POT-side-POT vs KBI: Finding the Balance in Bifurcation PCI

International Journal of Medical Science

© 2025 by SSRG - IJMS Journal

Volume 12 Issue 5

Year of Publication : 2025

Authors : Ahmad Alabrass, Eyas Al Khayer, Akram Jahjah

10.14445/23939117/IJMS-V12I5P101

How to Cite?

Ahmad Alabrass, Eyas Al Khayer, Akram Jahjah, "POT-side-POT vs KBI: Finding the Balance in Bifurcation PCI," SSRG International Journal of Medical Science, vol. 12,  no. 5, pp. 1-4, 2025. Crossref, https://doi.org/10.14445/23939117/IJMS-V12I5P101

Abstract:

Background: There are still technical challenges related to the treatment of Coronary Bifurcation Lesions (CBLs) during Percutaneous Coronary Interventions (PCI) owing to the complex morphology of the arteries and the potential risk of Side Branch (SB) loss. There have been ongoing discussions on the optimal approach in SB optimization, whether the Kissing Balloon Inflation (KBI) technique or the Proximal Optimization Technique with side sequential inflation (POT-side POT) technique. Objective: To evaluate clinical efficacy and procedural safety of the Proximal Optimization Technique with side sequential inflation (POT-side-POT) technique in provisional stenting of non-complex Coronary Bifurcation Lesions (CBLs) in comparison with KBI. Methods: This study focused on 60 patients with CBLs under treatment during the period of June 2021 to June 2024. Participants were split into two similar groups based on technique preference (KBI or POT-side POT). These groups were compared based on the clinical and angiographic outcomes recorded. Specifically, the primary outcomes of interest were adverse cardiac events, stent thrombosis, contrast-induced acute kidney injury (CI-AKI), SB dissection, and the need for additional SB stenting. To account for potential selection bias, the Inverse Probability Weighting (IPW) technique was applied. Results: CBLs treated during this time period displayed similar baseline demographic characteristics across each group. KBI showed longer procedure times and more contrast use. Following IPW adjustment, SB dissection and the need for additional stenting were more frequent with KBI. No mortality was recorded in the clinical follow-up and 30 days post-discharge. Subgroup analysis demonstrated considerable improvement when using the POT-side POT technique for true bifurcation lesions, with reduced procedure times and lower rates of SB-related complications. Conclusion: For provisional stenting of non-complex CBLs, POT-side-POT offers a safe and effective strategy, reducing the risks of dissection and stent deformation, while also shortening procedure time. KBI is still valid should further SB expansion be needed.

Keywords:

Coronary Bifurcation Lesions, POT-side-POT, Kissing Balloon Inflation, Provisional stenting, PCI, Side branch optimization.

References:

[1] Ioannis Iakovou, Lei Ge, and Antonio Colombo, “Contemporary Stent Treatment of Coronary Bifurcations,” Journal of the American College of Cardiology, vol. 46, no. 8, pp. 1446-1455, 2005.
[CrossRef] [Google Scholar] [Publisher Link]
[2] David Hildick-Smith et al., “Consensus from the 5th European Bifurcation Club Meeting,” EuroIntervention, vol. 6, no. 1, pp. 34-38, 2010.
[Google Scholar] [Publisher Link]
[3] Marco Zimarino et al., “Late Thrombosis after Double versus Single Drug-Eluting Stent in the Treatment of Coronary Bifurcations: A Meta-Analysis of Randomized and Observational Studies,” JACC: Cardiovascular Interventions, vol. 6, no. 7, pp. 687-695, 2013.
[CrossRef] [Google Scholar] [Publisher Link]
[4] Nicolas Foin et al., “Stent Malapposition and the Risk of Stent Thrombosis: Mechanistic Insights from an in Vitro Model,” EuroIntervention, vol. 13, no. 9, 2017.
[CrossRef] [Google Scholar] [Publisher Link]
[5] François Dérimay et al., “Benefits of Final Proximal Optimization Technique (POT) in Provisional Stenting,” International Journal of Cardiology, vol. 274, pp. 71-73, 2019.
[CrossRef] [Google Scholar] [Publisher Link] 
[6] Yoshinobu Murasato et al., “Feasibility and Efficacy of an Ultra-Short Side Branch-Dedicated Balloon in Coronary Bifurcation Stenting,” EuroIntervention, vol. 17, pp. e425-432, 2021.
[CrossRef] [Google Scholar] [Publisher Link]
[7] Bernard Chevalier et al., “Clinical Outcomes of Proximal Optimization Technique (POT) in Bifurcation Stenting,” EuroIntervention, vol. 17, no. 11, 2021.
[CrossRef] [Publisher Link]
[8] Diaa Hakim et al., “Role of Proximal Optimization Technique Guided by Intravascular Ultrasound on Stent Expansion, Stent Symmetry Index, and Side-Branch Hemodynamics in Patients with Coronary Bifurcation Lesions,” Circulation: Cardiovascular Interventions, vol. 10, no. 10, 2017.
[CrossRef] [Google Scholar] [Publisher Link]
[9] M.D. Bernhard Meier, “Kissing Balloon Coronary Angioplasty,” The American Journal of Cardiology, vol. 54, pp. 918-920, 1984.
[CrossRef] [Publisher Link]
[10] Rupert Bauersachs et al., “Burden of Coronary Artery Disease and Peripheral Artery Disease: A Literature Review,” Cardiovascular Therapeutics, vol. 2019, no. 1, pp. 1-9, 2019.
[CrossRef] [Google Scholar] [Publisher Link]
[11] Molly Mack, and Ambarish Gopal, “Epidemiology, Traditional and Novel Risk Factors in Coronary Artery Disease,” Heart Failure Clinics, vol. 12, pp. 1-10, 2016.
[CrossRef] [Google Scholar] [Publisher Link]
[12] Seymour Glagov et al., “Compensatory Enlargement of Human Atherosclerotic Coronary Arteries,” New England Journal of Medicine, vol. 316, pp. 1371-1375, 1987.
[CrossRef] [Google Scholar] [Publisher Link]