Feasibility and Efficacy of the Jailed Pressure Wire Technique for Coronary Bifurcation Lesions.

Abstract

During provisional stenting (PS) of a bifurcationlesion (BL), evaluation of the side branch (SB) resultcan be challenging (1). To our knowledge, no studieshave evaluated the feasibility of using a pressure wire(PW) as a jailed wire for the evaluation of SB resultsduring PS. Thus, we designed a descriptive pilotstudy to analyze the feasibility of using a jailed PW inthe SB during PS, as well as the use of the use of theinstantaneous wave-free ratio (iFR) as a new index forthe physiological evaluation of SB results.From June 2017 to July 2018, we included 40selected patients who underwent BL interventionusing PS. Initially, the PW (Volcano Verrata) waspassed distal to the SB lesion. Under stable hemody-namic conditions, the baseline SB iFR was deter-mined. Main vessel (MV) stenting was performed bytrapping the PW with continuous SB iFR monitoring,and a new SB iFR was determined with the PW jailedonce the effect of possible hyperemic agents hadpassed. To evaluate the possibility of PW drift, weremoved the jailed PW to the MV ostium. If MVostium iFR differed by 1 0.01, we considered thatthe PW had drifted. In these cases, repeat MV ostiumcalibration was performed, and a new SB iFR valuewas obtained after SB rewiring. SB post-dilation wasperformed according to the obtained iFR in the base,extrapolating from native vessel thresholds estab-lished in clinical trials (2,3). If the iFR was >0.89, nofurther measures were taken. If the iFR was #0.89,the SB was post-dilated, and a new iFR wasdetermined. If the iFR remained #0.89 after SB post-dilation, we considered the need for a second stent.