For the bench visualization custom bifurcated silicone model, with proximal MB internal diameter (ID) 3.5 mm, distal MB ID 3.0 ♠ mm, SB ID 2.5 mm, and 3.0 mm. Three types of models were used according to distal branching angle — ♠ 30°, 45° and 60° models. The POKI technique has been simulated using a dedicated 3.5 mm diameter to 6 mm ♠ length non-compliant POT balloon (Brosmed, China). The balloon is specifically designed for the POT technique with shortened balloon shoulders and ♠ specific cylindrical shape. This prevents inappropriate stent deformations at the place of inflation. Following deployment, the models were visualized using ♠ fluoroscopy and fluorography (Innova, GE Healthcare).

In-vivo procedure

In total 41 patients (41 vessels) were evaluated. Two case examples are illustrated in ♠ Figure 2. The mean age was 72.5 ± 8.4, and 70.6% were males. Patient clinical characteristics are shown in Table ♠ 1. The target vessel was left main in 9 (22.0%) patients, left anterior descending artery — in 26 (63.4%), left ♠ circumflex artery — in 4 (9.8%) and right coronary artery — in 2 (4.9%). The predominant type of bifurcation lesion ♠ was Medina 1-1-1 (62.6%). Eight (19.5%) patients presented with chronic total occlusions of the target vessels. Patient procedural characteristics are ♠ shown in Table 2.

Proximal optimization with KBI is a novel stent-optimization technique for bifurcation lesions. It showed excellent feasibility and ♠ success-rate both in bench and in-vivo evaluation.