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Side Branch Protection: Jailed Balloon Technique “ 拘禁 ” 球囊分支保护技术

Side Branch Protection: Jailed Balloon Technique “ 拘禁 ” 球囊分支保护技术. Luo Jianfang 罗建方 Guangdong General Hospital. Do not loss SB !?. Your Strategy?. Two-stent T stent V stent Crush cullote dedicated stent? Provisional stenting ? Cross over and final kissing? Too small vessel !.

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Side Branch Protection: Jailed Balloon Technique “ 拘禁 ” 球囊分支保护技术

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  1. Side Branch Protection: Jailed Balloon Technique“拘禁”球囊分支保护技术 Luo Jianfang 罗建方 Guangdong General Hospital

  2. Do not loss SB !?

  3. Your Strategy? • Two-stent • T stent \ V stent \ Crush \ cullote \ dedicated stent? • Provisional stenting ? • Cross over and final kissing? Too small vessel !

  4. Provisional stenting • Stenting of the SB may be required in up to 51%. • MB stenting can cause plaque shift, spasm, protrusion of the stent struts into the SB • Changes in the bifurcation angle The jailed balloon technique(JBT) is a novel modified provisional stenting technique that aims to maintain SB patency and improve SB access.

  5. Jailed Balloon Technique • Both limbs of the bifurcation are accessed with 0.014“ wire • Predilatation of the MB with a standard semicompliant balloon Step 1 Step 2

  6. Jailed Balloon Technique 3. A monorail balloon that is sized to approximate the SB vessel diameter (generally 1.5–2.0 mm and of adequate length) The proximal marker of the SB balloon is positioned approximately (0- 2 mm) proximal to the stent Step 3

  7. Jailed Balloon Technique 4.The MB stent is deployed to nominal pressures, jailing the SB wire and balloon Step 4

  8. Jailed Balloon Technique 5. If the SB has not been compromised (i.e., TIMI 3 flow), then the trapped SB balloon is inflated to low pressure(< 6 ATMs) If there is less than TIMI 3 flow in the SB, routine balloon angioplasty is performed before the balloon and wire are removed Keep stent balloon initial position! Step 5

  9. Jailed Balloon Technique • 6. The MB stent balloon’s position is maintained carefully during SB balloon removal Step 6

  10. Jailed Balloon Technique 7. The stent balloon is then fully expanded to moderate or high pressure, optimization of MB stent apposition, and to correct any stent deformation as a result of the jailed-balloon inflation Step 7

  11. Jailed Balloon Technique 8. Final angiography will then reveal whether or not recrossing through the stent struts into the SB is necessary for provisional angioplasty and/or stenting. Step 8

  12. Long Term Outcome

  13. Some Findings • The SB jailed balloon was removed in all patients without damage or entrapment of the balloon. • JBT did not lead to any MB stent strut fractures • Only one patient had stent deformation (IVUS) • Reexpansion of the MB stent balloon after removing the jailed-balloon did not cause significant plaque shift.

  14. Flow model finding JBT KB

  15. The case stent 3.0*33 pre dalitation 2.0*20 JBT 2.0*20

  16. LCX-Result

  17. JBT 2.0*20 Stent 3.0*18

  18. LAD-Result

  19. Take Home Message • JBT has high rate of procedural success and SB patency in dealing with bifurcation lesions • It simplifies the procedure , save time and may improve the long-term outcome • JBT may be a optimal option for protecting the lower size SB especially

  20. Thank you!

  21. Thank you!

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