Author + information
- Received June 18, 2013
- Revision received August 21, 2013
- Accepted September 26, 2013
- Published online March 1, 2014.
- Peter Mortier, PhD∗,†∗ (, )
- Yutaka Hikichi, MD‡,
- Nicolas Foin, PhD§,
- Gianluca De Santis, PhD∗,†,
- Patrick Segers, PhD†,
- Benedict Verhegghe, PhD∗,† and
- Matthieu De Beule, PhD∗,†
- ∗FEops, Ghent, Belgium
- †IBiTech-bioMMeda, Ghent University, Ghent, Belgium
- ‡Department of Cardiovascular Medicine, Saga University, Saga, Japan
- §International Centre for Circulatory Health, Imperial College London, London, United Kingdom
- ↵∗Reprint requests and correspondence:
Dr. Peter Mortier, FEops, IIC UGhent, Technologiepark 3, 9052 Ghent, Belgium.
Objectives This study sought to better understand and optimize provisional main vessel stenting with final kissing balloon dilation (FKBD).
Background Main vessel stenting with FKBD is widely used, but many technical variations are possible that may affect the final result. Furthermore, most contemporary stent designs have a large cell size, making the impact of stent platform selection for this procedure unclear.
Methods Finite element simulations were used to virtually deploy and post-dilate 3 stent platforms in 3 bifurcation models. Two FKBD strategies were evaluated: simultaneous FKBD (n = 27) and modified FKBD (n = 27). In the simultaneous FKDB technique, both balloons were simultaneously inflated and deflated. In the modified FKBD technique, the side branch balloon was inflated first, then partially deflated, followed by main branch balloon inflation.
Results Modified FKBD results in less ostial stenosis compared with simultaneous FKBD (15 ± 9% vs. 20 ± 11%; p < 0.001) and also reduces elliptical stent deformation (ellipticity index, 1.17 ± 0.05 vs. 1.36 ± 0.06; p < 0.001). The number of malapposed stent struts was not influenced by the FKBD technique (modified FKBD, 6.3 ± 3.6%; simultaneous FKBD, 6.4 ± 3.4%; p = 0.212). Stent design had no significant impact on the remaining ostial stenosis (Integrity [Medtronic, Inc., Minneapolis, Minnesota], 16 ± 11%; Omega [Boston Scientific, Natick, Massachusetts], 17 ± 11%; Multi-Link 8 [Abbott Vascular, Santa Clara, California], 19 ± 8%).
Conclusions The modified FKBD procedure reduces elliptical stent deformation and optimizes side branch access.
Medtronic provided financial support and all stent samples for this study. Dr. De Santis is an employee of FEops Drs. Mortier, De Beule, and Verhegghe are shareholders in FEops, an engineering consultancy spinoff of Ghent University; and have served as consultants for Medtronic, Boston Scientific, and Terumo. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 18, 2013.
- Revision received August 21, 2013.
- Accepted September 26, 2013.
- American College of Cardiology Foundation