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Stent sizing is performed according to the distal reference diameter. Step II: POT in proximal 🤶 MV. Proximal optimization balloon is inflated in proximal MV. The exact positioning is made by placing the distal balloon marker 🤶 proximal from the carina tip. The POT balloon is inflated several times to ensure complete stent strut apposition in the 🤶 proximal region.
Figure 1. Schematic representation (above) and bench visualization (below) of each step of the proximal optimization with kissing balloon 🤶 inflation (POKI) technique. I) The stent is implanted in main vessel (MV). Stent sizing is performed according to the distal 🤶 reference diameter. II) Proximal optimization balloon is inflated in the proximal MV. The exact positioning is made by placing the 🤶 distal balloon marker proximal from the carina tip. The proximal optimization technique (POT) balloon is inflated several times to ensure 🤶 complete stent strut apposition in proximal region. III) The balloon positioning for POKI — in MV the distal balloon marker 🤶 touches the carina tip, the side branch balloon is positioned with proximal marker exactly at the stent struts borders. The 🤶 proximal SB balloon marker and MV balloon distal marker could be in parallel or MV balloon marker could be a 🤶 little bit distally in the direction to the carina tip (depending on anatomy in practice). IV) During balloon inflation the 🤶 stent is optimally deformed to achieve maximum apposition to the side branch ostium. V) Final result.
The mean MV lesion length 🤶 was 38.6 ± 20.5 and the mean SB lesion length was 9.18 ± 2.24. Baseline proximal MV DS% was 60.0 🤶 ± 23.7%, distal MV DS% — 58.8 ± 28.9% and SB DS% 53.0 ± 32.0%. The application of the POKI 🤶 technique was feasible in 41 (100%) of the vessels. Post-PCI residual DS at proximal MV was 11.5 ± ± 15.4%, 🤶 distal MV — 6.6 ± 9.3%, and SB — 22.9 ± 28.5% (Fig. 3). Patient QCA characteristics are shown in 🤶 Table 3. Both procedural and angiographic success were 100%.
What would be the clinical consequences and if a better angiographic result 🤶 translates into better clinical result is currently under investigation by the present group.
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