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The article is accompanied by the editorial on page 894
After stent deployment in MV (sized according to the distal vessel🤑 diameter) the POKI technique includes the following steps: (1) Proximal optimization technique with a non-compliant (NC) balloon sized according to🤑 the proximal MV diameter; (2) SB recrossing with a wire and removal of jailed wire; (3) Kissing balloon inflation using🤑 a NC balloon in the SB, with proximal marker of the balloon into the stent borders and an NC POT🤑 balloon in the MV, with distal balloon marker positioned parallel to carina tip.
For the bench visualization custom bifurcated silicone model,🤑 with proximal MB internal diameter (ID) 3.5 mm, distal MB ID 3.0 mm, SB ID 2.5 mm, and 3.0 mm.🤑 Three types of models were used according to distal branching angle — 30°, 45° and 60° models. The POKI technique🤑 has been simulated using a dedicated 3.5 mm diameter to 6 mm length non-compliant POT balloon (Brosmed, China). The balloon🤑 is specifically designed for the POT technique with shortened balloon shoulders and specific cylindrical shape. This prevents inappropriate stent deformations🤑 at the place of inflation. Following deployment, the models were visualized using fluoroscopy and fluorography (Innova, GE Healthcare).
Angiographic analysis
Figure 1.🤑 Schematic representation (above) and bench visualization (below) of each step of the proximal optimization with kissing balloon inflation (POKI) technique.🤑 I) The stent is implanted in main vessel (MV). Stent sizing is performed according to the distal reference diameter. II)🤑 Proximal optimization balloon is inflated in the proximal MV. The exact positioning is made by placing the distal balloon marker🤑 proximal from the carina tip. The proximal optimization technique (POT) balloon is inflated several times to ensure complete stent strut🤑 apposition in proximal region. III) The balloon positioning for POKI — in MV the distal balloon marker touches the carina🤑 tip, the side branch 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 anatomy in practice). IV) During balloon inflation the stent is optimally🤑 deformed to achieve maximum apposition to the side branch ostium. V) Final result.
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