Postdilation Strategies Following Provisional Stenting of Left Main Coronary Bifurcations
Year: 2026
Type: article
Abstract: BACKGROUND: Provisional stenting is the preferred percutaneous coronary intervention strategy for noncomplex left main (LM) bifurcations; yet, the optimal postdilation strategy remains debated. OBJECTIVES: The objective of the study was to quantitatively compare postdilation techniques following LM provisional stenting using validated computational simulations. METHODS: Four patient-specific LM bifurcations were reconstructed in three dimensions and virtually stented. Seven postdilation techniques were evaluated: 1) standard proximal optimization technique (POT; P); 2) POT and simultaneous kissing balloon inflation (KBI); 3) POT and simultaneous KBI and re-POT; 4) POT and sequential KBI; 5) POT plus sequential and simultaneous KBI; 6) POT plus sequential and simultaneous KBI with re-POT; and 7) POT plus left circumflex dilation and re-POT (P-S-P). Techniques were compared based on lumen/stent morphology and hemodynamics. RESULTS: P ranked lowest overall, resulting in 27% smaller ostial area, 59% greater stent jailing, and 76% larger area exposed to high wall shear stress gradient at the left circumflex ostium compared with other techniques. P-S-P ranked second lowest, yielding 14% smaller ostial area and 29% greater area exposed to high relative residence time at the left anterior descending artery ostium. Techniques incorporating KBI showed the most favorable performance, with combined sequential and simultaneous KBI performing best, particularly in calcified or fibrous plaques. Final POT after KBI did not confer incremental benefit. CONCLUSIONS: KBI is superior to P or P-S-P. Combined high-pressure sequential and nominal-pressure simultaneous KBI outperforms sequential or simultaneous KBI alone, particularly in stiff calcified or fibrous lesions. Final POT after KBI provides no incremental advantage.
Source: JACC Advances
Authors: Shijia Zhao, Wei Wu, Changkye Lee, Yash Vardhan Trivedi, Priyansh Patel, Parth Munjal, Ruben K.A. Tapia-Orihuela, Rakshita Ramesh Bhat, Rahul Chikatimalla, Varsha Miriyala, Yaman Issa, Muhammad Fiyaz Alam, Parth Vikram Singh, Haritha Darapaneni, Sree Sindhu Vijayarao, Abdulkader Shaar, Jeevan Kumar Sahni, Kanishka Goswami, Aman Agrawal, Ioanna Chatzizisi, Yves Louvard, Goran Stankovic, Jens F. Lassen, Yoshinobu Murasato, Thomas W. Johnson, Francesco Burzotta, Emmanouil S. Brilakis, George Dangas, Yiannis S. Chatzizisis
Institutions: University of Miami, University of Miami Health System, Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, University of Belgrade, Univerzitetski Klinički Centar Srbije, University of Southern Denmark, Odense University Hospital, National Kyushu Medical Center, University of Bristol, Università Cattolica del Sacro Cuore, Agostino Gemelli University Polyclinic, Istituti di Ricovero e Cura a Carattere Scientifico, Icahn School of Medicine at Mount Sinai
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,936
OpenAlex ID: W7156239558