Modified jailed balloon technique: a novel technique to avoid side-branch occlusion regarding PCI for bifurcation lesions (Shishido K.,..., Saito S. EuroIntervention, 6 May 2016)

AIMS
Side branch (SB) occlusion after main branch (MB) stenting is accompanied by a serious complication during bifurcation angioplasty. We introduce a new systematic approach in bifurcation lesions and report the first clinical experience.

METHODS AND RESULTS
The bench test confirmed safety for the new technique. The modified jailed balloon technique was applied for a bifurcation lesion. After crossing guidewires into both branches, a jailed balloon was introduced into the SB, while a stent was placed in the MB as crossing the SB. The size of the jailed balloon was uniformly decided to be a half of the stent size in the MB. The proximal position of the jailed balloon was adjusted as only about 1 mm of part of it was overlapping with the MB stent. Both stent and jailed balloon were simultaneously inflated with the same pressure. After pulling out the stent balloon and the jailed balloon, guidewires were re-crossed. If ballooning or stenting in the SB was considered necessary, kissing balloon inflation (KBI) and/or T And small Protrusion (TAP) stenting were applied.
Between February 2015 and November 2015, 159 patients (171 bifurcation lesions including 36 left main trunk disease) underwent percutaneous coronary intervention using this modified jailed balloon technique. If the target lesion located involved a bifurcation with a non-negligible SB, the modified jailed balloon technique was applied without any exclusion. Among these patients, transradial intervention was performed in 145 patients (91.2%). A 6 Fr guiding catheter was mostly used (153 patients, 89.5%). The mean main branch stent diameter was 3.2+/-0.4 mm, and the mean side branch balloon diameter was 1.6+/-0.3 mm at stent deployment using the modified jailed balloon technique. Procedure success was achieved in all cases (100%). KBI was performed for 128 lesions (74.9%) and TAP stenting was employed for 22 lesions (12.9%). Occlusion in the SB was not documented in these patients.

CONCLUSIONS
This is the first report of clinical experiences using the modified jailed balloon technique. This novel technique can be safe and feasible for complex bifurcation lesions.

 

Mini crush technique