A Novel Strategy to Simplify the Procedures in Treating Complicated Coronary Bifurcation Lesions: From a Bench Test to Clinical Application
BackgroundAlthough provisional stenting strategy based on jailed balloon side branch (SB) protection could be useful for high-risk bifurcation lesion in certain clinical scenarios, its complexity still gives rise to procedure complications. We proposed a novel strategy, the jailed balloon proximal o...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2022-04-01
|
| Series: | Frontiers in Cardiovascular Medicine |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2022.854063/full |
| _version_ | 1818393131298586624 |
|---|---|
| author | Dongdong Li Wenshuai Ma Pengyun Liu Hao Liu Baobao Bai Mingming Zhang Wangang Guo |
| author_facet | Dongdong Li Wenshuai Ma Pengyun Liu Hao Liu Baobao Bai Mingming Zhang Wangang Guo |
| author_sort | Dongdong Li |
| collection | DOAJ |
| description | BackgroundAlthough provisional stenting strategy based on jailed balloon side branch (SB) protection could be useful for high-risk bifurcation lesion in certain clinical scenarios, its complexity still gives rise to procedure complications. We proposed a novel strategy, the jailed balloon proximal optimization technique (JB-POT), to simplify the procedures in treating complex coronary bifurcation lesions (CBLs). The present study was designed to verify the safety and efficacy of JB-POT under bench testing and clinical circumstances.MethodsAfter a stent was deployed in main vessel (MV) with a balloon jailed in SB, POT and post-dilation of the stent were performed without retrieving the jailed balloon. A re-POT was performed 2 mm away from SB branching point to minimize proximal stent malapposition. The JB-POT procedure was performed on 10 samples of a silicone bifurcation bench model, and optical coherence tomography (OCT) was utilized to evaluate stent deployment. From December 2018 to July 2021, a total of 28 consecutive patients with true CBLs treated with JB-POT were enrolled. Immediate procedure results were observed, and clinical follow-ups were performed.ResultsThe bench test showed that JB-POT did not induce significant stent malapposition, underexpansion or distortion, as indexed by the malapposition rate, minimum stent area (MSA), eccentricity index and symmetry index determined through OCT. Under clinical circumstances, JB-POT did not induce significant malapposition, underexpansion or distortion. Among the 30 lesions, there was no primary endpoint event defined as SB occlusion, need to rewire the SB with a polymer-covered guide wire, or failure to retrieve a jailed wire or balloon. One rewiring event and 0 double stenting events occurred as secondary endpoint events. One patient died of heart failure in the 8th month after discharge.ConclusionsThe JB-POT protocol, which tremendously simplifies the current standard provisional stenting procedure in complicated bifurcation lesions, shows acceptability in safety and efficacy. Hence, it might become an applicable strategy for treating high-risk bifurcation lesions, especially those with multiple risked SBs. |
| first_indexed | 2024-12-14T05:40:26Z |
| format | Article |
| id | doaj.art-f0cc1cbef3b9499ab20b32b90d760aa1 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-12-14T05:40:26Z |
| publishDate | 2022-04-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-f0cc1cbef3b9499ab20b32b90d760aa12022-12-21T23:15:02ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2022-04-01910.3389/fcvm.2022.854063854063A Novel Strategy to Simplify the Procedures in Treating Complicated Coronary Bifurcation Lesions: From a Bench Test to Clinical ApplicationDongdong LiWenshuai MaPengyun LiuHao LiuBaobao BaiMingming ZhangWangang GuoBackgroundAlthough provisional stenting strategy based on jailed balloon side branch (SB) protection could be useful for high-risk bifurcation lesion in certain clinical scenarios, its complexity still gives rise to procedure complications. We proposed a novel strategy, the jailed balloon proximal optimization technique (JB-POT), to simplify the procedures in treating complex coronary bifurcation lesions (CBLs). The present study was designed to verify the safety and efficacy of JB-POT under bench testing and clinical circumstances.MethodsAfter a stent was deployed in main vessel (MV) with a balloon jailed in SB, POT and post-dilation of the stent were performed without retrieving the jailed balloon. A re-POT was performed 2 mm away from SB branching point to minimize proximal stent malapposition. The JB-POT procedure was performed on 10 samples of a silicone bifurcation bench model, and optical coherence tomography (OCT) was utilized to evaluate stent deployment. From December 2018 to July 2021, a total of 28 consecutive patients with true CBLs treated with JB-POT were enrolled. Immediate procedure results were observed, and clinical follow-ups were performed.ResultsThe bench test showed that JB-POT did not induce significant stent malapposition, underexpansion or distortion, as indexed by the malapposition rate, minimum stent area (MSA), eccentricity index and symmetry index determined through OCT. Under clinical circumstances, JB-POT did not induce significant malapposition, underexpansion or distortion. Among the 30 lesions, there was no primary endpoint event defined as SB occlusion, need to rewire the SB with a polymer-covered guide wire, or failure to retrieve a jailed wire or balloon. One rewiring event and 0 double stenting events occurred as secondary endpoint events. One patient died of heart failure in the 8th month after discharge.ConclusionsThe JB-POT protocol, which tremendously simplifies the current standard provisional stenting procedure in complicated bifurcation lesions, shows acceptability in safety and efficacy. Hence, it might become an applicable strategy for treating high-risk bifurcation lesions, especially those with multiple risked SBs.https://www.frontiersin.org/articles/10.3389/fcvm.2022.854063/fullbifurcationbench testjailed balloon techniqueproximal optimization techniqueprovisional stenting |
| spellingShingle | Dongdong Li Wenshuai Ma Pengyun Liu Hao Liu Baobao Bai Mingming Zhang Wangang Guo A Novel Strategy to Simplify the Procedures in Treating Complicated Coronary Bifurcation Lesions: From a Bench Test to Clinical Application Frontiers in Cardiovascular Medicine bifurcation bench test jailed balloon technique proximal optimization technique provisional stenting |
| title | A Novel Strategy to Simplify the Procedures in Treating Complicated Coronary Bifurcation Lesions: From a Bench Test to Clinical Application |
| title_full | A Novel Strategy to Simplify the Procedures in Treating Complicated Coronary Bifurcation Lesions: From a Bench Test to Clinical Application |
| title_fullStr | A Novel Strategy to Simplify the Procedures in Treating Complicated Coronary Bifurcation Lesions: From a Bench Test to Clinical Application |
| title_full_unstemmed | A Novel Strategy to Simplify the Procedures in Treating Complicated Coronary Bifurcation Lesions: From a Bench Test to Clinical Application |
| title_short | A Novel Strategy to Simplify the Procedures in Treating Complicated Coronary Bifurcation Lesions: From a Bench Test to Clinical Application |
| title_sort | novel strategy to simplify the procedures in treating complicated coronary bifurcation lesions from a bench test to clinical application |
| topic | bifurcation bench test jailed balloon technique proximal optimization technique provisional stenting |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2022.854063/full |
| work_keys_str_mv | AT dongdongli anovelstrategytosimplifytheproceduresintreatingcomplicatedcoronarybifurcationlesionsfromabenchtesttoclinicalapplication AT wenshuaima anovelstrategytosimplifytheproceduresintreatingcomplicatedcoronarybifurcationlesionsfromabenchtesttoclinicalapplication AT pengyunliu anovelstrategytosimplifytheproceduresintreatingcomplicatedcoronarybifurcationlesionsfromabenchtesttoclinicalapplication AT haoliu anovelstrategytosimplifytheproceduresintreatingcomplicatedcoronarybifurcationlesionsfromabenchtesttoclinicalapplication AT baobaobai anovelstrategytosimplifytheproceduresintreatingcomplicatedcoronarybifurcationlesionsfromabenchtesttoclinicalapplication AT mingmingzhang anovelstrategytosimplifytheproceduresintreatingcomplicatedcoronarybifurcationlesionsfromabenchtesttoclinicalapplication AT wangangguo anovelstrategytosimplifytheproceduresintreatingcomplicatedcoronarybifurcationlesionsfromabenchtesttoclinicalapplication AT dongdongli novelstrategytosimplifytheproceduresintreatingcomplicatedcoronarybifurcationlesionsfromabenchtesttoclinicalapplication AT wenshuaima novelstrategytosimplifytheproceduresintreatingcomplicatedcoronarybifurcationlesionsfromabenchtesttoclinicalapplication AT pengyunliu novelstrategytosimplifytheproceduresintreatingcomplicatedcoronarybifurcationlesionsfromabenchtesttoclinicalapplication AT haoliu novelstrategytosimplifytheproceduresintreatingcomplicatedcoronarybifurcationlesionsfromabenchtesttoclinicalapplication AT baobaobai novelstrategytosimplifytheproceduresintreatingcomplicatedcoronarybifurcationlesionsfromabenchtesttoclinicalapplication AT mingmingzhang novelstrategytosimplifytheproceduresintreatingcomplicatedcoronarybifurcationlesionsfromabenchtesttoclinicalapplication AT wangangguo novelstrategytosimplifytheproceduresintreatingcomplicatedcoronarybifurcationlesionsfromabenchtesttoclinicalapplication |