Non-compliant balloons for final kissing inflation in coronary bifurcation lesions treated with provisional side branch stenting: a pilot study

Aims: To assess the procedural and long-term results of non-compliant (NC) kissing balloon inflation (KB) in patients undergoing bifurcation intervention with the provisional side branch (SB) stenting technique. Provisional SB stenting is the default strategy for coronary bifurcation intervention. Recent data have suggested that KB with compliant balloons increases the risk of SB dissection and restenosis. However, NC KB may reduce SB complications. Methods and results: We prospectively enrolled patients undergoing provisional SB stenting at two French centres. KB was systematically performed with NC balloons. Quantitative coronary angiography and digital stent enhancement (DSE) were performed in all cases. Thirty-day and one-year major adverse cardiac event (MACE) rates were assessed. We recruited 100 patients with a mean age of 67.3 +/- 11.7 years. Diabetes mellitus was prevalent in 23%, renal dysfunction in 21%, and multivessel disease in 69%. Intervention was performed for stable angina in 48% and acute coronary syndromes in 27%. Target lesions were the left main in 15% and the left anterior descending in 51%. True bifurcation stenoses accounted for 46% of lesions (Medina class: 1,1,1/1,0,1/0,1,1). All lesions were successfully treated with NC KB. SB stenting was required in 6% (five dissections, one residual stenosis). Using DSE, a SB stent scaffold was evident in 89% following KB. The cumulative 12-month MACE rate was 4%. Target lesion revascularisation was required in 3%. No stent thrombosis occurred during follow-up. Conclusions: Provisional SB stenting followed by NC KB is associated with high procedural success and low rates of clinical target lesion failure.