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

Abstract

110YAMAWAKI M et al. Circulation JournalOfficial Journal of the Japanese Circulation Society http://www. j-circ.or.jp oronary bifurcation has been regarded as one of the most challenging lesion subsets due to poor clinical outcomes compared with non-bifurcated lesions. 1 Provisional intervention of the side branch (SB) after main vessel (MV) stenting is now the standard approach for most bifurcations. 2,3 Although the final kissing balloon technique (FKB) has been established as the first-line strategy for bifurcations treated with an elective 2-stent approach, 4,5 its efficacy in a 1-stent approach is presently under debate. 6,7 Randomized trials showed no benefit of FKB in a 1-stent approach; 8,9 however, the long-term clinical outcome remains unclear as limited data is currently available. 6,10 The purpose of the present study is to: (1) investigate the long-term outcomes after a 1-stent approach with and without FKB; and (2) to ascertain the clinical outcome after cross-over stenting without FKB in comparison with non-bifurcation patients. MethodsThis study is a sub-analysis of the TAXUS Japan Postmarket Surveillance Study (TAXUS-PMS), which evaluated the safety and performance of a paclitaxel-eluting stent (PES; TAXUS

Optimal Revascularization Strategy on Medina 0,1,0 Left Main Bifurcation Lesions in Type 2 Diabetes

“…Our computational findings are in keeping with the results because, in our considered models, although we simulated a relative tight residual stenosis in the LCX ostium after crossover technique, the distal LCX flow was not significantly affected. Regarding whether the final kissing balloon inflation should be performed after crossover stenting, our findings are in keeping with the results of clinical trials that documented that kissing inflation can be avoided in bifurcation lesions uneventfully treated with crossover technique [ 23 , 24 ]. Recent studies have demonstrated that a stent-induced increase in lumen diameter of the distal MV forces the position of the carina into the SB ostium and this carina shift is the main mechanism of the SB narrowing after MV stent implantation [ 25 , 26 ].…”

Effect of Final Kissing Balloon Dilatation after One-stent Technique at Left-main Bifurcation

“…Randomized trials comparing simple and complex techniques for non-left-main (LM) coronary bifurcation disease demonstrated that provisional one-stent is easier and not inferior to two-stent technique. [ 1 2 3 4 5 ] Although the provisional one-stent approach is now regarded as standard technique for most non-LM bifurcation lesions,[ 6 ] three studies reached inconsistent conclusions on necessity of final kissing ballooning (FKB) after main vessel stenting,[ 7 8 9 ] and there are no studies on FKB in LM bifurcation lesions. [ 10 11 12 13 14 15 16 17 18 19 20 ] So, whether FKB dilatation after one-stent implantation at LM bifurcation site remains unclear currently.…”

Mini‐ versus classical kissing balloon inflation in provisional technique for bifurcation intervention

“…However, further studies showed that, despite using POT, C‐KBI in the provisional stenting strategy could not improve the angiographic or the clinical outcomes . This was mainly attributed to the geometric deformation of the MV stent and MV intimal injury, both of which might result in suboptimal MV outcomes …”