Optimal balloon positioning for the proximal optimization technique? An experimental bench study.
Int J Cardiol
; 292: 95-97, 2019 10 01.
Article
in En
| MEDLINE
| ID: mdl-31130279
ABSTRACT
AIMS:
The proximal optimization technique (POT) in coronary bifurcation stenting improves apposition and side-branch obstruction. The POT balloon should be positioned with the distal radio-opaque marker at the carina cut plane. However, the real impact of positioning remains unknown. METHODS ANDRESULTS:
Synergy™ stents (Boston Scientific, USA) were implanted on left-main fractal bench models. Initial POT was performed in 3 positions according to distal shoulder position (loss of balloon parallelism) relative to the carina cut plane (nâ¯=â¯5/group) i) "proximal", 1â¯mm before carina; ii) "medium", just at carina; iii) "distal", 1â¯mm after carina. Results were quantified on 2D- and 3D-OCT. Compared to implantation, initial POT improved malapposition in all positions ("proximal" 61.5⯱â¯1.4% vs. 5.1⯱â¯2.7%; "medium" 60.2⯱â¯2.4% vs. 1.3⯱â¯0.6%; "distal" 60.5⯱â¯2.9% vs. 1.1⯱â¯1.8%, pâ¯<â¯0.05). However, residual malapposition was greater in "proximal" position (pâ¯<â¯0.05). "Proximal", unlike "medium" or "distal" POT, also failed to improve side-branch obstruction. Conversely, "distal" POT significantly overstretched the main-branch ostium, with stent/artery ratio 1.22⯱â¯0.04 vs. 1.11⯱â¯0.07 for "medium" POT (pâ¯<â¯0.05).CONCLUSION:
Shoulder positioning is essential to optimize the mechanical benefit of POT without main-branch overstretch (too distal position). Experimentally, the best position is just at the carina cut plane ("medium").
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Angioplasty, Balloon, Coronary
/
Stents
Language:
En
Journal:
Int J Cardiol
Year:
2019
Document type:
Article