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. 2018 Oct;97(42):e12808.
doi: 10.1097/MD.0000000000012808.

The modified balloon crush technique: A simplified approach to optimizing final kissing balloon inflation

Jae-Hyung Roh  1 , Young-Hak Kim  2 , Hee Jun Kang  2 , Pil Hyung Lee  2 , Sung-Han Yoon  3 , Mineok Chang  4 , Jung-Min Ahn  2 , Duk-Woo Park  2 , Soo-Jin Kang  2 , Seung-Whan Lee  2 , Cheol Whan Lee  2 , Seong-Wook Park  2 , Seung-Jung Park  2
Affiliations

The modified balloon crush technique: A simplified approach to optimizing final kissing balloon inflation

Jae-Hyung Roh et al. Medicine (Baltimore). 2018 Oct.

Abstract

This study aimed to investigate the feasibility and safety of the modified balloon crush technique.The conventional crush technique accompanies difficult and suboptimal final kissing balloon inflation (FKI)In a single-center percutaneous coronary intervention registry, 515 patients with 515 bifurcation lesions were treated with the modified balloon technique (n = 70) or the conventional crush technique (n = 445). In contrast to the conventional crush technique, where the implanted side branch (SB) stent is crushed by expansion of the main branch (MB) stent, the modified balloon crush technique uses balloon crushing and additional SB ballooning across the crushed SB stent before MB stenting to facilitate FKI. The primary outcome of interest was major adverse cardiovascular event (MACE), a composite of all-cause death, spontaneous myocardial infarction, and target vessel revascularization.Baseline clinical and angiographic characteristics were similar between the 2 treatment groups. FKI had comparable success rates in both groups (97.1% for the modified balloon group and 98.4% for the conventional crush group; P = .35). There were no differences in procedure time, fluoroscopic time, or contrast amount between the 2 groups. At 1-year follow up, the cumulative MACE incidences were comparable between the 2 groups (7.3% vs 8.8%; P = .73). The incidence of target lesion revascularization (TLR) was significantly lower after the modified balloon crush technique compared with the conventional crush technique (0% vs 5.6%; P = .048).The modified balloon crush technique appears to be a feasible and safe alternative to the conventional crush technique with the potential to reduce the revascularization rate.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Modified balloon crush technique. A, After predilation of the main branch (MB) and side branch (SB), the stent is placed in the SB with the balloon catheter loaded in the MB. B, After deployment of the SB stent, it is crushed by the inflated MB balloon. C, The SB ostium is re-opened by balloon inflation. D, The stent is implanted in the MB. E–F, The procedure is completed with final kissing balloon inflation.
Figure 2
Figure 2
A representative case treated with the modified balloon crush technique. A patient with distal left main bifurcation stenosis was successfully treated with the modified balloon crush technique. A–B, Initial angiography shows significant stenosis involving the distal left main bifurcation. C, The stent in the left circumflex coronary artery (LCX) was deployed with the balloon catheter placed in the left anterior descending coronary artery (LAD). D, The protruding portion of the LCX stent was flattened by inflation of the LAD balloon. E, The LCX ostium was reopened by balloon inflation. F, The left main coronary artery and LAD were stented. G, The procedure was completed with final kissing balloon inflation. H, The procedure was found to have been successful on the final angiography.
Figure 3
Figure 3
Cumulative incidence of major adverse cardiovascular event and its individual components over 1 year. MACE = major adverse cardiac event.
See this image and copyright information in PMC

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