title: Comparative Analysis of Sequential Proximal Optimizing Technique Versus Kissing Balloon Inflation Technique in Provisional Bifurcation Stenting: Fractal Coronary Bifurcation Bench Test.
abstract: OBJECTIVE
  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.
authors: Department of Interventional Cardiology, Cardiovascular Hospital and Claude Bernard University and INSERM Unités Mixtes de Recherche 1060, Lyon, France. Electronic address: gerard.finet@univ-lyon1.fr.
authors: Gérard
authors: G
authors: Finet
authors: Department of Interventional Cardiology, Cardiovascular Hospital and Claude Bernard University and INSERM Unités Mixtes de Recherche 1060, Lyon, France.
authors: François
authors: F
authors: Derimay
authors: Cardiology Department, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France.
authors: Pascal
authors: P
authors: Motreff
authors: Cardiology, Unités Mixtes de Recherche 915, l'Institut du Thorax, Nantes, France.
authors: Patrice
authors: P
authors: Guerin
authors: Cardiology, Unités Mixtes de Recherche 915, l'Institut du Thorax, Nantes, France.
authors: Paul
authors: P
authors: Pilet
authors: 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.
authors: Jacques
authors: J
authors: Ohayon
authors: Clinique Saint Augustin, Bordeaux, France.
authors: Olivier
authors: O
authors: Darremont
authors: Department of Interventional Cardiology, Cardiovascular Hospital and Claude Bernard University and INSERM Unités Mixtes de Recherche 1060, Lyon, France.
authors: Gilles
authors: G
authors: Rioufol
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D001696:Biomechanical Phenomena; D003198:Computer Simulation; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D003326:Coronary Circulation; D023903:Coronary Restenosis / Q000209:etiology; D003331:Coronary Vessels / Q000473:pathology / Q000503:physiopathology; D054855:Drug-Eluting Stents; D017709:Fractals; D006801:Humans; D008953:Models, Anatomic; D008955:Models, Cardiovascular; D011474:Prosthesis Design; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D055114:X-Ray Microtomography
keywords: bifurcation bench model; coronary bifurcation; kissing balloon inflation; stent design