Author + information
- Received February 3, 2015
- Revision received March 31, 2015
- Accepted May 5, 2015
- Published online August 24, 2015.
- Gérard Finet, MD, PhD∗∗ (, )
- François Derimay, MD, MSc∗,
- Pascal Motreff, MD, PhD†,
- Patrice Guerin, MD, PhD‡,
- Paul Pilet, B Eng‡,
- Jacques Ohayon, PhD§,
- Olivier Darremont, MD‖ and
- Gilles Rioufol, MD, PhD∗
- ∗Department of Interventional Cardiology, Cardiovascular Hospital and Claude Bernard University and INSERM Unités Mixtes de Recherche 1060, Lyon, France
- †Cardiology Department, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France
- ‡Cardiology, Unités Mixtes de Recherche 915, l'Institut du Thorax, Nantes, France
- §Laboratory TIMC-IMAG, DynaCell, Centre National de la Recherche Scientifique, Unités Mixtes de Recherche 5525, Institut de l’Ingénierie et de l’Information de Santé (In3S), Grenoble, France
- ‖Clinique Saint Augustin, Bordeaux, France
- ↵∗Reprint requests and correspondence:
Prof. Gérard Finet, Département de Cardiologie, Hôpital Cardiologique L. Pradel, B.P Lyon-Monchat, 69394 Lyon Cedex 03, France.
Objectives This study used a fractal bifurcation bench model to compare 6 optimization sequences for coronary bifurcation provisional stenting, including 1 novel sequence without kissing balloon inflation (KBI), comprising initial proximal optimizing technique (POT) + side-branch inflation (SBI) + final POT, called “re-POT.”
Background In provisional bifurcation stenting, KBI fails to improve the rate of major adverse cardiac events. Proximal geometric deformation increases the rate of in-stent restenosis and target lesion revascularization.
Methods A bifurcation bench model was used to compare KBI alone, KBI after POT, KBI with asymmetric inflation pressure after POT, and 2 sequences without KBI: initial POT plus SBI, and initial POT plus SBI with final POT (called “re-POT”). For each protocol, 5 stents were tested using 2 different drug-eluting stent designs: that is, a total of 60 tests.
Results Compared with the classic KBI-only sequence and those associating POT with modified KBI, the re-POT sequence gave significantly (p < 0.05) better geometric results: it reduced SB ostium stent-strut obstruction from 23.2 ± 6.0% to 5.6 ± 8.3%, provided perfect proximal stent apposition with almost perfect circularity (ellipticity index reduced from 1.23 ± 0.02 to 1.04 ± 0.01), reduced proximal area overstretch from 24.2 ± 7.6% to 8.0 ± 0.4%, and reduced global strut malapposition from 40 ± 6.2% to 2.6 ± 1.4%.
Conclusions In comparison with 5 other techniques, the re-POT sequence significantly optimized the final result of provisional coronary bifurcation stenting, maintaining circular geometry while significantly reducing SB ostium strut obstruction and global strut malapposition. These experimental findings confirm that provisional stenting may be optimized more effectively without KBI using re-POT.
Boston Scientific France and Terumo France provided all stent samples, unconditionally, for this study. Dr. Motreff has served as a consultant for St. Jude Medical, Abbott Vascular, and Terumo. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Finet and Derimay contributed equally to this work.
- Received February 3, 2015.
- Revision received March 31, 2015.
- Accepted May 5, 2015.
- 2015 American College of Cardiology Foundation