Functional comparison of different jailed balloon techniques in treating non-left main coronary bifurcation lesions

https://doi.org/10.1016/j.ijcard.2022.05.036Get rights and content

Highlights

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    Active-jailed balloon technique provides a new means for protecting the side branch of coronary bifurcation lesions.

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    Quantitative flow ratio is initially used to evaluate the coronary bifurcation lesions.

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    Active-jailed balloon technique can reduce side branch occlusion as well as improve the functional blood flow.

Abstract

Background

There is a paucity of data comparing functional difference between active jailed balloon technique (A-JBT) and conventional jailed balloon technique (C-JBT) in treating non-left main coronary bifurcation lesions (CBLs).

Methods

In this retrospective cohort study, we consecutively enrolled 232 patients with non-left main CBLs who underwent percutaneous coronary intervention (PCI) using JBTs between January 2018 and March 2019. Among them, 191 patients entered the final analysis with 12-months angiographic follow-up. We stratified patients into A-JBT group (130 patients) and C-JBT group (61 patients). The functional analysis by Murray law-based quantitative flow ratio (μQFR) and Seattle angina questionnaire (SAQ) were performed to compare the two techniques.

Results

Compared with C-JBT group, A-JBT group observed a lower abrupt (0.8% vs. 11.1%, p = 0.002) and final SB occlusion (0 vs. 7.9%, p = 0.005). Meanwhile, A-JBT group had a significantly higher μQFR of side branch (SB) both post-PCI and 12-months follow-up (median [interquartile range (IQR)]: 0.91 (0.86–0.96) vs. 0.82 (0.69–0.92), p < 0.001; median [IQR]: 0.95 (0.89–0.98) vs. 0.85 (0.74–0.93), p < 0.001) than C-JBT group. Besides, A-JBT group gained a μQFR improvement at follow-up period compared with post-PCI data (median [IQR]: 0.95 [0.89–0.98] vs. 0.91[0.86–0.96] of SB, p < 0.001) and a higher SAQ scores at 12-months follow-up compared with C-JBT group (p < 0.001).

Conclusions

Compared with C-JBT, A-JBT provided excellent SB protection during MV stenting and improved the SB functional blood flow as well as the angina relief even after 12 months.

Introduction

Coronary bifurcation lesions (CBLs) account for approximately 15%–20% of all percutaneous coronary intervention (PCI) [1]. Patients with true CBLs have a lower PCI success rate and worse clinical outcomes [2]. The two-stent technique and provisional stent (PS) technique are the mainstream choice in treating CBLs, but which approach is the optimal option remains controversial. Previous comparative studies found the similar clinical outcomes between single-stent and two-stent strategy [[3], [4], [5]], but more myocardial infarction with two-stent strategy was proved in other studies [6,7]. The DEFINITION II trial [8] found the systematic two-stent approach was associated with better clinical outcomes compared with PS approach in complex CBLs including left-main bifurcation lesions. However, the EBC MAIN [9] proved the stepwise provisional strategy with fewer major adverse cardiac events in true left main CBLs. Overall, the PS strategy was found with superior safety and lower costs [7], even after long-term follow-up [10]. Consequently, the PS technique is considered as the “standard” approach for most CBLs and the two-stent technique was recommended as the bail-out treatment of a side branch (SB) during the PS technique or as the elective approach of the bifurcation lesions with complex anatomy and diffuse atherosclerotic involvement of the MV and SB [11].

To keep the SB patency during the interventional treatment is the paramount objective no matter which technique approaching. The jailed wire technique (JWT) has been taken to reduce the risk of SB occlusion in the previous study, but the risk of SB occlusion was still high [12]. Jailed balloon technique (JBT) provided a new means for protecting the SB, especially more beneficial to reduce the risk of SB occlusion [13,14]. According to whether the preset balloon in SB is dilated or not, the JBTs are generally divided into active and conventional jailed balloon technique. However, few studies have compared active jailed balloon technique (A-JBT) and conventional jailed balloon technique (C-JBT) in CBLs, and traditional evaluation methods are limited to the anatomical distinctions of the coronary artery.

Quantitative flow ratio (QFR), a novel non-invasive technique, could be more convenient and efficient for the coronary functional evaluation. Also, the Murray law-based quantitative flow ratio (μQFR) [15] is verified more appropriate for CBLs.

Therefore, the aim of this study is to determine if the A-JBT would provide more advantages in non-left main CBLs by the functional estimation of μQFR.

Section snippets

Study design and study population

This was a retrospective cohort study. A total of 232 patients with non-left main CBLs intended for PCI with PS technique in MV-stenting and JBT in side branch were consecutively enrolled from Zhongshan Hospital (Shanghai, China) between January 2018 and March 2019 (Fig. 1). The non-left main CBLs were defined as a non-left main coronary artery narrowing occurring adjacent to, and/or involving, the origin of a significant side branch [16]. A significant SB was a branch that one did not want to

Baseline characteristics

A total of 191 patients (196 CBLs) were enrolled in the final analysis and there was no significant difference in clinical data compared with excluded 41 patients (Supplemental Table 1). A-JBT and C-JBT were performed in 130 (133 lesions) and 61 (63 lesions) patients, respectively. The mean age of the patients was 62.8 ± 10.0 years. There were 158 (80.6%) lesions involved left anterior descending coronary artery (LAD) and 189 (96.4%) true CBLs. The demographic and clinical characteristics

Discussion

The major findings from the present study, which investigated the functional impact by different jailed balloon techniques in treating non-left main CBLs, are that: 1). Active-JBT provides better SB protection and optimized functional effects both at post-procedure immediately and 12-months follow-up; 2). μQFR could be a feasible and safe tool for the functional assessment of CBLs during PCI.

In the PCI process, CBL is associated with low rate of procedural success and high incidence of adverse

Conclusion

A-JBT provides excellent SB protection and optimized functional coronary effects during MV stenting compared with the C-JBT technique and these benefits maintain at 12-month follow-up.

Funding

This study was funded by Clinical Research Plan of Shanghai Hospital Development Center (No. SHDC2020CR5009).

Disclosures

S Tu is a consultant of Pulse Medical and received research grants from Pulse Medical. The other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

CRediT authorship contribution statement

Jingpu Wang: Conceptualization, Methodology, Software, Investigation, Data curation, Formal analysis, Writing – original draft. Chenguang Li: Conceptualization, Methodology, Software, Formal analysis, Writing – review & editing. Daixin Ding: Conceptualization, Methodology, Writing – review & editing. Mingyou Zhang: Conceptualization, Methodology, Writing – review & editing. Yizhe Wu: Conceptualization, Methodology. Rende Xu: Conceptualization, Methodology. Hao Lu: Conceptualization,

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    • Cited by (3)

    1

    Jingpu Wang and Chenguang Li contributed equally to this article (co-first autor)

    2

    All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation

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