ABSTRACT:

Background: Coronary bifurcation lesions had been one of the most technically complicated subsets of percutaneous coronary intervention (PCI). These lesions were linked to increased restenosis and poor cardiac events. The modified jailed balloon technique (M-JBT) was already presented as a development of the traditional jailed balloon technique, which seeks to shield the side branch, and maximizes expansion of the main vessel stents. Although it has been used increasingly, there was paucity in clinical evidence that has assessed its safety and effectiveness in clinical practice.
Purpose: The purpose of this study was to assess the effectiveness and operational results of the modified jailed balloon technique in management of the coronary bifurcation lesions in patients undergoing PCI procedure at a tertiary cardiac care centre.
Methods: It was a prospective observational study at AFIC/NIHD, which was conducted in September 2023 to February 2024. One hundred and ten patients with known cases of coronary bifurcation lesions and referred to undergo PCI were used. Left main disease patients who need complicated two-stent procedures or they have extreme calcification were excluded. All subjects were provided with PCI using the modified jailed balloon procedure where a side branch balloon was placed and jailed during main vessel stenting with no inflation followed by optional side branch optimization depending on angiographic outcomes. The success of the procedure, residual stenosis, side branch flow, and in-hospital complications were noted. Lesion characteristics and post procedural outcomes were measured by quantitative coronary angiography. The SPSS version 26 was used to conduct statistical analysis where p < 0.05 was regarded to be significant.
Results: 96% of cases of the modified jailed balloon technique resulted in procedural success. The proportion of the main vessel after stenting was 6.8 ± 2.4% in mean residual stenosis and the side branch residual stenosis was 14.5 ± 3.7% in mean. TIMI-3 flow in both of the branches was preserved in 93 per cent of patients. Minor dissections were noted in 3 percent of the cases, and none of the cases had any side branch occlusion. Procedure duration of 45 minutes with 160 mL of contrast was on average 45 + 8 minutes. None of the major adverse cardiac events was identified during hospitalization. All in all, the method showed better side branch protection and was also the best in angiographic results.
Conclusion: It was observed that the modified jailed balloon technique was a safe, effective, and technically feasible method of treating coronary bifurcation lesions. It gave good procedural success, maintenance of side branch patency, and reduction of complications. The results were in favor of M-JBT as a desirable approach to the selected bifurcation lesions and provided a balance between simplicity and effectiveness.
Keywords: Modified jailed balloon technique, coronary bifurcation lesions, percutaneous coronary intervention, side branch protection, procedural success.interventional cardiology.