The article is accompanied by the editorial on page 894
In MV the distal balloon marker is exactly at the carina tip. SB balloon is positioned with proximal marker exactly at the stent struts borders. The proximal SB balloon marker and MV balloon distal marker could be in parallel or MV balloon marker could be a little bit distally in the direction to the carina tip (depending on the specific anatomy). Step IV: Simultaneous balloon inflation. During balloon inflation the stent is optimally deformed to achieve maximum apposition to the SB. A schematic representation of the POKI procedure is illustrated in Figure 1.
Therefore, the current findings have important clinical implications. This novel stent optimization technique combines the benefits from POT and KBI and may provide improved post-PCI results in bifurcation lesions. POKI technique shortens the procedure time by combining POT and KBI in a one-step approach. The operator should not be concerned about further carina shifting as SB ostium is dilated simultaneously. Furthermore, the visualization of the SB balloon at the stent border provides a firm marker of the carina position and facilitates the positioning of the MV POT balloon. If during inflation the POT balloon slips proximally, it should be positioned one marker distally after deflation, without doubting excessive carina shifting.
What would be the clinical consequences and if a better angiographic result translates into better clinical result is currently under investigation by the present group.
The study has the following limitations to be considered: first, bench models fail to truly replicate the geometry and elasticity of diseased coronary vessels. Balloon inflation in diseased coronary vessels with differential distribution of fibrosis and calcification may behave differently to silicon. However, the results from this in-vivo evaluation were confirmatory of the on-bench findings. Second, the findings include a relatively low sample size of 41 vessels. Third, for the present study intravascular imaging was not performed. Lastly, presented herein are the immediate angiographic and QCA results after the index procedure. Further follow-up study with intravascular ultrasound assessment is currently performed to evaluate the long-term procedural result.
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