Key result
KBI lacks clinical benefit in provisional bifurcation stenting but reduces MACE in two-stent deployment.
Why the study?
Final kissing balloon inflation after provisional bifurcation stenting has not shown clear clinical benefit except in two-stent deployment, and optimization techniques may overcome its drawbacks.
Optimizing final kissing balloon inflation techniques may improve outcomes in bifurcation stenting by correcting malapposition and optimizing stent geometry.
May warrant optimized KBI in two-stent bifurcations; leaves open benefit after provisional stenting.
Final kissing balloon inflation (KBI) after provisional bifurcation stenting has failed to provide clear clinical benefit except for a decrease in side branch stenosis, while a significant reduction of major adverse cardiac events has been documented in two-stent deployment. The optimisation of KBI in terms of proximal optimisation technique, appropriate guidewire re-crossing, minimal balloon overlapping, and balloon size selection may overcome the drawbacks of conventional KBI by: 1) correcting the proximal malapposition expected from fractal geometry; 2) optimising side branch ostium strut opening while conserving a bifurcation area free of malapposition at both the carina and the side branch ostium; and 3) optimising the geometry, velocity fields and shear rate.
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Murasato et al. (2015) conducted a review in Coronary bifurcation lesions. Final kissing balloon inflation (KBI) vs. No final kissing balloon inflation was evaluated. Final kissing balloon inflation after provisional bifurcation stenting has failed to provide clear clinical benefit except for a decrease in side branch stenosis, though it reduces major adverse cardiac events in two-stent deployment.
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