Side Branch Wiring and Protection Techniques

Dr. Hacı Ali Kürklü

Ankara Etlik City Hospital, Department of Cardiology, Ankara, Türkiye

ABSTRACT

In recent years, advancements in wire and stent technology have significantly enhanced the efficacy of coro- nary interventions, particularly in the management of complex cases. One of the most technically challenging aspects of interventional treatment for coronary artery disease is managing bifurcation lesions that require side branch (SB) preservation. While various strategies exist for SB protection, the clinical decision-making process remains complex due to the variable morphology, diameter, and angle of the SB relative to the main vessel (MV). The stepwise provisional approach is widely adopted as a relatively simpler technique; however, it carries the risk of complete SB occlusion, which can increase procedural complexity compared to dedicated bifurcation stenting strategies. This section provides an in-depth analysis of the latest strategies and advance- ments in SB wiring and protection techniques, based on current consensus reports and clinical guidelines.

Keywords: Atherosclerosis; Coronary artery disease; Angioplasty; Balloon; Coronary

Referanslar

  1. Lansky AJ, Yaqub M, Hermiller JB, Smith RS, Farhat N, Caputo R, et al. Side branch occlusion with everolimus-elut- ing and paclitaxel-eluting stents: three-year results from the SPIRIT III randomised trial. EuroIntervention 2010;6 Suppl J: J44-52. 2011/10/05. [Crossref]  [PubMed]
  2. Hahn JY, Chun WJ, Kim JH, Song YB, Oh JH, Koo BK, et al. Predictors and outcomes of side branch occlusion after main vessel stenting in coronary bifurcation lesions: results from the COBIS II Registry (COronary BIfurcation Stenting). J Am Coll Cardiol 2013;62(18): 1654-59. 2013/08/21. [Crossref]
  3. Dou K, Zhang D, Xu B, Yang Y, Yin D, Qiao S, et al. An an- giographic tool for risk prediction of side branch occlusion in coronary bifurcation intervention: the RESOLVE score sys- tem (Risk prEdiction of Side branch OccLusion in coronary bifurcation interVEntion). JACC Cardiovasc Interv 2015 8(1 Pt A): 39-46. 2015/01/27. [Crossref]
  4. Pan M, Lassen JF, Burzotta F, Ojeda S, Albiero R, Lefèvre T, et al. The 17th expert consensus document of the European Bifurcation Club - techniques to preserve access to the side branch during stepwise provisional stenting. EuroInterven-tion 2023;19(1): 26-36. 2023/05/12. [Crossref]  [PubMed]  [PMC]
  5. Lunardi M, Louvard Y, Lefèvre T, Stankovic G, Burzotta F, Kassab GS, et al. Definitions and Standardized Endpoints for Treatment of Coronary Bifurcations. EuroIntervention 2023 19(10): e807-e31. 2022/05/19. [Crossref]  [PubMed]  [PMC]
  6. Kim HY, Doh JH, Lim HS, Nam CW, Shin ES, Koo BK, et al. Identification of Coronary Artery Side Branch Supplying Myocardial Mass That May Benefit From Revascularization. JACC Cardiovasc Interv 2017 10(6): 571-81. 2017/03/06. [Crossref]  [PubMed]
  7. Lee SH, Lee JM, Song YB, Park TK, Yang JH, Hahn JY, et al. Prediction of side branch occlusions in percutaneous coronary interventions by coronary computed tomography: the CT bifurcation score as a novel tool for predicting in- traprocedural side branch occlusion. EuroIntervention 2019 15(9): e788-e95. 2019/01/15. [Crossref]  [PubMed]
  8. Meier B, Gruentzig AR, King SB, 3rd, Douglas JS, Jr., Hollman J, Ischinger T, et al. Risk of side branch occlusion during coronary angioplasty. Am J Cardiol 1984 53(1): 10-4. 1984/01/01. [Crossref]  [PubMed]
  9. Burzotta F, De Vita M, Sgueglia G, Todaro D, Trani C. How to solve difficult side branch access? EuroIntervention 2010 6 Suppl J: J72-80. 2011/10/05. [PubMed]
  10. Medina A, Suárez de Lezo J, Pan M. [A new classification of coronary bifurcation lesions]. Rev Esp Cardiol 2006 59(2): 183. 2006/03/17. [PubMed]
  11. Albiero R, Burzotta F, Lassen JF, Lefèvre T, Banning AP, Chatzizisis YS, et al. Treatment of coronary bifurcation le- sions, part I: implanting the first stent in the provisional path- way. The 16th expert consensus document of the European Bifurcation Club. EuroIntervention 2022 18(5): e362-e76. 2022/05/17. [Crossref]  [PubMed]  [PMC]
  12. Legrand V, Thomas M, Zelisko M, De Bruyne B, Reifart N, Steigen T, et al. Percutaneous coronary intervention of bi- furcation lesions: state-of-the-art. Insights from the second meeting of the European Bifurcation Club. EuroIntervention 2007 3(1): 44-9. 2007/05/01. [PubMed]
  13. Thomas M, Hildick-Smith D, Louvard Y, Albiero R, Darre- mont O, Stankovic G, et al. Percutaneous coronary interven- tion for bifurcation disease.A consensus view from the first meeting of the European Bifurcation Club. EuroIntervention 2006 2(2): 149-53. 2006/08/01. [PubMed]
  14. Burzotta F, Trani C, Sianos G. Jailed balloon protection: a new technique to avoid acute side-branch occlusion during provisional stenting of bifurcated lesions. Bench test report and first clinical experience. EuroIntervention 2010 5(7): 809-13. 2010/02/10. [Crossref]  [PubMed]
  15. Qu WB, Zhang W, Liu JY, Zhang F, Mu SN, Zhang SM, et al. Modified balloon-stent kissing technique avoid side- branch compromise for simple true bifurcation lesions. BMC Cardiovasc Disord 2019 19(1): 89. 2019/04/10. [Crossref]  [PubMed]  [PMC]
  16. Shishido K, Moriyama N, Hayashi T, Yokota S, Miyashita H, Mashimo Y, et al. The efficacy of modified jailed bal- loon technique for true bifurcation lesions. Catheter Car- diovasc Interv 2020 96(1): 20-28. 2020/02/26. [Crossref]  [PubMed]
  17. Çaylı M, Şeker T, Gür M, Elbasan Z, Şahin DY, Elbey MA, et al. A Novel-Modified Provisional Bifurcation Stenting Technique: Jailed Semi-Inflated Balloon Technique. J In- terv Cardiol 2015; 28(5): 420-9. 2015/09/09. [Crossref]  [PubMed]
  18. Yang H, Song Y, Cao J, Weng X, Zhang F, Dai Y, et al. Dou- ble kissing inflation outside the stent secures the patency of small side branch without rewiring. BMC Cardiovasc Dis- ord 2021(1): 232. 2021/05/09. [Crossref]
  19. Numasawa Y, Sakakura K, Yamamoto K, Yamamoto S, Taniguchi Y, Fujita H, et al. A novel side branch protection technique in coronary stent implantation: Jailed Corsair technique. Cardiovasc Revasc Med 2017 18(4): 295-98. 2017/01/26. [Crossref]  [PubMed]
  20. Kuno T, Sugiyama T, Imaeda S, Hashimoto K, Ryuzaki T, Yokokura S, et al. Novel Insights of Jailed Balloon and Jailed Corsair Technique for Percutaneous Coronary Intervention of Bifurcation Lesions. Cardiovasc Revasc Med 2019 20(12): 1065-72. 2019/03/02. [Crossref]