Predicting Side Branch Occlusion in Acute Coronary Syndrome Using the Perfusion Balloon

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.

This study aimed to determine whether perfusion balloon dilatation can predict the occurrence of side branch occlusion.

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.

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).

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.