Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access
Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc
Journal website https://www.cardiologyres.org

Original Article

Volume 12, Number 3, June 2021, pages 201-207

Balloon Deflection Technique to Facilitate Stent Delivery in Impassable Situations During Percutaneous Coronary Intervention

Figures

Figure 1.
Figure 1. Schematic representation of deflection balloon technique. (a) Stent could not be crossed in side branch. (b) Deflection balloon at proximal edge of main vessel stent to facilitate side branch delivery.
Figure 2.
Figure 2. (a) Chronic total occlusion of left circumflex artery. (b) Wire was tried to cross using Finecross microcatheter (Asahi Inc., Japan). (c) After successfully crossing using Conquest Pro 12 (Asahi Inc, Japan), distal injection was given through Finecross which confirmed its true position (yellow arrow).
Figure 3.
Figure 3. (a) Distal obtuse marginal branch was wired with Sion blue wire (Asahi Inc, Japan; A). (b) It was stented with 3.5 × 38 Endeavour Resolute (Zotarolimus eluting stent, Medtronic; USA). (c) Ostial severe disease of distal circumflex branch (yellow arrow).
Figure 4.
Figure 4. (a) Distal circumflex branch was rewired using Sion black wire. (b, c) After pre-dilatation of distal LCX, stent could not be negotiated into it because of tortuosity and calcification. A 3 × 10 Sprinter NC balloon (Medtronic Inc.; Japan) was used as deflection balloon which was kept little inside at proximal part of LCX (yellow arrow) and 2.75 × 12 mm Endeavour Resolute stent was successfully delivered into distal LCX (double arrow). LCX: left circumflex artery.
Figure 5.
Figure 5. (a) Stent was positioned into distal LCX, deflection balloon was pushed and positioned across the distal LCX branch and stent was inflated. (b) Final kissing inflation was performed at 16 atm pressure after pulling LCX stent balloon little up. LCX: left circumflex artery.
Figure 6.
Figure 6. (a, b) Well apposed stent in main vessel and side branch with TIMI III flow. LCX: left circumflex artery.

Tables

Table 1. Baseline Characteristics of Patients (N = 37)
 
VariableN (%)
CAD: coronary artery disease; PCI: percutaneous coronary intervention; STEMI: ST-segment elevation myocardial infarction; NSTEMI: non-ST-segment elevation myocardial infarction; UA: unstable angina; CCS: chronic coronary syndrome.
Age (years)75.4 ± 6.5
Male/female28 (75.7)/9 (24.3)
Risk factors for CAD
  Hypertension12 (32.4)
  Diabetes mellitus10 (27.1)
  Dyslipidemia6 (16.2)
  Smoking9 (24.3)
Indication for PCI
  STEMI5 (13.5)
  NSTEMI9 (24.4)
  UA4 (10.8)
  CCS19 (51.3)

 

Table 2. Angiographic Characteristics and Procedural Outcome of Patients Who Underwent PCI Using Balloon Deflection Technique (N = 37)
 
VariableN (%)
LAD: left anterior descending artery; LCX: left circumflex coronary artery; RCA: right coronary artery; CTO: chronic total occlusion; PCI: percutaneous coronary intervention; MI: myocardial infarction; ST: stent thrombosis.
Success/failure36 (97.3)/1 (2.7)
Target vessel
  LAD11 (29.7)
  LCX16 (43.2)
  RCA10 (27.1)
Lesion characteristics
  Calcification7 (18.9)
  Tortuosity9 (24.3)
  Angulation10 (27.1)
  CTO8 (21.6)
  Distally located lesion3 (8.1)
Type of lesion
  B17 (18.9)
  B217 (45.9)
  C13 (35.2)
  Mean diameter of the stents3.3 ± 0.9 mm
  Mean length of stents18 ± 6 mm
  Mean diameter of defection balloon3 ± 0.5 mm
  Mean length of defection balloon20 ± 0.5 mm
Lesion preparation
  Aggressive pre-dilatation36 (100)
  Cutting balloon modification of the lesion7 (19.4)
  Buddy wire technique20 (54.1)
Complications
  Peri-procedural (dissection, stent dislodgement)1 (3.7)
  In hospital (MI, ST)0 (0.0)
  Mortality at 30 day0 (0.0)