Key result
Perfusion balloon pre-dilation is linked to ~34 percentage points less tissue protrusion versus direct stenting.
Why the study?
Perfusion balloons allow long-time pre-dilation to enhance thrombus and plaque compression during PCI, whereas direct stenting avoids lesion manipulation to improve reperfusion. The relative efficacy and safety of long-time perfusion balloon pre-dilation versus direct stenting in primary PCI for AMI required investigation.
Does long-time (180 sec) pre-dilation with a perfusion balloon prior to stent implantation improve intravascular imaging outcomes and reduce major adverse cardiovascular events compared to direct stenting in patients with acute myocardial infarction undergoing primary PCI?
Observational (n=279)
Does long-time (180 sec) pre-dilation with a perfusion balloon prior to stent implantation improve intravascular imaging outcomes and reduce major adverse cardiovascular events compared to direct stenting in patients with acute myocardial infarction undergoing primary PCI?
In primary PCI for acute myocardial infarction, 180-second pre-dilation with a perfusion balloon improves stent expansion and intra-stent lumen area by reducing irregular thrombus/plaque protrusion compared to direct stenting, without increasing procedural complications or altering 1-year MACE.
Perfusion balloon pre-dilation was associated with better stent expansion in primary PCI; leaves open clinical benefit pending randomized data.
Background Perfusion balloon, which enables long-time pre-dilation by maintaining coronary blood flow, is expected to enhance thrombus/plaque compression and promote lesion dilation during percutaneous coronary intervention (PCI). On the other hand, direct stenting without pre-dilation aims to avoid unnecessary manipulation of the target lesion and improve epicardial and myocardial reperfusion as well as clinical outcomes. Purpose We sought to investigate the efficacy and safety of long-time pre-dilation with perfusion balloon prior to stent implantation as compared to direct stenting in primary PCI for acute myocardial infarction (AMI). Methods We studied 279 AMI patients who underwent primary PCI with long-time (180 sec) pre-dilation using a perfusion balloon prior to stent implantation (n = 105) or direct stenting (n = 174). The findings of angiography and intravascular imaging at post-PCI, as well as major adverse cardiovascular events (MACE: defined as a composite of cardiac death, myocardial infarction, or clinically-driven target lesion failure) at one-year follow-up, were compared between the two groups. Results Patient and lesion characteristics at baseline were not different between the perfusion balloon pre-dilation group and the direct stenting group. The diameter of perfusion balloon for pre-dilation was 3.0 mm (interquartile range [IQR]: 3.0–3.0 mm). Stent diameter was similar between the two groups. The frequency of post-dilation balloon use was comparable between the two groups. At post-PCI, minimum stent area was numerically larger in the perfusion balloon pre-dilation group than the direct stenting group (7.16 mm2 [IQR: 5.77–8.20 mm2] vs. 6.88 mm2 [IQR: 5.38–8.06 mm2], p = 0.172). Stent expansion index (83 % [IQR: 75–92 %] vs. 78 % [IQR: 69–88 %], p = 0.001) and minimum intra-stent lumen area (6.57 mm2 [IQR: 5.55–8.12 mm2] vs. 5.98 mm2 [IQR: 4.92–7.42 mm2], p = 0.003) were significantly larger in the perfusion balloon pre-dilation group than the direct stenting group. The frequency of irregular thrombus/plaque protrusion was significantly lower in the perfusion balloon pre-dilation group than the direct stenting group (14 % vs. 48 %, p < 0.001). Maximum thrombus/plaque protrusion area was significantly smaller in the perfusion balloon pre-dilation group than the direct stenting group (0.31 mm2 [IQR: 0.00–0.59 mm2] vs. 0.66 mm2 [IQR: 0.00–1.31 mm2], p < 0.001). There was no significant difference between the two groups in the frequency of slow flow/no reflow and distal embolization during PCI, nor in the frequency of MACE at one-year follow-up. Conclusion In primary PCI for AMI, the long-time pre-dilation with a perfusion balloon prior to stent implantation, compared to direct stenting, resulted in a larger intra-stent lumen area by reducing irregular thrombus/plaque protrusion without increasing slow flow/no reflow and distal embolization.
No takes yet. Share an insight, caveat, or question.
Takihara et al. (2026) conducted an observational in Acute myocardial infarction (AMI) (n=279). Long-time (180 sec) pre-dilation with perfusion balloon prior to stent implantation vs. Direct stenting without pre-dilation was evaluated on Minimum intra-stent lumen area and irregular thrombus/plaque protrusion at post-PCI (p=0.003). Long-time perfusion balloon pre-dilation yielded a larger minimum intra-stent lumen area (6.57 vs 5.98 mm2, p=0.003) and less irregular protrusion (14% vs 48%, p<0.001) than direct stenting.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: