Mini- versus classical kissing balloon inflation in provisional technique for bifurcation intervention.

Abstract

We compared the potential benefits of mini-KBI (M-KBI), an optimized kissing balloon inflation (KBI), and classical KBI (C-KBI) in provisional bifurcation stenting. The long-term clinical outcomes of C-KBI in a provisional stenting strategy continue to be under debate due to main vessel (MV) stent deformation and overexpansion. Twelve stents were deployed in a silicone coronary bifurcation model using a provisional stenting strategy: C-KBI (two non-compliant balloons juxtaposed within the MV stent) was performed in six cases, and M-KBI (the side branch (SB) balloon protruded only into the MV at the upper edge of the SB ostium) was performed in the remaining six cases, all of which were followed by proximal optimization technique POT. Stent geometry was evaluated by bench photos, videoscope, micro-CT, microscopy, and intravascular ultrasound (IVUS). C-KBI rectified the MV stent malapposition, but resulted in stent deformation, overexpansion and the "bottleneck" effect, which could not be rectified by POT. M-KBI also rectified the MV stent malapposition, without notable stent deformation, overexpansion, or the "bottleneck" effect. POT optimized the MV strut apposition. M-KBI, an optimized KBI, is recommended to prevent stent deformation and overexpansion and to optimize stent deployment in a provisional stenting strategy.