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José Manuel Alberto López (born 6 December 2000), commonly known as Flaco López, is an Argentine professional footballer who plays7️⃣ as a striker for Palmeiras.
López was promoted into Luis Zubeldía's senior squad in late-2024, appearing on the substitute's bench for7️⃣ Copa de la Liga Profesional encounters with Aldosivi and Defensa y Justicia.[1][5] López, in the aforementioned competition, made his professional7️⃣ debut on 3 January 2024 during a draw on the road against Patronato, after he was substituted on in place7️⃣ of Gonzalo Torres with twenty-five minutes left.[1][6] On his second appearance, López scored his first goal during a win over7️⃣ Rosario Central on 9 January.[1]
Appearances and goals by club, season and competition Club Season League Cup League Cup Continental Other7️⃣ Total Division Apps Goals Apps Goals Apps Goals Apps Goals Apps Goals Apps Goals Lanús 2024–21[nb 1] Primera División 27️⃣ 1 0 0 0 0 0 0 0 0 2 1 Career total 2 1 0 0 0 0 07️⃣ 0 0 0 2 1
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Coronary bifurcation lesions correspond to nearly 20–25% of all percutaneous coronary interventions (PCI) [1, 2]. Interventions in this subset of👄 lesions pose a technical challenge with high early and late complication rates [3]. PCI of bifurcation lesions can be performed👄 using a variety of techniques, depending on the plaque distribution across the main and daughter branches, and the bifurcation geometry👄 [4]. The fractal geometry of coronary bifurcations defines a discrepancy in diameters between the proximal main vessel (MV) and the👄 daughter branches — the distal MV (main branch, MB) and side branch (SB) [5]. Kissing balloon inflation (KBI) has been👄 one of the first proposed stent-optimization techniques specific for bifurcation lesions and continues to play an essential role in bifurcation👄 PCI by optimizing stent apposition and improving SB access. However, the application of KBI requires SB recrossing after main vessel👄 stenting, which adds additional procedure and fluoroscopy time, as well as contrast. It also requires certain operator experience, especially in👄 cases with SB occlusion after stenting. Additional disadvantages of KBI are the elliptical deformation of the proximal MV, which can👄 further compromise long-term results [6]. Proximal optimization technique (POT) has been proposed as a stent-optimization technique able to adjust the👄 tubular design of the coronary stent to the natural bifurcation anatomy [7]. It was expected that POT could correct stent👄 apposition, respecting fractal vessel anatomy, without compromising and even improving SB patency. However, studies demonstrated that for the preservation of👄 SB patency, without any functional vessel flow compromise, an additional SB balloon dilation is required [8]. The optimal result of👄 POT is highly dependent on the precise balloon positioning, and inaccurate placing of the balloon may lead to uncomplete strut👄 apposition to the SB lateral wall [9, 10]. Moreover, it is currently demonstrated that even an appropriately positioned POT balloon👄 (according to the current criteria [4]) could cause further elliptical deformation at SB ostium thus additionally stenosing it [11]. Therefore,👄 proposed herein is a new stent-optimization technique following bifurcation stenting consisting of a combination of POT and kissing-balloon inflation.
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The main findings of the present study are the following: i) A novel stent optimization technique combining proximal optimization balloon👄 inflation and kissing balloon technique was introduced and was found to be feasible both in bench-test and in-vivo evaluation; ii)👄 Procedural and angiographic success after POKI in the current patient series, was excellent; iii) The immediate angiographic result after the👄 procedure was significantly better compared with previously reported data assessing stent optimization techniques in bifurcation lesions.
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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