Kissing Balloon Inflation in Percutaneous Coronary Interventions

Abstract

Bifurcation lesions are the most frequently approached complex coronary lesions in everyday interventional practice. Bifurcations complexity relies essentially on their very specific anatomy that is imperfectly handled by current coronary devices and, despite dedicated techniques and drug-eluting stents, percutaneous coronary interventions directed toward the treatment of bifurcations are technically demanding and require proper execution. Kissing balloon (KB) inflation was the first specific bifurcation technique to have been developed for percutaneous bifurcation interventions and continues to currently play an important role. Indeed, KB has been proposed to optimize stent apposition, improve side branch access while correcting stent deformation or distortion. Over the years, the KB technique has been deeply investigated by many different methods, from bench testing and computer simulations to in vivo intravascular imaging and clinical studies, producing a large amount of data pointing out the benefits and limitations of the technique. We sought to provide here a comprehensive overview of all those aspects.

Long-Term Clinical Outcome of a Single Stent Approach With and Without a Final Kissing Balloon Technique for Coronary Bifurcation

“…22 Technical improvements to the FKB technique have been proposed, including rewiring through cell struts near the carina, appropriate selection of balloon size (avoiding usage of smaller MV kissing balloon diameter than that for the deploying balloon), simultaneous balloon deflation in both vessels, and non-compliant balloon use. 23- 27 The FKB, using these technical considerations and newer generation DES, coupled with longer-term follow up, might be crucial to clarify the benefit of it in a 1-stent approach.…”

Computational fluid dynamic simulations of image-based stented coronary bifurcation models

“…The authors examined the different haemodynamic scenarios provoked by the final kissing balloon (FKB) inflation performed with a proximal or a distal access to the SB. This procedure consists of the simultaneous expansion of two balloons in both the branches and usually concludes the PSB [7]. The haemodynamic influence of the FKB was also studied by Foin et al [8] comparing this technique with a simpler two-step sequential post-dilatation of the SB and MB.…”

Clinical outcomes after final kissing balloon inflation compared with no final kissing balloon inflation in bifurcation lesions treated with a dedicated coronary bifurcation stent

“…One of the most deeply investigated is the final kissing balloon inflation (FKBI) technique 11. In general, with the FKBI technique, two balloons are introduced over two separate guide wires: one balloon is positioned in the SB while the other is placed in the MB crossing the SB.…”

“…In general, with the FKBI technique, two balloons are introduced over two separate guide wires: one balloon is positioned in the SB while the other is placed in the MB crossing the SB. The balloons are inflated simultaneously, opening the SB while preventing geometric distortions in the MB 11. Currently, there is consensus that FKBI is mandatory in complex two-stent bifurcation techniques,12 based on non-randomised studies evaluating the crush13–15 and culotte16 two-stent techniques.…”