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European Bifurcation Club Update and Provisional S ...
Discussion: Part 2
Discussion: Part 2
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Video Transcription
<v ->Thank you very much.</v> We have a whole bunch of chat questions. So, John, what are we selected to ask? <v ->Thank you.</v> So, there's a question about how you size and choose your balloons for your kissing balloon inflation. So, how do you size them first, and then where are you putting the semi-compliant balloon and non-compliant balloon? And then if you could describe your steps to the kiss, if it is high pressure in both or sequential? <v ->So, regarding the phase of predilation,</v> we try to use a size that is one-to-one according to the stent we are implanting. Regarding the predilation of the side branch, honestly, we are always conservative and we do not, systematically do, I mean, we do it only in the case we think that it may reduce the risk of occlusion of the side branch because there is an interesting randomized trial by Manual Pan showing that in true Medina and in true bifurcations, the predilation increases the risk of the side branch, increases the patency after crossover stenting. So, now predilation is considered, not systematically, but when you have tight stenosis into the side branch. Regarding the selection of the balloons, you should have a balloon that allows you to understand that you are able to expand your stent at the end. So, if you have calcified lesions, it is close to one-to-one to the stent that you are implanting. If there is a soft plaque, you may consider having a little bit under-sizing, I mean... And regarding the use of non-compliant balloon or semi-compliant balloon, we are using more and more for predilation, non-compliant balloons. And for the postulation, again, non-compliant balloons, as much as possible. For POT, if there is no huge plaque, you may consider using also semi-compliant balloons. So this is an overview of the balloon selections. <v ->And then, for the final kissing balloon inflation,</v> you're using two non-compliant balloons, as well? <v ->Yes, if possible, yes.</v> I mean it is not something that is associated with long-term outcome benefit, but the concept is, we need the non-compliant balloon to optimize the result on the stent. Okay? So you need the non-compliant balloon, and most of the time I like to have the sequential kissing so that I can check if it is well expanded into the main vessel. For the side branch, the non-compliant balloons have the advantage, offer the advantage, of reducing the dog bone effect, that is related with the interaction with the metallic material of the stent. So, it is reported to be associated with less risk of side branch dissection. <v ->So, one final thing, Francesco,</v> when do you use a drug-coated balloon in this? Will you use a drug-coated balloon in side branch here, or not? <v ->Honestly, in the EBC there is a lot of discussion</v> in the last years about the role of drug-eluting balloon and their potential for side branches is one of the more recognized inside the group. However, honestly actually we do not have enough data to recommend their use. So, I think that is the ideal setting for future studies.
Video Summary
In this video, John is asked how he sizes and chooses balloons for kissing balloon inflation. He explains that they try to use a size that is one-to-one according to the stent being implanted. They are conservative in predilating the side branch unless necessary to reduce the risk of occlusion. The selection of balloons depends on the type of plaque, with calcified lesions requiring close to one-to-one sizing. Non-compliant balloons are increasingly used for predilation and postdilation. For the final kissing balloon inflation, two non-compliant balloons are preferred to optimize stent expansion. The use of drug-coated balloons in side branches is still under discussion and requires further research.
Keywords
balloons
kissing balloon inflation
sizing
predilation
non-compliant balloons
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