Abstract 17889: Sequential Side-Main-Side Branch Balloon Dilation - Sms Technique - As an Alternative to Final Kissing Balloon Inflation in Bifurcation Lesions Treated with Provisional Stenting

Abstract

Introduction. Final kissing balloon inflation is recommended in provisional stenting in order to accommodate the stent to the bifurcation anatomy. However KBI induces an asymmetry in the proximal stent and does not totally correct the deformation induced under the side branch origin after isolated SB dilation. Objective. To evaluate with IVUS the scaffolding and changes in stent geometry with a new sequential balloon dilation technique which we named SMS-technique. Methods. 63 patients with a true bifurcation coronary lesion (LM 4, LAD 47, LCx 10 and RCA 2) were treated with the SMS technique (Figure). The stent diameter was selected using the distal main branch (MB) reference, then (S) side branch balloon angioplasty was performed with a balloon selected according to its diameter. (M) another balloon, selected according to the proximal main branch reference diameter, was inflated proximally and at the carinal region. (S) final balloon angioplasty of the side branch (SB). An IVUS study was performed at each step. Results. Primary success was obtained in all lesions. Two patients needed a second stent. The table shows the quantitative IVUS findings at each step (*p<0,01). After SMS technique, complete apposition at the proximal stent segment was achieved in all cases. No cases of stent thrombosis were recorded. Conclusion. The SMS technique provides optimal apposition of the stent at the proximal segment of the MB and correction of the stent deformation under the SB origin.