François Dérimay1, Gilles Rioufol2, Takeshi Nishi3, Yuhei Kobayashi3, William F Fearon3, Joëlle Veziers4, Patrice Guérin4, Gérard Finet2. 1. Department of Interventional Cardiology, Cardiovascular Hospital and INSERM Unit 1060 CARMEN, Lyon, France; Stanford University Medical Center and Palo Alto VA Health Care Systems, Stanford, CA, USA. Electronic address: francois.derimay@chu-lyon.fr. 2. Department of Interventional Cardiology, Cardiovascular Hospital and INSERM Unit 1060 CARMEN, Lyon, France. 3. Stanford University Medical Center and Palo Alto VA Health Care Systems, Stanford, CA, USA. 4. CHU Nantes, PHU4 OTONN, Nantes, F-44093, France.
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 AND RESULTS: 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 (n = 5/group): i) "proximal", 1 mm before carina; ii) "medium", just at carina; iii) "distal", 1 mm after carina. Results were quantified on 2D- and 3D-OCT. Compared to implantation, initial POT improved malapposition in all positions ("proximal": 61.5 ± 1.4% vs. 5.1 ± 2.7%; "medium": 60.2 ± 2.4% vs. 1.3 ± 0.6%; "distal": 60.5 ± 2.9% vs. 1.1 ± 1.8%, p < 0.05). However, residual malapposition was greater in "proximal" position (p < 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 ± 0.04 vs. 1.11 ± 0.07 for "medium" POT (p < 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").
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 AND RESULTS: 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 (n = 5/group): i) "proximal", 1 mm before carina; ii) "medium", just at carina; iii) "distal", 1 mm after carina. Results were quantified on 2D- and 3D-OCT. Compared to implantation, initial POT improved malapposition in all positions ("proximal": 61.5 ± 1.4% vs. 5.1 ± 2.7%; "medium": 60.2 ± 2.4% vs. 1.3 ± 0.6%; "distal": 60.5 ± 2.9% vs. 1.1 ± 1.8%, p < 0.05). However, residual malapposition was greater in "proximal" position (p < 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 ± 0.04 vs. 1.11 ± 0.07 for "medium" POT (p < 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").
Authors: Francesco Burzotta; Jens Flensted Lassen; Thierry Lefèvre; Adrian P Banning; Yiannis S Chatzizisis; Thomas William Johnson; Miroslaw Ferenc; Sudhir Rathore; Remo Albiero; Manuel Pan; Olivier Darremont; David Hildick-Smith; Alaide Chieffo; Marco Zimarino; Yves Louvard; Goran Stankovic Journal: EuroIntervention Date: 2021-03-19 Impact factor: 6.534