A Stepwise Approach to Coronary Bifurcation Stenting: Enhancing Safety and Efficacy With Modified Jailed Balloon Techniques

BACKGROUND: Compromise of the side branch (SB) during percutaneous coronary intervention (PCI) of bifurcation lesions is challenging. AIMES: This study aims to evaluate the safety and effectiveness of the novel modified JBT, which uses full nominal pressure in the SB balloon while stenting the main vessel (MV) in patients. METHODS: This single-center, prospective study included 74 patients with significant bifurcation lesions undergoing PCI. The method consisted of simultaneously inflating both the MV stent and the SB balloon (at nominal pressure), with balloon sizes customized to the SB diameter (ranging from 2.0 to 2.5 mm, with an ostial length of 10 mm or less). Outcomes including major adverse cardiac events (MACE), target vessel revascularization (TVR), SB patency, and overall procedural success, with a follow-up period of 12 months. RESULTS: All procedures were technically successful, with no balloon entrapment or need for SB stenting. Among all patients, 4.1% experienced dissection of the side branch, but none of these cases resulted in flow limitation. There were no incidences of MACE, TVR, or periprocedural myocardial infarction. Final TIMI 3 flow was observed in 100% of cases. EF improved in 16.2% of patients without deterioration in any case. Final kissing balloon inflation was rarely required (2.7%), and double stenting was needed in only 1.4% of cases. CONCLUSIONS: This novel modified JBT demonstrated high safety and effectiveness in protecting side branches, with no MACE or TVR reported. We suggest that it's a practical, reproducible method for bifurcation PCI, especially in cases involving small or short side branches.