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Protective ballooning technique for prevention of side branch occlusion in coronary nonleft main true bifurcation
1Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Insights
The protective ballooning technique effectively prevents side branch occlusion during coronary interventions for bifurcation lesions. This method demonstrates favorable 12-month clinical outcomes, offering a safer approach for patients.
Area of Science:
- Interventional Cardiology
- Cardiovascular Research
- Medical Device Technology
Background:
- Side branch (SB) occlusion is a significant complication during percutaneous coronary intervention (PCI) for coronary bifurcation lesions.
- Effective strategies are needed to minimize SB occlusion and improve procedural success.
Purpose of the Study:
- To evaluate the efficacy of a protective ballooning technique in preventing SB occlusion.
- To assess the long-term clinical outcomes of this technique in coronary nonleft main true bifurcation lesions.
Main Methods:
- A randomized trial comparing protective ballooning technique versus jailed wire technique.
- Patients (n=340) were assigned to either group and followed for 12 months.
- Outcomes included SB occlusion, TIMI flow, need for rewiring, and major adverse cardiovascular events.
Main Results:
- SB occlusion occurred in 0.6% with protective ballooning vs. 5.4% with jailed wire (p<0.05).
- Higher TIMI flow grade 3 in SB (98.8% vs. 95.2%) and significantly less rewiring (0.6% vs. 4.2%) were observed with protective ballooning.
- 12-month major adverse cardiovascular events were similar between groups.
Conclusions:
- The protective ballooning technique is effective in preventing SB occlusion for nonleft main true bifurcation lesions.
- This technique offers favorable long-term clinical outcomes at 12-month follow-up.
- It represents a valuable advancement in PCI for complex coronary anatomy.
Objectives:
We aimed to evaluate the efficacy of a protective ballooning technique in preventing side branch (SB) occlusion and to assess the long-term clinical outcomes for coronary nonleft main true bifurcation lesions.
Background:
SB occlusion is a major complication associated with percutaneous coronary intervention (PCI) for coronary bifurcation lesions.
Methods:
Patients were consecutively enrolled and randomly assigned to protective ballooning technique or jailed wire technique group. Periprocedural and long-term clinical outcomes were compared.
Results:
Patients in the protective ballooning technique (n = 173) and jailed wire technique (n = 167) groups were followed up for 12 months. SB occlusion occurred in one patient (0.6%) and nine patients (5.4%) in each group, respectively. The proportion of thrombolysis in myocardial infarction (TIMI) flow grade 3 of the SB was higher in the protective ballooning technique group (98.8% vs. 95.2%, p < 0.05). SB rewiring was necessary in one patient in the protective ballooning technique group (0.6%) with provisional stenting, significantly lower than that in the jailed wire technique group (seven patients, 4.2%; p = 0.03). Periprocedural myocardial infarction occurred in three (1.73%) and six (3.59%) patients in the protective ballooning technique and jailed wire technique groups without significant difference, respectively. Major adverse cardiovascular events at 12 months were similar in both groups.
Conclusions:
Protective ballooning technique is effective for the prevention of SB occlusion in nonleft main true bifurcation lesions and had favorable long-term outcomes at the 12-month follow-up.
