BALANCING SAFETY AND EFFICACY: COMPARATIVE ANALYSIS OF POT-SIDE-POT AND KBI IN PROVISIONAL BIFURCATION STENTING

Background: Coronary bifurcation lesions (CBLs) present significant challenges in percutaneous coronary interventions (PCI) due to complex anatomy and increased risk of side branch (SB) complications. The optimal technique for SB optimization—Kissing Balloon Inflation (KBI) versus Proximal Optimization Technique with sequential SB inflation (POT-side-POT)—remains debated. Objective: To compare the safety and efficacy of POT-side-POT versus KBI within a provisional stenting strategy for non-complex CBLs. Methods: This retrospective study included 60 patients undergoing PCI for CBLs at Al-Latakia University Hospital between June 2021 and June 2024. Patients were allocated to POT-side-POT (n=30) or KBI (n=30) at operator discretion. Inclusion criteria included main vessel diameter >2.5 mm and SB diameter >2 mm. Primary endpoints included combined adverse events, in-hospital and 30-day mortality, contrast-induced acute kidney injury (CI-AKI), stent thrombosis, SB dissection, and need for additional SB stenting. Statistical analysis incorporated inverse probability weighting (IPW) to reduce bias. Results: Demographics, clinical characteristics, and laboratory values were similar between groups. Procedural time and contrast volume were higher in KBI. Residual SB stenosis and rates of SB dissection and additional stenting were higher in the KBI group after IPW adjustment. No in-hospital or 30-day mortality occurred in either group. Subgroup analysis demonstrated POT-side-POT superiority in true bifurcation lesions regarding procedural efficiency and SB complication reduction without increasing CI-AKI or mortality. Conclusion: POT-side-POT offers a safe and efficient strategy for provisional stenting of non-complex coronary bifurcations, reducing SB dissection and stent thrombosis while minimizing procedural time and contrast exposure. KBI remains a viable secondary option when additional SB expansion is required. These findings support POT-side-POT as the preferred technique in routine practice for non-complex CBLs.