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Dedicated bifurcation quantitative coronary angiography (QCA) analysis was performed according to the recommendation of the consensus on QCA methods for 👍 bifurcation lesions using General Electric QCA software and MicroDicom QCA software [13]. True bifurcation lesions were defined as visual percent 👍 diameter stenosis (%DS) > 50% at the SB. The minimal luminal diameter (MLD), reference vessel diameter (RVD), and %DS were 👍 measured for every segment of the bifurcation (i.e., proximal, and distal MV and SB) pre-and post-intervention. Lesion length was measured 👍 from the proximal main vessel to the distal main branch (i.e., we considered beginning and ending points where hypothetically the 👍 stent will be implanted). SB lesion length was measured from the ostium to the first normal-appearing part of the vessel. 👍 All analyzes were performed by two investigators (N.M. and P.P.) and in case of disagreement, a consensus was formed with 👍 additional analysis from the first author (D.V.).
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Table 1. Patient demographic and clinical characteristics. Variables Overall (n = 41) Age 👍 [years] 72.5 ± 8.40 Sex, male 24 (70.6%) Body mass index [kg/m2] 29.7 ± 5.86 Dyslipidemia 38 (92.7%) Hypertension 41 👍 (100.0%) Diabetes mellitus 13 (31.7%) Current smoker 10 (24.4%) Previous MI 11 (26.8%) Previous PCI in non-target vessel 22 (53.7%) 👍 Cerebro-vascular disease 4 (9.8%) Peripheral-artery disease 2 (4.9%) Clinical presentation: Stable angina CCS II 2 (6%) Stable angina CCS III 👍 16 (47%) Stable angina CCS IV 15 (44%) Acute coronary syndrome 1 (3%) Non-anginal symptoms 10 (50.0%) Creatinine clearance 74.8 👍 ± 10.1 LVEF 51.7 ± 11.0 Hospitalization days 2.62 ± 0.88
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.
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