Methods: Bench and in-vivo evaluations were performed. For the bench visualization bifurcated silicone mock vessel was used. The POKI technique 🍐 was simulated using a 3.5 mm POT balloon. For the in-vivo evaluation patients with angiographic bifurcation lesions in a native 🍐 coronary artery with diameter ≥ 2.5 mm and ≤ 4.5 mm, SB diameter ≥ 2.0 mm, and percentage diameter stenosis 🍐 (%DS) more than 50% in the main vessel (MV) were included. Provisional stenting was the default strategy.
This article is available 🍐 in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, allowing to download articles and share 🍐 them with others as long as they credit the authors and the publisher, but without permission to change them in 🍐 any way or use them commercially.
After stent deployment in MV (sized according to the distal vessel diameter) the POKI technique 🍐 includes the following steps: (1) Proximal optimization technique with a non-compliant (NC) balloon sized according to the proximal MV diameter; 🍐 (2) SB recrossing with a wire and removal of jailed wire; (3) Kissing balloon inflation using a NC balloon in 🍐 the SB, with proximal marker of the balloon into the stent borders and an NC POT balloon in the MV, 🍐 with distal balloon marker positioned parallel to carina tip.
Step I: The stent is implanted in MV. Stent sizing is performed 🍐 according to the distal reference diameter.
In MV the distal balloon marker is exactly at the carina tip. SB 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 the specific anatomy). Step IV: Simultaneous balloon inflation. During balloon inflation the stent is optimally deformed to 🍐 achieve maximum apposition to the SB. A schematic representation of the POKI procedure is illustrated in Figure 1.
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