Prevention of no-reflow phenomenon in culprit lesions involving a large side branch

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Medicine

Background:

• The no-reflow/slow-flow phenomenon (NF) is a significant predictor of adverse outcomes following percutaneous coronary intervention (PCI).
• Distal protection devices (DPDs) are utilized to mitigate myocardial damage from embolic debris during PCI, but their efficacy is limited in complex bifurcation lesions involving large side branches.
• Protecting the side branch in bifurcation lesions remains a challenge in preventing distal embolization and subsequent myocardial injury.

Observation:

• This report details the application of a sequential, two-step deflation kissing-balloon technique in four patients with bifurcation lesions posing a high risk for NF.
• The technique was employed to protect both the main vessel and the critical side branch during the intervention.
• All procedures were successfully completed without immediate complications.

Findings:

• The implemented kissing-balloon strategy, utilizing sequential deflation, successfully prevented the no-reflow/slow-flow phenomenon in all four patients.
• Patients were discharged within 24 hours post-procedure, showing no electrocardiogram (ECG) changes or elevation in serum creatine kinase levels, indicating preserved myocardial function.
• The technique demonstrated safety and efficacy in managing NF risk in complex bifurcation scenarios.

Implications:

• The sequential deflation kissing-balloon technique presents a promising alternative strategy for preventing no-reflow/slow-flow phenomenon, particularly in bifurcation lesions with significant side branches.
• This method may enhance the safety and effectiveness of PCI in complex coronary anatomies.
• Further investigation and larger studies are warranted to validate this technique as a standard approach for managing NF in bifurcation lesions.