Side Branch Protection in Coronary Bifurcation Stenting: A Systematic Review and Meta-Analysis of Jailed Wire Versus...

Bifurcation percutaneous coronary intervention (PCI) remains technically challenging and is considered high risk to procedural complications, particularly side branch (SB) occlusion. The jailed wire technique (JWT) is commonly recommended for SB protection; however, it does not fully prevent the complication. The jailed balloon technique (JBT) was introduced to provide more active protection, but previous evidence has been inconsistent. This study aimed to provide updated evidence on the effectiveness of JBT versus JWT for SB protection during bifurcation PCI. PubMed, ScienceDirect, and the Cochrane Library were searched for randomized trials and cohort studies comparing JBT and JWT in patients undergoing bifurcation PCI. The primary end points were procedure-related adverse events, including SB occlusion, coronary dissection, and peri-procedural myocardial infarction. Secondary end points included all-cause mortality, cardiac death, target-lesion revascularization, and major adverse cardiovascular events (MACE). Odds ratios with 95% confidence intervals were calculated as a measure. Study quality was assessed using the Newcastle-Ottawa Scale and risk of bias 2.0 tool. Ten studies involving 2,329 patients were included (793 JBT and 1,536 JWT). The risk of SB occlusion was lower in JBT group compared to JWT group (odds ratio = 0.31, 95% confidence interval 0.20 to 0.48; p <0.00001). There were no significant differences between the 2 techniques in coronary dissection, peri-procedural myocardial infarction, all-cause mortality, cardiac death, target-lesion revascularization, or MACE. All studies were considered good quality. In conclusion, the use of JBT was associated with a reduced risk of SB occlusion during bifurcation PCI, while both techniques demonstrated comparable outcomes for other procedural and long-term clinical outcomes.