François Dérimay1, Gilles Rioufol2, Guillaume Cellier2, Géraud Souteyrand3, Gérard Finet2. 1. Department of Interventional Cardiology, Cardiovascular Hospital and Claude Bernard University and INSERM Unit 1060 CARMEN, Lyon, France. Electronic address: fderimay@hotmail.fr. 2. Department of Interventional Cardiology, Cardiovascular Hospital and Claude Bernard University and INSERM Unit 1060 CARMEN, Lyon, France. 3. Cardiology Department, Clermont-Ferrand University Hospital Center, Clermont-Ferrand, France.
Abstract
AIMS: Initial proximal optimization technique (POT) in provisional stenting improves global malapposition, side-branch (SB) obstruction (SBO) and conservation of arterial circularity. The specific mechanical effects of a final POT sequence concluding the main provisional stenting techniques, on the other hand, are unknown. METHODS AND RESULTS: Synergy™ stents were implanted on fractal coronary bifurcation bench models using the main provisional stenting techniques (n = 5 per group): kissing-balloon inflation (KBI), snuggle, and rePOT (initial POT + SB inflation + final POT). Final results were quantified on 2D and 3D OCT before and after final POT. Whichever the technique, final POT significantly decreased global malapposition (from 7.6 ± 5.3% to 2.2 ± 2.5%, p < 0.05) and proximal elliptic deformation (from 1.15 ± 0.07 to 1.09 ± 0.04, p < 0.05), without impact on SBO (from 11.5 ± 9.6% to 12.9 ± 10.6%, NS). However, final POT failed to completely correct the elliptic deformation induced by balloon juxtaposition during the KBI and snuggle techniques, with final elliptic ratios of 1.11 ± 0.03 and 1.11 ± 0.04 respectively, significantly higher than with the complete rePOT sequence: 1.05 ± 0.02 (p < 0.05). CONCLUSIONS: Like initial POT, final POT is recommended whatever the provisional stenting technique used. However, final POT fails to completely correct all proximal elliptic deformation associated with "kissing-like" techniques, in contrast to results with the rePOT sequence.
AIMS: Initial proximal optimization technique (POT) in provisional stenting improves global malapposition, side-branch (SB) obstruction (SBO) and conservation of arterial circularity. The specific mechanical effects of a final POT sequence concluding the main provisional stenting techniques, on the other hand, are unknown. METHODS AND RESULTS: Synergy™ stents were implanted on fractal coronary bifurcation bench models using the main provisional stenting techniques (n = 5 per group): kissing-balloon inflation (KBI), snuggle, and rePOT (initial POT + SB inflation + final POT). Final results were quantified on 2D and 3D OCT before and after final POT. Whichever the technique, final POT significantly decreased global malapposition (from 7.6 ± 5.3% to 2.2 ± 2.5%, p < 0.05) and proximal elliptic deformation (from 1.15 ± 0.07 to 1.09 ± 0.04, p < 0.05), without impact on SBO (from 11.5 ± 9.6% to 12.9 ± 10.6%, NS). However, final POT failed to completely correct the elliptic deformation induced by balloon juxtaposition during the KBI and snuggle techniques, with final elliptic ratios of 1.11 ± 0.03 and 1.11 ± 0.04 respectively, significantly higher than with the complete rePOT sequence: 1.05 ± 0.02 (p < 0.05). CONCLUSIONS: Like initial POT, final POT is recommended whatever the provisional stenting technique used. However, final POT fails to completely correct all proximal elliptic deformation associated with "kissing-like" techniques, in contrast to results with the rePOT sequence.
Authors: Indulis Kumsars; Niels Ramsing Holm; Matti Niemelä; Andrejs Erglis; Kari Kervinen; Evald Høj Christiansen; Michael Maeng; Andis Dombrovskis; Vytautas Abraitis; Aleksandras Kibarskis; Thor Trovik; Gustavs Latkovskis; Dace Sondore; Inga Narbute; Christian Juhl Terkelsen; Markku Eskola; Hannu Romppanen; Mika Laine; Lisette Okkels Jensen; Mikko Pietila; Pål Gunnes; Lasse Hebsgaard; Ole Frobert; Fredrik Calais; Juha Hartikainen; Jens Aarøe; Jan Ravkilde; Thomas Engstrøm; Terje K Steigen; Leif Thuesen; Jens F Lassen Journal: Open Heart Date: 2020-01-19