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Benefits of final proximal optimization technique (POT) in provisional stenting
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International audience. Aims: Initial proximal optimization technique (POT) in provisional stenting improves global malapposition, side-branch (SB) obstruction (SBO) and conservation of arterial circularity. The specific mechanical effects of a final POT sequence concluding the main provisional stenting techniques, on the other hand, are unknown. Methods and results: Synergy (TM) stents were implanted on fractal coronary bifurcation bench models using the main provisional stenting techniques (n = 5 per group): kissing-balloon inflation (KBI), snuggle, and rePOT (initial POT + SB inflation + final POT). Final results were quantified on 2D and 3D OCT before and after final POT. Whichever the technique, final POT significantly decreased global malapposition (from 7.6 +/- 5.3% to 2.2 +/- 2.5%, p \textless 0.05) and proximal elliptic deformation (from 1.15 +/- 0.07 to 1.09 +/- 0.04, p \textless 0.05), without impact on SBO (from 11.5 +/- 9.6% to 12.9 +/- 10.6%, NS). However, final POT failed to completely correct the elliptic deformation induced by balloon juxtaposition during the KBI and snuggle techniques, with final elliptic ratios of 1.11 +/- 0.03 and 1.11 +/- 0.04 respectively, significantly higher than with the complete rePOT sequence: 1.05 +/- 0.02 (p \textless 0.05). Conclusions: Like initial POT, final POT is recommended whatever the provisional stenting technique used. However, final POT fails to completely correct all proximal elliptic deformation associated with "kissing-like" techniques, in contrast to results with the rePOT sequence. (c) 2018 Elsevier B.V. All rights reserved.
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