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Predicting Side Branch Occlusion in Acute Coronary Syndrome Using the Perfusion Balloon
Hiroshi Abe1, Dai Ozaki1, Haruhiko Hara1
1Department of Cardiology, Juntendo University Urayasu Hospital, Urayasu, Japan.
Insights
Perfusion balloon side branch-assisted flow stability (PB-SAFE) effectively predicts side branch occlusion in acute coronary syndrome patients. Maintaining side branch flow during intervention prevents occlusion, unlike cases with flow loss.
Area of Science:
- Cardiovascular Interventions
- Interventional Cardiology
- Percutaneous Coronary Intervention
Background:
- Coronary bifurcation lesions represent 20% of percutaneous coronary interventions.
- Assessing thrombotic risk in these lesions remains challenging.
- No established methods exist for predicting side branch occlusion in thrombus-containing bifurcations.
Purpose of the Study:
- To evaluate perfusion balloon dilatation as a predictor of side branch occlusion.
- To assess the utility of side branch flow during intervention for risk stratification.
Main Methods:
- 38 acute coronary syndrome patients with 65 side branches were analyzed.
- Percutaneous coronary intervention utilized a perfusion balloon.
- Branches were categorized into PB-SAFE (flow maintained) and not-SAFE (flow loss) groups based on intra-procedural flow.
Main Results:
- No side branch occlusion occurred in the PB-SAFE group.
- Side branch occlusion occurred in 31.7% of not-SAFE group branches.
- The not-SAFE group was a significant independent predictor of side branch occlusion (aOR 20.8, p<0.01).
Conclusions:
- Perfusion balloon side branch-assisted flow stability (PB-SAFE) is a novel predictor of side branch occlusion.
- This method can identify patients at high risk for side branch occlusion during PCI for ACS bifurcation lesions.
Background:
Coronary bifurcation lesions account for 20% of all percutaneous coronary interventions. Acute coronary syndromes involve thrombotic conditions; however, methods for assessing this risk in thrombus-containing bifurcations are unestablished.
Aims:
This study aimed to determine whether perfusion balloon dilatation can predict the occurrence of side branch occlusion.
Methods:
A total of 38 acute coronary syndrome patients with 65 side branches undergoing percutaneous coronary intervention using a perfusion balloon were enrolled. Based on the side branch flow during perfusion balloon dilatation, the branches were divided into PB-SAFE (perfusion balloon side branch-assisted flow stability, with side branch flow maintained) and not-SAFE (with side branch flow loss) groups.
Results:
The PB-SAFE group did not have cases of side branch occlusion, whereas side branch occlusion occurred in 13 (31.7%) branches in the not-SAFE group. Further, this group was identified as a significant predictor of side branch occlusion (p < 0.01). In a lesion-level multivariable analysis with per-patient clustering, not-SAFE remained an independent predictor of side branch occlusion (adjusted OR 20.8, 95% CI 4.08-106, p < 0.01).
Conclusion:
The PB-SAFE, our original predictor of side branch occlusion, can predict patients at risk of side branch occlusion during acute coronary syndrome bifurcation lesions.
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