Modified kissing balloon inflation associated with better results after Culotte stenting for bifurcation lesions: A bench test

• Published in: Catheterization and cardiovascular interventions 2020-07, Vol.96 (1), p.E34-E44
• Main Authors: Liu, Jia, Li, Li, Chen, Can, Wei, Jianrui, Chen, Xiwei, Li, Biao, Chen, Yaogui, Luo, Jingyun, Chen, Shao‐Liang
• Format: Article
• Language: English
• Subjects: Angioplasty, Balloon, Coronary - adverse effects; Angioplasty, Balloon, Coronary - instrumentation; Apposition; Balloon treatment; bifurcation lesions; Coronary Artery Disease - therapy; Coronary Vessels - diagnostic imaging; Culotte technique; Equipment Failure Analysis; Humans; Implants; kissing balloon inflation; Materials Testing; Microscopy; Models, Anatomic; Models, Cardiovascular; Optimization techniques; Prosthesis Failure; Scanning electron microscopy; Stents
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.28497

Background Main vessel (MV) stent deformation and overstretch caused by classical kissing balloon inflation (C‐KBI) using two balloons with a longer overlapping in the MV for bifurcation lesions has caused a widespread concern. Purpose This bench study tested our hypothesis that mini‐KBI (M‐KBI) with a shorter protrusion of side branch (SB) balloon would ascertain a better result after Culotte stenting. Methods Twenty‐four coronary stents were deployed using Culotte approach in twelve bifurcation models with a bifurcation angle of 45°, 3.5 mm in MV diameter, and 3.0 mm in SB diameter. After stent implantation, the final KBI were assigned to C‐KBI (two kissing balloons juxtaposed within the MV stent, at least overlap for 3 mm; n = 6) and M‐KBI (the proximal marker of SB balloon just sited at the level of upper edge of SB ostium; n = 6). Proximal optimization technique (POT) was performed after KBI. Stent geometry was visually evaluated based on bench photos, microscopy, videoscopy, micro‐CT, and scanning electron microscopy. Stent deformation index, minimal lumen diameter, and cross‐sectional area at either carina level of MV and ostium of SB were measured from optical coherence tomography (OCT). Results In Culotte technique, C‐KBI was associated with visually significant stent deformation, overexpansion and the “bottleneck” effect of the MV stent, which could not be effectively rectified by POT, while M‐KBI could keep the circle shape of MV stent with good stent apposition in both MV and SB stent. By quantitative measurements, deformation index of MV was 0.06 ± 0.01 after M‐KBI, significantly lower than 0.25 ± 0.02 if C‐KBI was performed. In the line in carina, compared to C‐KBI, M‐KBI has smaller CSA‐stent/CSA‐reference, which indicated a less overstretch of MV stent. However, minimal lumen diameter and cross‐sectional area of SB ostium was not different in the mini‐KBI group (3.0958 ± 0.0285 mm and 7.9667 ± 0.1741 mm), when compared those after C‐KBI (3.1217 ± 0.0772 mm and 7.9083 ± 0.3115 mm, p > .05). Conclusions Followed by POT, M‐KBI is preferable than C‐KBI in preventing stent deformation, overexpansion in MV stent and could get well apposed of MV stent and well‐opened SB stent as expected in a Culotte technique.