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[Protection of side-branch ostium by the jailed balloon technique validated by three-dimensional optical coherence
1School of Medicine, Nankai University, Tianjin 300071, China Department of Cardiology, General Hospital of Chinese People's Liberation Army, Beijing 100853, China.
Insights
The jailed balloon technique effectively protects the side branch (SB) ostium during percutaneous coronary intervention (PCI) for bifurcation lesions. Active techniques and larger balloons offer enhanced SB protection, particularly in true bifurcation cases.
Area of Science:
- Interventional Cardiology
- Medical Imaging
- Vascular Biology
Context:
- Coronary artery bifurcation lesions pose technical challenges during percutaneous coronary intervention (PCI).
- Preserving side branch (SB) ostium patency is crucial for long-term outcomes after PCI.
- Three-dimensional optical coherence tomography (3D-OCT) provides high-resolution imaging for detailed anatomical assessment.
Purpose:
- To evaluate the protective efficacy of the jailed balloon technique on the SB ostium using 3D-OCT.
- To compare the SB ostium area changes between jailed balloon and unprotected techniques.
- To identify technical parameters of the jailed balloon technique associated with improved SB protection.
Summary:
- A retrospective study of 176 patients with 236 bifurcation lesions compared the jailed balloon technique with unprotected PCI.
- The jailed balloon technique demonstrated significantly greater SB ostium area preservation compared to the unprotected group (P<0.001), especially in true bifurcation lesions.
- Active jailed balloon technique and larger balloon diameters (>2.0 mm) were associated with improved SB ostium area preservation, with a positive correlation noted between jailed balloon diameter and SB ostium area difference (r=0.344, P=0.019).
Impact:
- The jailed balloon technique offers significant protection to the SB ostium, particularly in true bifurcation lesions.
- Specific techniques, such as active jailed ballooning and the use of larger diameter balloons, may enhance SB protection during PCI.
- Findings support the optimization of jailed balloon technique parameters to improve procedural success and patient outcomes in complex coronary interventions.
Abstract:
Objective: To evaluate the protective effect of jailed balloon technique on side branch (SB) ostium using three-dimensional optical coherence tomography(OCT). Methods: This is a retrospective study. Consecutive coronary disease patients with coronary artery bifurcation lesions who underwent percutaneous coronary intervention (PCI) and completed pre-and post-procedural OCT examinations at the Chinese People's Liberation Army General Hospital from September 2019 to March 2022 were enrolled. Patients were divided into the jailed balloon technique group and the unprotected group according to the options applied for the SB. The SB ostium area difference was calculated from OCT images (SB ostium area difference=post-PCI SB ostium area-pre-PCI SB ostium area). The SB ostium area differences were compared between the two groups and compared further in the subgroup of true bifurcation lesions and non-true bifurcation lesions. In the jailed balloon group, the SB ostium area difference was compared between the active jailed balloon technique and the conventional jailed balloon technique, between the jailed balloon>2.0 mm diameter and the jailed balloon≤2.0 mm diameter, and between the higher balloon pressure (>4 atm, 1 atm=101.325 kPa) and the lower balloon pressure (≤4 atm). Multivariate linear regression analysis was used to explore the correlation between the technical parameters of the jailed balloon technique and the SB protection effect. Results: A total of 176 patients with 236 bifurcation lesions were enrolled, aged (60.7±9.3) years, and there were 128 male patients (72.7%). There were 67 patients in the jailed balloon technique group with 71 bifurcation lesions and 123 patients in the unprotected group with 165 bifurcation lesions. Fourteen patients had 2 to 3 lesions, which were treated in different ways, so they appeared in the unprotected group and the jailed balloon technique group at the same time. The area difference in SB ostium was greater in the jailed balloon group than in the unprotected group (0.07 (-0.43, 1.05)mm2 vs.-0.33 (-0.83, 0.26)mm2, P<0.001), and the results were consistent in the true bifurcation lesion subgroup (0.29 (-0.35, 0.96)mm2 vs.-0.26 (-0.64, 0.29)mm2, P=0.004), while the difference between the two groups in the non-true bifurcation lesion subgroup was not statistically significant (P=0.136). In the jailed balloon technique group, the SB ostium area difference was greater in patients treated with the active jailed balloon technique than in those treated with the conventional jailed balloon technique ((0.43±1.36)mm2 vs. (-0.22±0.52)mm2, P=0.013). The difference in SB ostium area was greater in those using>2.0 mm diameter jailed balloons than in those using≤2.0 mm diameter jailed balloons (0.25 (-0.51, 1.31) mm2 vs.-0.01 (-0.45, 0.63) mm2, P=0.020), while SB ostium area difference was similar between those endowed with higher balloon pressure (>4 atm) compared to those with lower balloon pressure (≤4 atm) (P=0.731). Multivariate linear regression analysis showed that there was a positive correlation between jailed balloon diameter and SB ostium area difference (r=0.344, P=0.019). Conclusions: The jailed balloon technique significantly protects SB ostium, especially in patients with true bifurcation lesions. The active jailed balloon technique and larger diameter balloons may provide more protection to the SB.
