Corrective kissing balloon inflation for a suboptimal optical coherence tomography result after POT-side-POT: An OCT...

In the randomized CRABBIS trial, a proximal optimization technique (POT)-kissing-POT (PKP) sequence gave a better optical coherence tomography (OCT)-defined stent geometry than POT-Side-POT (PSP) in large bifurcations. Whether a suboptimal PSP result can be corrected during the same procedure is unknown.

In this pre-specified OCT sub-analysis, a suboptimal post-PSP result (minimal stent area < 90% of reference and/or malapposition) was corrected with kissing-balloon inflation and final POT. Stent geometry before and after correction was compared across four segments and with the randomized single-stent PKP arm.

The result was suboptimal in 22 of 30 patients (73.3%); 16 had paired OCT. After correction, minimal stent area increased in the proximal (12.5 to 14.6 mm²) and distal main vessel (7.4 to 9.1 mm²), both significant after Holm correction, and distal underexpansion fell from 13/16 (81%) to 5/16 (31%). Proximal-edge and bifurcation-core gains and the reduction in malapposition did not survive correction; eccentricity did not change significantly. No significant difference from the single-stent PKP arm was found, but the study had 80% power only for differences of 2.1 to 3.3 mm². Of eight results judged optimal, six still showed distal underexpansion.

A suboptimal PSP result can be improved in the same procedure by corrective kissing-balloon inflation and final POT, mainly through larger main-vessel stent area and expansion. It did not differ significantly from an upfront PKP, but equivalence cannot be established. A PSP result judged optimal during the procedure is not necessarily optimal at offline OCT analysis.