In-stent Anchoring Technique Facilitates The Delivery Of Side Branch Balloon During Bifurcation PCI

Background and AimsBifurcation lesions are common in percutaneous coronary intervention.However,the treatment of bifurcation lesions is still limited by the low success rate of procedures,high rate of angiographic restenosis,and poor clinical outcomes.In the treatment of bifurcation lesions,Kissing Balloon inflation is recommended for all double stent strategies to optimize stent position,correct stent distortions or distortions,reduce angiography side branch(re)stenosis,and improve clinical outcomes.Kissing Balloon inflation is also recommended for provisional stenting when a significant side branch ostial lesion(stenosis> 75% or TIMI <3)is presence after the stent implantation of main vessel.However,using a conventional balloon for recrossing an impaired or obstructed side branch is hard,which may be obstructed by the ostial plaque or the stent struts.We have previously reported an improved in-stent anchoring technique,which allows easy balloon delivery and avoid to injure the vessel of anchored area.The aim of this study is to assess whether the in-stent anchoring technique is safe and effective in improving the final kissing balloon delivery by follow-up.Methods159 consecutive patients with bifurcation(166 bifurcation lesions)were enrolled in this study from December 2012 to March 2015 in the Department of Cardiology,Xinqiao Hospital.If the conventional techniques,including the use of low-profile balloons,were unsuccessful,in-stent anchoring was proceeded as a bailout method.The technique success was defined as the side branch recrossing successfully and final kissing balloon delivery performed.The patients were followed up for major adverse cardiovascular events(MACEs)and stent thrombosis(ST).The data obtained from the follow-up were analyzed by SPSS 18.0 Chinese version.ResultsWe successfully performed the kissing balloon delivery with conventional techniques in 149 of the 166 bifurcation lesions with success rate of 89.8%.Recrossing the main vessel stent strut was unsuccessful in the remaining 17 bifurcation lesions(10.2%),therefore,in-stent anchoring was used as a bailout method.Recrossing the main vessel stent strut was successful in 15(88.2%)Of these 17 bifurcation lesions,and the final kissing balloon delivery was achieved.Finally,the final kissing balloon delivery were performed in 164 of the 166 bifurcation lesions(98.8%),and the success rate was 100% in the single stent group and 97.6% in the double stent group.Two cases of unsuccessful recrossing the main vessel stent strut were complicated bifurcation lesions with significant calcification.There was no Vascular dissection in the anchored area.The patients were followed up for at least 9 months,with a mean follow-up of 11 months.The incidence of major adverse cardiovascular events(MACEs)was 8.18%.There were 3 confirmed stent thrombosis.ConclusionsWhen recrossing the main vessel stent strut with a low-profile balloons or other conventional technology was not successful,the in-stent anchoring technique is a safe and effective Choice as a bailout method.However,further large-scale trial evaluation is necessary.