Corrective kissing balloon inflation for a suboptimal optical coherence tomography result after POT-side-POT: An OCT sub-analysis of the randomized CRABBIS trial.

BACKGROUND

In the randomized CRABBIS trial, a proximal optimization technique (POT)-kissing-POT (PKP) sequence gave a better optical coherence tomography (OCT)-defined stent geometry than POT-Side-POT (PSP) in large bifurcations. Whether a suboptimal PSP result can be corrected during the same procedure is unknown.

METHODS

In this pre-specified OCT sub-analysis, a suboptimal post-PSP result (minimal stent area < 90% of reference and/or malapposition) was corrected with kissing-balloon inflation and final POT. Stent geometry before and after correction was compared across four segments and with the randomized single-stent PKP arm.

RESULTS

The result was suboptimal in 22 of 30 patients (73.3%); 16 had paired OCT. After correction, minimal stent area increased in the proximal (12.5 to 14.6 mm2) and distal main vessel (7.4 to 9.1 mm2), both significant after Holm correction, and distal underexpansion fell from 13/16 (81%) to 5/16 (31%). Proximal-edge and bifurcation-core gains and the reduction in malapposition did not survive correction; eccentricity did not change significantly. No significant difference from the single-stent PKP arm was found, but the study had 80% power only for differences of 2.1 to 3.3 mm2. Of eight results judged optimal, six still showed distal underexpansion.

CONCLUSIONS

A suboptimal PSP result can be improved in the same procedure by corrective kissing-balloon inflation and final POT, mainly through larger main-vessel stent area and expansion. It did not differ significantly from an upfront PKP, but equivalence cannot be established. A PSP result judged optimal during the procedure is not necessarily optimal at offline OCT analysis.