Pressure wire assessment of jailed balloon technique efficacy in a patient with complex bifurcated lesion

Coronary Physiology to Guide Percutaneous Coronary Intervention: Why, When, and How

Over most of the history of interventional cardiology, it has been tacitly assumed that once flow-limiting coronary disease had been documented, angiography was sufficient to plan percutaneous coronary intervention (PCI) and, subsequently, to decide if an optimal procedural result had been achieved. This view has been challenged by recent studies evaluating the results of PCI with fractional flow reserve and nonhyperemic pressure ratios. Evidence has accumulated showing that suboptimal functional PCI results occur frequently despite a good angiographic result and that they are associated with worse patient outcomes. In this article, we discuss how available coronary physiology tools, either guide wire or image-based, may address this problem by facilitating better procedural planning and PCI precision and optimization.

Jailed balloons for side branch protection: a review of techniques and literature: Jailed balloons for side branch protection

Coronary bifurcation lesions are commonly encountered, and side branch compromise is a major complication of these bifurcation interventions. Jailing a wire in the side branch is the most common method of significant side branch protection. Jailing a balloon in the side branch is a less well known and seldom practiced strategy of side branch preservation but tends to have lower occlusion rates as compared to conventional jailed wires. Various modifications have been applied to the original jailed balloon technique to further improve side branch patency. Complications arising from this technique have been limited to case reports only and relate mainly to calcified vessels.