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Article: Kissing balloon or sequential dilation of the side branch and main vessel for provisional stenting of bifurcations: Lessons from micro-computed tomography and computational simulations

TitleKissing balloon or sequential dilation of the side branch and main vessel for provisional stenting of bifurcations: Lessons from micro-computed tomography and computational simulations
Authors
Issue Date2012
Citation
JACC: Cardiovascular Interventions, 2012, v. 5 n. 1, p. 47-56 How to Cite?
AbstractThis study sought to evaluate post-dilation strategies in bifurcation stenting. In bifurcation stenting practice, it is still controversial how post-dilation should be performed and whether the kissing balloon (KB) technique is mandatory when only the main vessel (MV) receives a stent. A series of drug-eluting stents (DES) (n = 26) were deployed in a coronary bifurcation model following a provisional approach. After the deployment of the stent in the MV, post-dilation with the KB technique was compared with a 2-step, sequential post-dilation of the side branch (SB) and MV without kissing. The percentage of the SB lumen area free of stent struts was similar after KB (79.1 ± 8.7%) and after the 2-step sequence (74.4 ± 11.6%, p = 0.25), a considerable improvement compared with MV stenting only without dilation of the stent at the SB ostium (30.8 ± 7.8%, p < 0.0001). The rate of strut malapposition in the ostium was 21.3 ± 9.2% after KB and 24.9 ± 10.4% after the 2-step sequence, respectively, a significant reduction compared with a simple SB dilation (55.3 ± 16.8%, p < 0.0001) or MV stenting only (47.0 ± 8.5%, p < 0.0005). KB created a significant elliptical overexpansion of the MV lumen, inducing higher stress concentration proximal to the SB. KB also led to a higher risk of incomplete stent apposition at the proximal stent edge (30.7 ± 26.4% vs. 2.8 ± 9.6% for 2-step, p = 0.0016). Sequential 2-step post-dilation of the SB and MV may offer a simpler and more efficient alternative to final KB technique for provisional stenting of bifurcations. © 2012 American College of Cardiology Foundation.
Persistent Identifierhttp://hdl.handle.net/10722/194457
ISSN
2015 Impact Factor: 7.63
2015 SCImago Journal Rankings: 5.063
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorFoin, N-
dc.contributor.authorTorii, R-
dc.contributor.authorMortier, P-
dc.contributor.authorDe Beule, M-
dc.contributor.authorViceconte, N-
dc.contributor.authorChan, PH-
dc.contributor.authorDavies, JE-
dc.contributor.authorXu, XY-
dc.contributor.authorKrams, R-
dc.contributor.authorDi Mario, C-
dc.date.accessioned2014-01-30T03:32:36Z-
dc.date.available2014-01-30T03:32:36Z-
dc.date.issued2012-
dc.identifier.citationJACC: Cardiovascular Interventions, 2012, v. 5 n. 1, p. 47-56-
dc.identifier.issn1936-8798-
dc.identifier.urihttp://hdl.handle.net/10722/194457-
dc.description.abstractThis study sought to evaluate post-dilation strategies in bifurcation stenting. In bifurcation stenting practice, it is still controversial how post-dilation should be performed and whether the kissing balloon (KB) technique is mandatory when only the main vessel (MV) receives a stent. A series of drug-eluting stents (DES) (n = 26) were deployed in a coronary bifurcation model following a provisional approach. After the deployment of the stent in the MV, post-dilation with the KB technique was compared with a 2-step, sequential post-dilation of the side branch (SB) and MV without kissing. The percentage of the SB lumen area free of stent struts was similar after KB (79.1 ± 8.7%) and after the 2-step sequence (74.4 ± 11.6%, p = 0.25), a considerable improvement compared with MV stenting only without dilation of the stent at the SB ostium (30.8 ± 7.8%, p < 0.0001). The rate of strut malapposition in the ostium was 21.3 ± 9.2% after KB and 24.9 ± 10.4% after the 2-step sequence, respectively, a significant reduction compared with a simple SB dilation (55.3 ± 16.8%, p < 0.0001) or MV stenting only (47.0 ± 8.5%, p < 0.0005). KB created a significant elliptical overexpansion of the MV lumen, inducing higher stress concentration proximal to the SB. KB also led to a higher risk of incomplete stent apposition at the proximal stent edge (30.7 ± 26.4% vs. 2.8 ± 9.6% for 2-step, p = 0.0016). Sequential 2-step post-dilation of the SB and MV may offer a simpler and more efficient alternative to final KB technique for provisional stenting of bifurcations. © 2012 American College of Cardiology Foundation.-
dc.languageeng-
dc.relation.ispartofJACC: Cardiovascular Interventions-
dc.titleKissing balloon or sequential dilation of the side branch and main vessel for provisional stenting of bifurcations: Lessons from micro-computed tomography and computational simulations-
dc.typeArticle-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1016/j.jcin.2011.08.019-
dc.identifier.pmid22230150-
dc.identifier.scopuseid_2-s2.0-84862944932-
dc.identifier.volume5-
dc.identifier.issue1-
dc.identifier.spage47-
dc.identifier.epage56-
dc.identifier.isiWOS:000299669000007-

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