In-Stent Anchoring Technique

By:  Xiaohui Zhao

Kissing-balloon (KB) inflation has been deeply investigated and variably recommended to optimize stent apposition, correct stent deformation or distortion, reduce angiographic side-branch (SB) (re)stenosis, and improve outcomes. However, KB is potentially difficult, with a success rate that varies between 64%-92% due to inability to advance the SB balloon across the main vessel (MV) stent structure(s).

We have had some cases of failure during KB. Thus, we use balloon anchoring techniques to enhance the support of the guiding catheter. However, dissection could occur at the site of balloon inflation, which is a complication we want to avoid.
In this paper, we describe for the first time an improved in-stent anchoring technique to facilitate balloon delivery and to avoid possible vascular injury, suggesting a safe and effective method to increase the success rate of final KB inflation.

Furthermore, we suggest this improved technique as the first-line method for SB balloon delivery in the setting of severe ostial SB stenosis for two reasons: (1) No additional equipment is needed for in-stent anchoring. Therefore, it may shorten the operation time to try this handy technique in case KB is necessary. (2) It is likely complementary with other devices and/or techniques, such as smaller balloons, microcatheters, Buddy wire or Glider balloon, or in cases when in-stent anchoring technique fails. That’s also the reason we didn’t use 1~1.25 mm balloons or mcirocatheters prior to the anchoring technique.

However, more cases are needed to provide further verification and evaluation.

Read the full article at:

More Bifurcation Lesion articles available in this month’s Journal:

 

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