The First‐in‐Man Technique of Drug Eluting and Perfusion Therapy for Left Main Coronary Artery Disease

Figures

• 

  Figure 1. Structure of Perfusion Balloon. The perfusion balloon used in this study equipes with 16 proximal and 8 distal perfusion holes (φ300 μm), which allow coronary blood flow to pass from the proximal to the distal segment through the balloon shaft. [Color figure can be viewed at wileyonlinelibrary.com]

• 

  Figure 2. Comparative Schema between C‐KBT and W‐KBT. In performing KBT with conventional balloons (C‐KBT) for the left main bifurcation lesion, prolonged inflation may not be feasible due to the full‐occlusion of the LMT with the risk of hemodynamic instability. Following C‐KBT, no drug is delivered to the LCx ostial lesion (A). The novel W‐KBT utilizes a PB for the LMT‐LAD and a DCB for the LMT‐LCx, which allows a prolonged inflation safely without hemodynamic instability, because of the preserved coronary blood flow through the perfusion holes of the balloon, potentially enhancing drug delivery to the ostial lesion of the LCx. Following W‐KBT, the effect of drug is expected to reduce adverse cardiovascular events arising from LCx ostial lesion (B). C‐KBT, conventional kissing balloon technique; DCB, drug‐coated balloon; LAD, left anterior descending artery; LCx, left circumflex artery; LMT, left main trunk; PB, perfusion balloon; PCI, percutaneous coronary intervention; W‐KBT, double‐effect kissing balloon technique. [Color figure can be viewed at wileyonlinelibrary.com]

• 

  Figure 3. Demonstration of Preserved Coronary Flow in LAD during W‐KBT. (A) Simultaneous balloon inflation with a 3.5 mm PB for the LMT‐LAD and a 2.75 mm DCB for the LMT‐LCx (Caudal view). (B) Contrast media passing through the distal LAD can be observed during W‐KBT, despite the semi‐occlusive status of the LMT (Cranial view). Abbreviations as in Figure 2. [Color figure can be viewed at wileyonlinelibrary.com]

• 

  Figure 4. Study flow. Within a year, 12 patients were included in this study. ISR, in‐stent restenosis; LMD, left main coronary artery disease; POT, proximal optimization technique; STEMI, ST‐elevation myocardial infarction. Other abbreviations as in Figure 2. [Color figure can be viewed at wileyonlinelibrary.com]

• 

  Figure 5. Representative Case undergoing W‐KBT. A patient with stable angina pectoris and an anatomically hypoplastic right coronary artery (left‐dominant circulation) underwent PCI for a left main bifurcation lesion. Initial angiography revealed moderate stenoses in the mid‐LAD and LCx (A, B). After stenting of the mid‐LAD and LCx and appropriate lesion preparation for the LMD, crossover‐stenting from the LMT to the LAD was performed (C), followed by POT (D) under IVUS guidance. C‐KBT was then carried out (E). After confirming optimal LM‐PCI results by IVUS and angiography (F), W‐KBT was additionally performed (G). Final angiography demonstrated a successful result (H). A temporary pacemaker was placed during the procedure due to the left‐dominant coronary anatomy. IVUS, intravascular ultrasound. Other abbreviations as in Figure 2 and Figure 4.

• 

  Central Illustration 1. In this pilot study assessing the safety and feasibility of W‐KBT in PCI for LMD with the ostial lesion of the LCx, procedural success was achieved in 100% and the W‐KBT was maintained for 60 seconds without hemodynamic instability and ST‐elevation, providing adequate drug application to the ostial LCx lesion. [Color figure can be viewed at wileyonlinelibrary.com]