title: A modified provisional stenting approach to coronary bifurcation lesions: clinical application of the "jailed-balloon technique".
abstract: OBJECTIVE
  To demonstrate the application of a novel provisional side branch (SB) stenting strategy for coronary bifurcation lesions using a "jailed-balloon" technique (JBT).
  
  
  BACKGROUND
  Adverse cardiac events are higher for percutaneous coronary intervention (PCI) of bifurcation lesions. Recent studies support the use of provisional SB stenting, but a risk of SB closure and a higher rate of target lesion revascularization (TLR) remain important limitations.
  
  
  METHODS
  From December 2007 to August 2010, 100 patients with 102 bifurcation lesions underwent PCI using the JBT. Baseline and postprocedural quantitative coronary angiography (QCA) analysis were performed. Procedural and immediate clinical outcomes were reviewed.
  
  
  RESULTS
  The majority of patients presented with acute coronary syndrome (68%) and had Medina class 1,1,1 bifurcation lesions (91%). TIMI 3 flow was established in 100% of main branch and 99% of SB lesions. QCA revealed preservation of the bifurcation angle after PCI (pre-PCI: 59.6 ± 30.0; post-PCI: 63.3 ± 26.8, P = 0.41). Nine patients (9%) had lesions that required rewiring and two patients (2%) required provisional stenting of the SB. SB loss occurred in one patient (1%). The jailed-balloon or wire was not entrapped during any PCI. One patient (1%) suffered a periprocedural myocardial infarction (MI).
  
  
  CONCLUSIONS
  Provisional stenting of complex coronary bifurcation lesions using a JBT is associated with a high procedural success rate, improved SB patency, and a low rate of immediate cardiac events. Further study is warranted to evaluate the role of JBT in improving long-term clinical outcomes in PCI of complex bifurcation lesions.
authors.affiliation: Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA. JZSINGH@dom.wustl.edu
authors.forename: Jasvindar
authors.initials: J
authors.lastname: Singh
authors.forename: Yogesh
authors.initials: Y
authors.lastname: Patel
authors.forename: Jeremiah P
authors.initials: JP
authors.lastname: Depta
authors.forename: Santhosh J
authors.initials: SJ
authors.lastname: Mathews
authors.forename: Tillmann
authors.initials: T
authors.lastname: Cyrus
authors.forename: Alan
authors.initials: A
authors.lastname: Zajarias
authors.forename: Howard I
authors.initials: HI
authors.lastname: Kurz
authors.forename: John M
authors.initials: JM
authors.lastname: Lasala
authors.forename: Richard G
authors.initials: RG
authors.lastname: Bach
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000628:therapy*; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000628:therapy*; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome