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.
Highlights
The Proximal Side Optimization (PSO) is the last proposed technique adjustment of DK crush, based on a Side Branch (SB) stent post-dilatation prior to the crush [1–3], Supplementary Material
Given the high resolution and the capability for three-dimensional (3D) reconstruction, we sought to use Optical Coherence Tomography (OCT) to further explore the potential intraprocedural benefits of this modification in a series of patients treated by two-stent DK Double Kissing Crush bifurcation stenting (Crush) approach for true bifurcation lesions
All SB DES were positioned with an adequate protrusion in Main Branch (MB) (3–5 mm depending on bifurcation angle) and deployed at nominal pressure
Summary
The Proximal Side Optimization (PSO) is the last proposed technique adjustment of DK crush, based on a Side Branch (SB) stent post-dilatation prior to the crush [1–3], Supplementary Material. Given the high resolution and the capability for three-dimensional (3D) reconstruction, we sought to use Optical Coherence Tomography (OCT) to further explore the potential intraprocedural benefits of this modification in a series of patients treated by two-stent DK Crush approach for true bifurcation lesions.
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