Optimal balloon positioning for the proximal optimization technique? An experimental bench study

François Dérimay, Gilles Rioufol, Takeshi Nishi, Yuhei Kobayashi, William F. Fearon, Joëlle Veziers, Patrice Guérin, Gérard Finet

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


Aims: The proximal optimization technique (POT) in coronary bifurcation stenting improves apposition and side-branch obstruction. The POT balloon should be positioned with the distal radio-opaque marker at the carina cut plane. However, the real impact of positioning remains unknown. Methods and results: Synergy™ stents (Boston Scientific, USA) were implanted on left-main fractal bench models. Initial POT was performed in 3 positions according to distal shoulder position (loss of balloon parallelism) relative to the carina cut plane (n = 5/group): i) “proximal”, 1 mm before carina; ii) “medium”, just at carina; iii) “distal”, 1 mm after carina. Results were quantified on 2D- and 3D-OCT. Compared to implantation, initial POT improved malapposition in all positions (“proximal”: 61.5 ± 1.4% vs. 5.1 ± 2.7%; “medium”: 60.2 ± 2.4% vs. 1.3 ± 0.6%; “distal”: 60.5 ± 2.9% vs. 1.1 ± 1.8%, p < 0.05). However, residual malapposition was greater in “proximal” position (p < 0.05). “Proximal”, unlike “medium” or “distal” POT, also failed to improve side-branch obstruction. Conversely, “distal” POT significantly overstretched the main-branch ostium, with stent/artery ratio 1.22 ± 0.04 vs. 1.11 ± 0.07 for “medium” POT (p < 0.05). Conclusion: Shoulder positioning is essential to optimize the mechanical benefit of POT without main-branch overstretch (too distal position). Experimentally, the best position is just at the carina cut plane (“medium”).

Original languageEnglish (US)
Pages (from-to)95-97
Number of pages3
JournalInternational Journal of Cardiology
StatePublished - Oct 1 2019
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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