A Novel ‘Bailout Switch Crush Technique’ for a Jailed Side Branch Unable to Rewire
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ABSTRACT:
SUBMITTER: Roh J
PROVIDER: S-EPMC8558566 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:ObjectivesThis study aimed to investigate the optimal jailed balloon inflation in the side branch during the modified jailed balloon technique for bifurcated lesions.BackgroundThe modified jailed balloon technique is one of the effective techniques to minimize the emergence of side branch (SB) compromise by preventing plaque or carina shifting during a single stent strategy in the main vessel with provisional SB treatment. However, there are no detailed studies on the method of optimal jailed balloon inflation.MethodsWe analyzed 51 consecutive patients who underwent percutaneous coronary intervention (PCI) for bifurcated lesions with a modified jailed balloon technique between September 2018 and December 2020. These 51 patients were divided into two groups according to the magnitude of inflation pressure of the jailed balloon: a higher pressure (HP) group and lower pressure (LP) group.ResultsNo significant differences in procedural outcomes were observed between the two groups. The findings of SB compromise were relatively common with our procedure (30.0% in the HP group; 33.3% in the LP group). The patterns of SB compromise such as dissection or stenosis increase were observed at similar frequencies between them. In particular, SB dissection was noted in the SB lesion with some plaque burden, irrespective of the magnitude of the jailed balloon inflation pressure. Univariate analysis showed that calcification in the main vessel and SB lesion length was significantly associated with SB compromise. Finally, all PCI procedures were successfully completed without any provisional stent deployment in SB.ConclusionsWe speculate that lesion characteristics rather than the PCI procedural factors may be critical determinants to cause SB compromise.
| S-EPMC7906823 | biostudies-literature
Project description:BackgroundThere is controversy regarding the effectiveness the of jailed wire technique (JWT) and jailed balloon technique (JBT) in preserving the side branch (SB) during treatment. This study compares the protective effect of JBT versus JWT on the SB ostium area in coronary bifurcation lesions using three-dimensional optical coherence tomography (3D-OCT).MethodsWe obtained data from coronary heart disease patients who received OCT-guided percutaneous coronary intervention (PCI) for bifurcation lesions. The SB protection strategies were divided into JWT and JBT, with the latter further subdivided into active JBT (A-JBT) and conventional JBT (C-JBT). The primary endpoint was the SB ostium area difference measured by 3D-OCT before and after PCI. Partial correlation analysis and propensity score matching (PSM) was used to mitigate confounding biases.ResultsA total of 207 bifurcation lesions from 191 patients were analyzed, including 136 lesions treated with JWT and 71 lesions treated with JBT. The SB ostium area was significantly greater in the JBT group compared to the JWT group (0.41 ± 1.22 mm2 vs. -0.25 ± 1.40 mm2, p = 0.001). Following 1:1 PSM to adjust for 60 pairs, the difference between groups was not statistically significant (0.28 ± 1.06 mm2 vs. -0.02 ± 1.29 mm2, p = 0.165). Subgroup analysis revealed that A-JBT provided superior protection in both true (0.47 ± 1.22 mm2 vs. -0.10 ± 1.10 mm2, p = 0.011) and non-true bifurcation lesions (0.56 ± 1.43 mm2 vs. -0.38 ± 1.62 mm2, p = 0.030) over JWT, while C-JBT provided protection similar to JWT. A positive partial correlation was observed between the diameter of the jailed balloon and the increase in SB ostium area (r = 0.296, p = 0.013).ConclusionsOverall, A-JBT, but not C-JBT, provided better protection in bifurcation lesions compared to JWT. The larger diameter of the jailed balloon, rather than the application of higher pressure, enhanced the SB protection.
| S-EPMC11366982 | biostudies-literature
Project description:The primary concern in percutaneous coronary intervention for bifurcation lesions is occlusion of a side branch after stenting of a main branch, especially in high-risk patients. We describe a novel technique, consecutive jailed- and kissing-Corsair technique, using a Corsair microcatheter for protection of side branches in bifurcation lesions.
| S-EPMC6813143 | biostudies-literature
Project description:AimThe aim of this study was to explore the potential intraprocedural benefits of the Proximal Side Optimization (PSO) technique by Optical Coherence Tomography (OCT).MethodsA case series of 10 consecutive true bifurcation lesions, with severe long pathology of long side branch (SB), were randomly assigned to be treated by standard DK Crush procedure (non-PSO group) as compared to DK Crush in PSO modification (PSO group). The data from OCT investigation before crushing of the SB Drug-Eluting Stent (DES), after crushing, after first kissing balloon inflation (KBI), and after final angiography were compared between the two groups (Public trials registry ISRCTN23355755).ResultsAll 10 cases were successfully treated by the assigned technique. The two groups were similar in terms of indications for the procedure, bifurcation angle, and stent dimensions. As compared to the non-PSO, the PSO group showed larger proximal SB stent areas (5.8 ± 1.8 vs. 4.5 ± 0.5 mm2; p = 0.02), the larger delta between distal and proximal stent areas before crush (1.5 ± 0.7 vs. 0.6 ± 0.5 mm2; p = 0.004), and the larger Space of Optimal Wiring (SOW) after Crush (5.3 ± 1.8 vs. 2.5 ± 1.1 mm2; p = 0.02). The gaps in scaffolding within the ostial segment of the Side Branch DES were found in two patients from the non-PSO group.ConclusionThe DK Crush in PSO modification results in larger SB DES and SOW areas with better apposition to the vessel wall. As result, the SB DES acquires a funnel shape, which reduces the risk of passage outside the SB stent struts during re-wiring, thus, allowing predictable and secure results.
| S-EPMC8965003 | biostudies-literature
Project description:An important therapeutic modality for heart failure with left ventricular dyssynchrony, left ventricular lead placement, cannot be achieved due to anatomic challenges in some cases. In the current case, a novel implantation technique to overcome an anatomic difficulty, angled takeoff of the side branch of the coronary sinus, was presented.
| S-EPMC5891404 | biostudies-literature
Project description:According to data from stent-enhanced three-dimensional optical coherence tomography, incomplete stent apposition after side branch dilation in coronary bifurcation stenting can be reduced by the free carina type (no links bridged from a carina) and by distal cell rewiring. This is the first report to describe a bent stent technique that was devised to achieve the free carina type (no links bridged from a carina), as a favorable jailing configuration.
| S-EPMC4819094 | biostudies-literature
Project description:This study introduces a case in which our novel "Transarterial Snare-Upholding REcovery technique for COMpletely pulled out LV wire for TAVR valve Insert system (TSURECOMI) technique" with snares was successfully performed for bailout of a transcatheter heart valve during transcatheter aortic valve replacement. (Level of Difficulty: Advanced.).
| S-EPMC8387829 | biostudies-literature
Project description:BackgroundDespite advancements in the devices and techniques used for percutaneous coronary intervention, side branch (SB) wiring remains highly challenging in certain complex bifurcation intervention cases.Methods and resultsIn this report, we demonstrate the efficacy and safety of the balloon block and support technique (BBST), which comprises inflation of an appropriately sized balloon 1-2 mm distal from the carina in the distal main branch to facilitate wire access to the SB. Between June 2012 and July 2017, we utilized the BBST as a bail-out strategy for six bifurcation cases with difficult SB wiring. In this report, we present in detail the oldest and the most recent of those cases to illustrate the use of the BBST. As a bail-out strategy, the BBST successfully facilitated SB wiring. No BBST-related complications were observed.ConclusionsThe BBST may be an efficient and safe method for facilitating SB wiring in complex bifurcation intervention cases and could be used as a bail-out technique.
| S-EPMC5779781 | biostudies-literature
Project description: Not available
| S-EPMC10015475 | biostudies-literature
Project description:ObjectivesTo analyze the impact of different techniques of lesion preparation of severely calcified coronary bifurcation lesions.BackgroundThe impact of different techniques of lesion preparation of severely calcified coronary bifurcation lesions is poorly investigated.MethodsWe performed an as-treated analysis on 47 calcified bifurcation lesions treated with scoring/cutting balloons (SCB) and 68 lesions treated with rotational atherectomy (RA) in the PREPARE-CALC trial. Compromised side branch (SB) as assessed in the final angiogram was the primary outcome measure and was defined as any significant stenosis, dissection, or thrombolysis in myocardial infarction flow <3.ResultsTrue bifurcation lesions were present in 49% vs. 43% of cases in the SCB and RA groups, respectively. After stent implantation, SB balloon dilatation was necessary in around one-third of cases (36% vs. 38%; p = 0.82), and a two-stent technique was performed in 21.3% vs. 25% (p = 0.75). At the end of the procedure, the SB remained compromised in 15 lesions (32%) in the SCB group and 5 lesions (7%) in the RA group (p = 0.001). Large coronary dissections were more frequently observed in the SCB group (13% vs. 2%; p = 0.02). Postprocedural levels of cardiac biomarkers were significantly higher in patients with a compromised SB at the end of the procedure.ConclusionsIn the PREPARE-CALC trial, side branch compromise was more frequently observed after lesion preparation with SCB as compared with RA. Consequently, in calcified bifurcation lesions, an upfront debulking with an RA-based strategy might optimize the result in the side branch.
| S-EPMC7673940 | biostudies-literature