Prevention of Side Branch Compromise by Partial Side Branch Predilatation in Patients Undergoing Provisional Stenting during Primary Percutaneous Coronary Intervention

Background: During primary percutaneous coronary intervention (PPCI), coronary bifurcation lesions continue to present technological challenges. Compromise of the side branch (SB) during main vascular stenting may result in ischemia, inadequate flow and adverse outcomes. Partial side branch predilatation has been proposed as a simple strategy to reduce SB compromise without increasing procedural complexity. So, we aimed to assess efficacy of preballoon dilatation of diseased side branch during provisional stenting of the main vessel in ST-elevation myocardial infarction (STEMI) patients. Methods: This randomized controlled clinical trial was conducted at Catheterization Laboratory, Cardiology Department, Faculty of Medicine, Zagazig University on 48 patients with STEMI who underwent PPCI. Participants were divided into: Group I consisted of 24 patients who were treated with PREDILATATION BALLON (PD) in the diseased side branch and group II consisted of 24 patients treated with NON PREDILATATION BALLON (NPD) in the diseased side branch. Results: Analysis of side branch dissection demonstrated no significant difference between two groups, although a numerical trend toward fewer dissections was observed in the PD cohort. Marked difference emerged in side branch recrossing, with 50% of patients in the NPD group requiring recrossing through provisional stent compared with 16.7% in PD group. Conversely, side branch stenting rates did not differ significantly between groups. Conclusion: In STEMI patients undergoing provisional stenting, diseased side branch balloon predilatation appears to confer significant procedural benefits, including reduced contrast utilization, shorter procedure time, lower fluoroscopy exposure, and a decreased need for recrossing through the provisional stent to the side branch.