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.
Highlights
Even in this modern era of interventional cardiology, an optimal percutaneous coronary intervention (PCI) strategy for bifurcated lesions, which accounts for 15–20% of all PCI, remains controversial [1, 2]
Discussion e present study describes 51 sequential cases in which we performed the modified jailed balloon technique in PCI for bifurcated lesions. e procedure of the modified jailed balloon technique in our hospital is fundamentally conducted according to Saito’s original one [16]. is inflation procedure is clearly different from the conventional modified jailed balloon technique in that the proximal end of the jailed balloon is positioned at the side branch (SB) ostium, which can lead to minimal interference with the main vessel (MV) stent
It can minimize the risk of occlusion in the SB ostium through preventing plaque or carina shifting during MV stent implantation due to the effect of spatial occupation of the SB ostium
Summary
Even in this modern era of interventional cardiology, an optimal percutaneous coronary intervention (PCI) strategy for bifurcated lesions, which accounts for 15–20% of all PCI, remains controversial [1, 2]. There is a consensus that a single stent strategy only for the main vessel (MV) with provisional side branch (SB) treatment is a preferable technique for the majority of bifurcated lesions [3]. During a provisional approach, stenting in the MV crossing over the SB often aggravates SB ostial stenosis, leading to SB compromise, which results in periprocedural myocardial infarction, one of the most serious procedure-related complications [4]. The main mechanism of this complication was considered to be plaque shift from MV toSB [5]. The carina itself can be shifted to SB, which is considered to be the major cause of anatomical SB compromise [7]
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