Functional Formula to Determine Adequate Balloon Diameter of Simultaneous Kissing Balloon Technique for Treatment of Bifurcated Coronary Lesions  Clinical Validation by Volumetric Intravascular Ultrasound Analysis

Morino, Yoshihiro; Yamamoto, Hiroaki; Mitsudo, Kazuaki; Nagaoka, Masakazu; Takeuchi, Hiroki; Okamoto, Nobuhiko; Ken, Kozuma; Matsuzaki, Akinobu; Tanabe, Kengo; Hara, Kazuhiro; Tanabe, T.; Ikari, Yuji

doi:10.1253/circj.72.886

Cited by 18 publications

(8 citation statements)

References 24 publications

(22 reference statements)

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“…Theoretically, the dilated balloon areas in daughter branches are maintained in the MoV (Figure 1A), and the sum of these areas is ideally identical to the MoV luminal area, thus the following formula (Mitsudo's law) is introduced: D MoV 2 =D MB 2 +D SB 2 . An IVUS study of the left main bifurcation revealed that the mean MoV stent diameter was significantly correlated with Mitsudo's law 28 . Another IVUS analysis of normal and diseased bifurcation revealed that vessel size of the external elastic membrane obeyed Murray's law 29 .…”

Section: Selection Of Balloon Sizementioning

confidence: 99%

Final kissing balloon inflation: the whole story

Murasato¹,

Finet²,

Foin³

2015

EuroIntervention

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Final kissing balloon inflation (KBI) after provisional bifurcation stenting has failed to provide clear clinical benefit except for a decrease in side branch stenosis, while a significant reduction of major adverse cardiac events has been documented in two-stent deployment. The optimisation of KBI in terms of proximal optimisation technique, appropriate guidewire re-crossing, minimal balloon overlapping, and balloon size selection may overcome the drawbacks of conventional KBI by: 1) correcting the proximal malapposition expected from fractal geometry; 2) optimising side branch ostium strut opening while conserving a bifurcation area free of malapposition at both the carina and the side branch ostium; and 3) optimising the geometry, velocity fields and shear rate.

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Section: Selection Of Balloon Sizementioning

confidence: 99%

Final kissing balloon inflation: the whole story

Murasato¹,

Finet²,

Foin³

2015

EuroIntervention

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“…The proximal MV balloon size for FKI was measured as theoretical mean hugging balloon diameter, as defined in a previous study. 12 age and thrombus formation. 8- 10 Thus, the purpose of the retrospective study was to assess the local tissue changes and thrombus formation at 6-12 months after DES implantation using OCT, and its impact on long-term clinical events.…”

Section: Qcamentioning

confidence: 99%

Potential Benefit of Final Kissing Balloon Inflation After Single Stenting for the Treatment of Bifurcation Lesions

Hasegawa

Shinke

Otake

et al. 2013

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp benefit of routine FKI after single stenting of bifurcation lesions. 6 In addition, inadequate side-branch dilatation may result in stent deformation or incomplete stent apposition. 7 In contrast, quantitative coronary angiography (QCA) conducted in the Nordic-Baltic Bifurcation Study III showed better expansion of the side-branch orifice in the FKI group. 6 Because delayed arterial healing characterized by exposed stent struts is considered a possible risk factor for stent thrombosis, 8 struts floating at the side-branch orifice (jailing strut) could affect thrombus formation after DES implantation. Despite these controversies, the relationship between stenting strategies and local findings, such as stent apposition, thrombus formation, and neointimal coverage, which may be associated with long-term clinical outcome, has not been well evaluated to date.Several studies have shown that the high resolution of optical coherence tomography (OCT) enables visualization of coronary arteries at the micron level for evaluation of strut coverercutaneous coronary intervention (PCI) using drugeluting stents (DES) reduces restenosis and major adverse cardiac events (MACE) compared to PCI with bare metal stents. 1 Even in the DES era, however, the procedures for bifurcation remain complex and challenging. 2,3 The single-stent strategy is currently considered preferable because the 2-stent strategy has higher rates of periprocedural myocardial infarction and long-term MACE, 4,5 which is probably associated with the increased use of contrast and prolonged procedure time. Therefore, a 1-stent strategy with a provisional approach to the side branch with final kissing inflation (FKI) might be the most acceptable strategy in clinical practice.Recently, the Nordic-Baltic Bifurcation Study III, a randomized comparison of clinical outcomes in patients with coronary bifurcation lesions treated with FKI vs. without FKI after main vessel (MV) stenting, found a similar 6-month clinical outcome between the 2 groups, raising questions regarding the Background: Treatment of coronary bifurcation lesions using a single stenting strategy is preferable over that using a 2-stent technique. The benefit of final kissing inflation (FKI), however, has not been established.

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“…Balloon to artery ratio (post‐balloon size divided by reference vessel diameter) was determined for each segments. In regard to post‐dilatation balloon size in proximal MV, theoretical hugging balloon size for final kissing‐balloon inflation (FKI) and proximal optimization technique (POT)‐balloon size for POT were used. Stent diameter was used in case of without post‐dilatation.…”

Section: Methodsmentioning

confidence: 99%