A Modified Provisional Stenting Approach to Coronary Bifurcation Lesions: Clinical Application of the “Jailed‐Balloon Technique”

Abstract

Provisional stenting of complex coronary bifurcation lesions using a JBT is associated with a high procedural success rate, improved SB patency, and a low rate of immediate cardiac events. Further study is warranted to evaluate the role of JBT in improving long-term clinical outcomes in PCI of complex bifurcation lesions.

A Novel‐Modified Provisional Bifurcation Stenting Technique: Jailed Semi‐Inflated Balloon Technique

“…Currently, provisional approach is recommended to treat for the majority of coronary bifurcation lesions . However, it is associated with the risk of SB occlusion after MV stenting due to plaque or carina shift into the SB . If SB occlusion occurs, rewiring of SB is attempted to reopen the SB, but SB wiring can be challenging after MV stenting, particularly in complex cases.…”

“…Singh et al performed provisional method with JBT to 102 bifurcation lesions in 100 patients. In this method, after MV stenting with nominal pressures, they removed the jailed SB balloon and wire.…”

“…Then, they fully expanded the stent balloon which was maintained into the MV stent with moderate or high pressure for optimization of MV stent apposition. They terminated the procedure without POT . It has been known that there is a difference between the proximal and the distal main branch diameter (Finet's law) .…”

“…During provisional approach, residual ostial stenosis or total occlusion of SB frequently occurs immediately after main vessel (MV) stenting . Several mechanisms can be responsible for SB occlusion during MB stenting including: plaque shift, carina shift, bifurcation angle changes, spasm, or dissection into the SB . If critical stenosis or occlusion of SB develops, rewiring of SB is attempted trying to SB salvage.…”

“…A modification of the provisional stenting strategy called the jailed‐balloon technique (JBT) is designed to increase SB patency. 14 Due to higher occupation of the SB ostium, the SB occlusion is reduced by using the JBT during MV stenting, but cannot fully prevent …”