Long-Term Clinical Outcomes of Final Kissing Ballooning in Coronary Bifurcation Lesions Treated With the 1-Stent Technique

Abstract

In coronary bifurcation lesions, we demonstrated that the 1-stent technique with FKB was associated with a favorable long-term clinical outcome, mainly driven by the reduction of target lesion revascularization in the MV or both vessels as a result of an increase in minimal lumen diameter. (Korean Coronary Bifurcation Stenting Registry II [COBIS II]: NCT01642992).

Prognostic impact of final kissing balloon technique after crossover stenting for the left main coronary artery: from the AOI-LMCA registry

“…Interestingly, the frequency of FKBT after crossover stenting for the LMCA in the present study was higher (78%) than those reported in previous studies (32–35%) [ 11 , 12 ]. Reflecting the operator preferences, there is a wide variation across countries and institutions, regarding the performance of FKBT after crossover stenting for LMCA.…”

“…FKBT is generally advocated after a two-stent strategy for any bifurcation [ 19 , 20 ]. However, the clinical benefits of routine FKBT after a 1-stent strategy appear uncertain at any bifurcation lesion according to the several previous studies [ 8 – 11 ]. The role of FKBT at LMCA bifurcation might be markedly different from that at any other bifurcation, because LMCA bifurcation involves LCX, which is often a large vessel and supplies a large myocardial territory.…”

“…A OCT study noted that FKBT may reduce the frequency of uncovered struts and subclinical thrombus at the side branch orifice, although FKBT did not decrease MACE and TLR in this small cohort [ 22 ]. The COBIS II registry, which included LMCA lesions in 26% of cases, demonstrated that a 1-stent technique with FKBT for any bifurcation lesions was associated with favorable long-term clinical outcomes, whereas a 1-stent strategy with FKBT for LMCA was not associated with better MACE outcomes compared with a 1-stent strategy without FKBT [ 11 ]. Furthermore, two recent single center registries found that midterm clinical outcomes were not significantly different regardless of FKBT after crossover stenting of the LMCA [ 12 , 13 ].…”

Reduction in incomplete stent apposition area caused by jailed struts after single stenting at left main bifurcation lesions: micro-CT analysis using a three-dimensional elastic bifurcated coronary artery model

“…An optical coherence tomography (OCT) study of bifurcation lesions treated with a single DES showed that the frequency of thrombus attachment at side-branch orifices was lower with kissing balloon inflation (KBI) as compared to the frequency of thrombus attachment without KBI, possibly because of the reduction in jailed struts [12]. The Korean multicenter registry trial demonstrated that the single DES strategy with KBI was associated with a lower rate of major adverse cardiac events (MACE) and target lesion revascularization (TLR) than the single DES strategy without KBI [13]. Some reports suggested the importance of KBI from the in vitro and in vivo findings of the optimization of bifurcation treatments [14, 15].…”

Facts speak louder than words

“…Acute intra‐procedural occlusion of a SB is benign in most cases; however, it is not rare, and to some extent, is fatal if a SB diameter is larger (particularly left circumflex or larger diagonal branch). The Korean Coronary Bifurcation Stenting (COBIS) registry study reported a higher rate of permanent occlusion of SBs among acutely occluded daughter vessels with a provisional stenting approach. As such, insight from the protective approaches, including jailed wires or jailed balloons, to build a stratification model predictive of the likelihood of acute SB occlusion is.…”