Modified jailed balloon technique for coronary artery bifurcation lesions

Shang-Yu Wen, Hong-Ying Yu, Hui Lie

Coronary bifurcation lesions are technically challenging, and implantation of a drug-eluting stent is associated with unfavourable long-term angiographic and clinical results. Risk stratification based on coronary anatomy from the recent DEFINITION study showed the benefit of a simpler stenting approach for simple bifurcation lesions1. Provisional stenting using a jailed side branch (SB) wire is the most extensively accepted simple technique and is effective for the vast majority of bifurcation lesions2. As a jailed wire is unable to prevent SB closure after stenting the main vessel (MV) for all lesions, the recently proposed jailed balloon technique has created a great deal of interest3. Similar to the jailed wire approach, the jailed balloon technique requires a small balloon to be positioned in the SB before stenting the MV. Unfortunately, the jailed balloon technique is limited in that: 1) predilating the SB is still required, which is associated with a high incidence of SB dissection; 2) it is unable to prevent SB closure in some difficult cases; and 3) it is very difficult to remove the jailed balloon in very calcified and complex settings. A schematic description of the modified jailed balloon technique is introduced in Figure 1, followed by a case description (Figure 2).