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Results

Bench simulation

In total 41 patients (41 vessels) were evaluated. Two case examples are illustrated in Figure 2. The mean age 💋 was 72.5 ± 8.4, and 70.6% were males. Patient clinical characteristics are shown in Table 1. The target vessel was 💋 left main in 9 (22.0%) patients, left anterior descending artery — in 26 (63.4%), left circumflex artery — in 4 💋 (9.8%) and right coronary artery — in 2 (4.9%). The predominant type of bifurcation lesion was Medina 1-1-1 (62.6%). Eight 💋 (19.5%) patients presented with chronic total occlusions of the target vessels. Patient procedural characteristics are shown in Table 2.

Stent underexpansion 💋 and malapposition are responsible for unsatisfactory post-PCI results and are associated with target lesion failure and stent thrombosis, therefore contemporary 💋 interventional practice uses stent optimization techniques to prevent these events [14, 15]. Current expert recommendations accept POT as mandatory step 💋 in bifurcation PCI as it enhances stent apposition in the proximal MV, and reduces stent deformation [4, 16]. However, inappropriate 💋 distal positioning of the POT balloon bears the risk of distal MV overstretch and carina shift to the SB. On 💋 the other hand, incorrect proximal positioning may lead to stent malapposition and underexpansion near the carina [17]. The present analysis 💋 demonstrated that POT could be a source of additional ostial SB stenosis, due to ostial stretch in elliptical fashion [11]. 💋 Concerning carina shift, KBI has shown to have an advantage over POT followed by SB balloon dilation [18]. However, KBI 💋 bears a risk of ellipsoid stent distortion of proximal MV and its overexpansion [19], which has been associated with higher 💋 rates of MV reintervention [20]. Furthermore, randomized clinical trials comparing provisional stent strategies with or without KBI failed to report 💋 any advantage on clinical outcomes for KBI [21, 22]. Finally, when comparing KBI and POT with a consequent SB dilation, 💋 randomized multicenter trial failed to show significant advantage for any of the two techniques over the other [23]. In the 💋 present view, these results could be justified by the improper choice of balloon diameters or inadequate balloon positioning which lead 💋 to insufficient correction of the stent deformation. The POT — SB dilatation — POT technique sounds logical, but in practice, 💋 as already mentioned, it did not correct SB ostial compromise. As mentioned above, POT at the level of SB ostium 💋 stretches SB perimeter in ellipse, which eliminates the positive effect of POT on carina shifting. Thus, in the end, regarding 💋 SB compromise, the final effect could be neutral.

Conclusions

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