Peter Mortier1, Yutaka Hikichi2, Nicolas Foin3, Gianluca De Santis4, Patrick Segers5, Benedict Verhegghe4, Matthieu De Beule4. 1. FEops, Ghent, Belgium; IBiTech-bioMMeda, Ghent University, Ghent, Belgium. Electronic address: peter.mortier@feops.com. 2. Department of Cardiovascular Medicine, Saga University, Saga, Japan. 3. International Centre for Circulatory Health, Imperial College London, London, United Kingdom. 4. FEops, Ghent, Belgium; IBiTech-bioMMeda, Ghent University, Ghent, Belgium. 5. IBiTech-bioMMeda, Ghent University, Ghent, Belgium.
Abstract
OBJECTIVES: This study sought to better understand and optimize provisional main vessel stenting with final kissing balloon dilation (FKBD). BACKGROUND: Main vessel stenting with FKBD is widely used, but many technical variations are possible that may affect the final result. Furthermore, most contemporary stent designs have a large cell size, making the impact of stent platform selection for this procedure unclear. METHODS: Finite element simulations were used to virtually deploy and post-dilate 3 stent platforms in 3 bifurcation models. Two FKBD strategies were evaluated: simultaneous FKBD (n = 27) and modified FKBD (n = 27). In the simultaneous FKDB technique, both balloons were simultaneously inflated and deflated. In the modified FKBD technique, the side branch balloon was inflated first, then partially deflated, followed by main branch balloon inflation. RESULTS: Modified FKBD results in less ostial stenosis compared with simultaneous FKBD (15 ± 9% vs. 20 ± 11%; p < 0.001) and also reduces elliptical stent deformation (ellipticity index, 1.17 ± 0.05 vs. 1.36 ± 0.06; p < 0.001). The number of malapposed stent struts was not influenced by the FKBD technique (modified FKBD, 6.3 ± 3.6%; simultaneous FKBD, 6.4 ± 3.4%; p = 0.212). Stent design had no significant impact on the remaining ostial stenosis (Integrity [Medtronic, Inc., Minneapolis, Minnesota], 16 ± 11%; Omega [Boston Scientific, Natick, Massachusetts], 17 ± 11%; Multi-Link 8 [Abbott Vascular, Santa Clara, California], 19 ± 8%). CONCLUSIONS: The modified FKBD procedure reduces elliptical stent deformation and optimizes side branch access.
OBJECTIVES: This study sought to better understand and optimize provisional main vessel stenting with final kissing balloon dilation (FKBD). BACKGROUND: Main vessel stenting with FKBD is widely used, but many technical variations are possible that may affect the final result. Furthermore, most contemporary stent designs have a large cell size, making the impact of stent platform selection for this procedure unclear. METHODS: Finite element simulations were used to virtually deploy and post-dilate 3 stent platforms in 3 bifurcation models. Two FKBD strategies were evaluated: simultaneous FKBD (n = 27) and modified FKBD (n = 27). In the simultaneous FKDB technique, both balloons were simultaneously inflated and deflated. In the modified FKBD technique, the side branch balloon was inflated first, then partially deflated, followed by main branch balloon inflation. RESULTS: Modified FKBD results in less ostial stenosis compared with simultaneous FKBD (15 ± 9% vs. 20 ± 11%; p < 0.001) and also reduces elliptical stent deformation (ellipticity index, 1.17 ± 0.05 vs. 1.36 ± 0.06; p < 0.001). The number of malapposed stent struts was not influenced by the FKBD technique (modified FKBD, 6.3 ± 3.6%; simultaneous FKBD, 6.4 ± 3.4%; p = 0.212). Stent design had no significant impact on the remaining ostial stenosis (Integrity [Medtronic, Inc., Minneapolis, Minnesota], 16 ± 11%; Omega [Boston Scientific, Natick, Massachusetts], 17 ± 11%; Multi-Link 8 [Abbott Vascular, Santa Clara, California], 19 ± 8%). CONCLUSIONS: The modified FKBD procedure reduces elliptical stent deformation and optimizes side branch access.