[Jailed balloon versus provisional stenting with drug-coated balloon in true bifurcation lesions]

Coronary bifurcation lesions remain a major challenge in percutaneous coronary intervention because of the risk of side branch compromise or occlusion. Several strategies, including provisional stenting, jailed balloon protection, and drug-coated balloons, have been developed to preserve side branch patency; however, direct comparative evidence in true bifurcation lesions remains limited.

To determine the frequency of side branch compromise in coronary bifurcation lesions treated with jailed balloon technique versus provisional stenting plus drug-coated balloon.

Open-label randomized clinical trial conducted at UMAE No. 1 Bajío, IMSS, from April to September 2025. A total of 32 patients with acute or chronic coronary syndrome and true bifurcation lesions (Medina 1-1-1, 1-0-1, 0-1-1) were randomized 1:1 to provisional stenting with drug-coated balloon or jailed balloon. The primary endpoint was side branch compromise (occlusion, > 90% ostial pinching, or dissection > A). Clinical, angiographic, and procedural outcomes were analyzed.

Sixteen patients were allocated to each technique. Baseline characteristics were similar. Both strategies achieved universal angiographic success (TIMI 3 flow in all cases). Conversion to two stents was infrequent (three cases). Contrast use per treated vessel was significantly lower with the jailed balloon technique (56.7 vs 115.0 ml; p = 0.0016). No major adverse events were reported during early follow-up.

Both strategies proved safe and effective for true bifurcation lesions, even in high-risk patients. The jailed balloon technique offered the additional advantage of significantly reducing contrast use, which may be especially beneficial in patients at risk of contrast-induced nephropathy.