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The article is accompanied by the editorial on page 894

In-vivo evaluation

Figure 3. Changes in percentage diameter stenosis before and after 💰 percutaneous coronary intervention (PCI) in the main vessel ( A ), main branch ( B ), and side branch ( 💰 C ) of the bifurcation lesion; %DS — percentage diameter stenosis.

Stent underexpansion and malapposition are responsible for unsatisfactory post-PCI results 💰 and are associated with target lesion failure and stent thrombosis, therefore contemporary interventional practice uses stent optimization techniques to prevent 💰 these events [14, 15]. Current expert recommendations accept POT as mandatory step in bifurcation PCI as it enhances stent apposition 💰 in the proximal MV, and reduces stent deformation [4, 16]. However, inappropriate distal positioning of the POT balloon bears the 💰 risk of distal MV overstretch and carina shift to the SB. On the other hand, incorrect proximal positioning may lead 💰 to stent malapposition and underexpansion near the carina [17]. The present analysis demonstrated that POT could be a source of 💰 additional ostial SB stenosis, due to ostial stretch in elliptical fashion [11]. Concerning carina shift, KBI has shown to have 💰 an advantage over POT followed by SB balloon dilation [18]. However, KBI bears a risk of ellipsoid stent distortion of 💰 proximal MV and its overexpansion [19], which has been associated with higher rates of MV reintervention [20]. Furthermore, randomized clinical 💰 trials comparing provisional stent strategies with or without KBI failed to report any advantage on clinical outcomes for KBI [21, 💰 22]. Finally, when comparing KBI and POT with a consequent SB dilation, randomized multicenter trial failed to show significant advantage 💰 for any of the two techniques over the other [23]. In the present view, these results could be justified by 💰 the improper choice of balloon diameters or inadequate balloon positioning which lead to insufficient correction of the stent deformation. The 💰 POT — SB dilatation — POT technique sounds logical, but in practice, as already mentioned, it did not correct SB 💰 ostial compromise. As mentioned above, POT at the level of SB ostium stretches SB perimeter in ellipse, which eliminates the 💰 positive effect of POT on carina shifting. Thus, in the end, regarding SB compromise, the final effect could be neutral.

The 💰 study was investigator-initiated, and funded by the local institution (Medica Cor Hospital, Russe, Bulgaria).