial

Murasato

Watanabe

Yamawaki

et al. 2022

Cathet Cardio Intervent

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Section: Methodsmentioning

confidence: 99%

Section: Stent Expansion Induced By Pot and Kbtmentioning

confidence: 98%

Section: Study Population and Designmentioning

confidence: 99%

“…In this study, recurrent KBT for proximal stent failure in the KBT group was counted as an additional procedure, which was not in the main study. 12…”

Section: Other Technical Considerationsmentioning

confidence: 99%

See 2 more Smart Citations

Effect of proximal optimization technique on coronary bifurcation stent failure: Insights from the multicenter randomized PROPOT trial

Murasato

Watanabe

Yamawaki

et al. 2022

Cathet Cardio Intervent

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“…Final KBI in CBLs) trial randomized 120 patients with CBL to POT followed by SB dilation versus KBI after MV stenting. [22] OCT was performed at baseline, immediately after wire recrossing to the SB, and at the final procedure. They showed that the rate of malapposed struts did not differ between the groups.…”

Section: The Role Of Oct On Stent Optimization and Clinical Outcome I...mentioning

confidence: 99%

New Insights into Intravascular Imaging of Coronary Bifurcation Lesions and Left Main Stenosis: What Have We Accomplished?

Leesar

Mering

Jneid

2022

Cardiology Discovery

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Coronary bifurcation lesions (CBL) are one of the most challenging lesions to treat in interventional cardiology. Intravascular imaging including intravascular ultrasound (IVUS) and optical coherence tomography (OCT) is paramount for the assessment of lesion characteristics and suboptimal stent results and to improve the outcome of percutaneous coronary intervention (PCI). After upgrading the use of IVUS and OCT by the American College of Cardiology/American Heart Association guidelines, their use has increased. Likewise, there has been significant improvement in image quality and the profile of system (ie, IVUS catheter size). The main indication for the use of IVUS includes: assessment of lesion characteristics, optimization of stent deployment, optimal stent expansion, exclusion of plaque burden >50%, and edge dissection. Intravascular imaging plays a significant role in the assessment and treatment of left main (LM) coronary artery stenosis and CBL. In particular, the use of intravascular imaging for alleviating mechanical issues during stenting and managing stent thrombosis has significantly increased. Overall, a compelling body of evidence has shown that the use of IVUS or OCT during PCI leads to optimal stenting results and mitigates the risk of adverse cardiac events. However, to date, the American College of Cardiology/American Heart Association Guidelines have assigned a Class IIb recommendation for IVUS or OCT, while the European Society of Cardiology Guidelines upgraded it to the Class IIa recommendation. This review summarized the role of IVUS and OCT for the assessment of stenosis and stent optimization in patients with CBL and LM stenosis. In addition, we discuss new insights into the role of IVUS-and OCT-guided stenting in patients with CBL and LM stenosis provided by the ongoing randomized trials.

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Proximal optimization technique and percutaneous coronary intervention for left main disease: POTENTIAL‐LM

Volet,

Puricel,

Cook

et al. 2024

Cathet Cardio Intervent

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BackgroundOptimal stent deployment in left main (LM) bifurcation is paramount, and incomplete stent apposition may cause major adverse cardiac events (MACE). Bench studies show that the proximal optimization technique (POT) provides the best stent apposition.AimsWe aimed to investigate the impact of POT on clinical outcomes in patients treated for unprotected LM (ULM) disease at our institution.MethodsWe identified 162 patients who underwent percutaneous coronary intervention (PCI) for ULM coronary disease in the Cardio‐FR database. Out of these, 99 (61%) had undergone POT, while 63 patients were treated without POT. The primary outcome was the bifurcation‐oriented composite endpoint (BOCE) of cardiac death, target‐bifurcation myocardial infarction and target‐bifurcation revascularization at maximal follow‐up.ResultsMean age was 76 years, and 69% presented with acute coronary syndrome. Mean follow‐up was 2.25 years (822 days). The BOCE occurred in 43 (27%) of which 20 (20%) in the POT group and 23 (37%) in the no‐POT group (p = 0.009). Cardiac death occurred in 15 (15%) patients in the POT‐ and 17 (27%) in no‐POT group (p = 0.26). Target bifurcation revascularization occurred in 4 (4%) patients in the POT‐ and 6 (10%) patients in the no‐POT group (p = 0.19). POT In the multivariate analysis, POT was the strongest parameter and was associated with BOCE, cardiac death, occurrence of any revascularization and all‐cause mortality.ConclusionThe POT improves clinical outcomes. These findings strongly support the systematic use of POT in patients undergoing ULM‐PCI.

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Proximal optimisation technique versus final kissing balloon inflation in coronary bifurcation lesions: the randomised, multicentre PROPOT trial

Cited by 19 publications

References 25 publications

Effect of proximal optimization technique on coronary bifurcation stent failure: Insights from the multicenter randomized PROPOT trial

Effect of proximal optimization technique on coronary bifurcation stent failure: Insights from the multicenter randomized PROPOT trial

New Insights into Intravascular Imaging of Coronary Bifurcation Lesions and Left Main Stenosis: What Have We Accomplished?

Proximal optimization technique and percutaneous coronary intervention for left main disease: POTENTIAL‐LM

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