Impact of Using a Scoring Balloon for Main Branch Predilatation on the Incidence of Side Branch Compromise in Bifurcation Lesion PCI

Abstract

Background. Side branch (SB) compromise represents a frequent challenge encountered during percutaneous coronary intervention (PCI) for bifurcation lesions. Numerous techniques have emerged for predilating the main branch (MB), aiming to mitigate the occurrence of SB compromise. Among these approaches, scoring balloons have gained recognition for their ability to reduce carina shift and migration, consequently lowering the risk of SB compromise. However, the optimal treatment strategy remains a topic of debate. Thus, the current study is designed to investigate and compare effects of using scoring versus nonscoring balloons for MB predilatation on the incidence of SB compromise. Methods. A total of 102 patients who underwent elective PCI were enrolled at Jakarta Heart Center, Jakarta, Indonesia, from July 2022 to July 2023. Patients were randomized into two arms, i.e., scoring balloon predilatation arm (n = 52) and nonscoring balloon predilatation arm (n = 50). Outcome was measured as a composite endpoint of reduced thrombolysis in myocardial infarction (TIMI) flow in SB after MB stenting, SB intervention needed, and new or progressing ostial SB stenosis more than 50% compared to baseline. Results. Both study arms were comparable in various aspects, including gender distribution with a male majority, the predominant involvement of the left anterior descending (LAD) vessel, the presence of minimal to mild calcification, type A lesion, SB diameter, SB angulation, and the use of SB wire protection. In-depth analysis was conducted that revealed no significant differences between encompassed factors such as TIMI flow, the necessity for SB intervention, new or progression of ostial SB stenosis exceeding 50% when compared to the baseline, as well as the composite endpoint. Furthermore, these confounding factors did not exhibit any association with the incidence of SB compromise. Conclusion. Our study revealed that employing either scoring or nonscoring balloon predilatation in the MB has equivalent effects on SB compromise.