title: Provisional stenting of coronary bifurcations: insights into final kissing balloon post-dilation and stent design by computational modeling.
abstract: OBJECTIVE
  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.
authors.affiliation: FEops, Ghent, Belgium; IBiTech-bioMMeda, Ghent University, Ghent, Belgium. Electronic address: peter.mortier@feops.com.
authors.forename: Peter
authors.initials: P
authors.lastname: Mortier
authors.affiliation: Department of Cardiovascular Medicine, Saga University, Saga, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Hikichi
authors.affiliation: International Centre for Circulatory Health, Imperial College London, London, United Kingdom.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Foin
authors.affiliation: FEops, Ghent, Belgium; IBiTech-bioMMeda, Ghent University, Ghent, Belgium.
authors.forename: Gianluca
authors.initials: G
authors.lastname: De Santis
authors.affiliation: IBiTech-bioMMeda, Ghent University, Ghent, Belgium.
authors.forename: Patrick
authors.initials: P
authors.lastname: Segers
authors.affiliation: FEops, Ghent, Belgium; IBiTech-bioMMeda, Ghent University, Ghent, Belgium.
authors.forename: Benedict
authors.initials: B
authors.lastname: Verhegghe
authors.affiliation: FEops, Ghent, Belgium; IBiTech-bioMMeda, Ghent University, Ghent, Belgium.
authors.forename: Matthieu
authors.initials: M
authors.lastname: De Beule
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D003198:Computer Simulation; D003324:Coronary Artery Disease / Q000601:surgery*; D003331:Coronary Vessels / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional; D011474:Prosthesis Design; D012372:ROC Curve; D015607:Stents
keywords: computer modeling; final kissing balloon dilation; stent design