Initial proximal optimisation technique (POT) in provisional stenting improves global malapposition, side-branch (SB) obstruction (SBO) and conservation of arterial circularity. The specific mechanical effects of a final POT sequence concluding the main provisional stenting techniques, on the other hand, are unknown.

SynergyTM stents were implanted on fractal coronary bifurcation bench models using the main provisional stenting techniques (n=5 per group): kissing-balloon inflation (KBI), snuggle, and rePOT (initial POT+SB inflation+final POT). Final results were quantified on 2D and 3D OCT before and after final POT.

Whichever the technique, final POT significantly decreased global malapposition (from 7.6±5.3% to 2.2±2.5%, P<0.05) and proximal elliptic deformation (from 1.15±0.07 to 1.09±0.04, P<0.05), without impact on SBO (from 11.5±9.6% to 12.9±10.6%, NS). However, final POT failed to completely correct the elliptic deformation induced by balloon juxtaposition during the KBI and snuggle techniques, with final elliptic ratios of 1.11±0.03 and 1.11±0.04 respectively, significantly higher than with the full rePOT sequence: 1.05±0.02 (P<0.05) (Fig. 1).

Like initial POT, final POT is mandatary whatever the provisional stenting technique used. However, final POT fails to completely correct all proximal elliptic deformation associated with “kissing-like” techniques, in contrast to results with the rePOT sequence.