The Jailed Stent-Balloon Bifurcation Stenting Technique

Bifurcation stenting of the coronary arteries represents a technical challenge that places patients at risk for poor outcomes. Existing techniques result in multiple stent layers at the neocarina, making for a challenging side branch recross and necessitating multiple kissing balloon inflations. This article presents a novel bifurcation stenting technique that provides full side branch coverage while maintaining carinal geometry, with an easier side branch recross and less technical complexity. Clinical outcomes at 1-year were investigated. Feasibility of the technique was demonstrated in a wet heart model. A retrospective cohort study was then performed of patients undergoing jailed stent-balloon bifurcation stenting at a single tertiary academic center. The primary end point was a composite of target lesion revascularization (TLR), target lesion myocardial infarction (TLMI), and cardiac death at 1 year postprocedurally. The primary composite outcome occurred in 13 (7.9%) cases who underwent jailed stent-balloon bifurcation stenting. At 1 year, TLR occurred in 9 (5.4%) cases, TLMI in 3 (1.8%) cases, and cardiac death in 3 (1.8%) cases. In patients with left main bifurcation disease, the primary composite outcome occurred in 6 (9.5%) cases, TLR in 3 (4.8%) cases, TLMI in 2 (3.2%) cases, and cardiac death in 3 (4.8%) cases. Jailed stent-balloon bifurcation stenting appears to be safe, feasible, and effective. Although not directly comparable, it appears to have similar clinical outcomes to existing bifurcation stenting techniques despite its reduced technical complexity.