FINAL kissing balloon dilatation (FKB) in patients treated with an upfront provisional stenting strategy for coronary bifurcation lesions shows no significant impact on major adverse cardiac events (MACE), but is associated with a modest reduction in lesion-oriented composite outcomes (LOCO), according to a large real-world registry analysis.
Coronary bifurcation lesions, which involve branching points of arteries, present unique challenges in stenting procedures. The provisional stenting strategy is widely used, but the role of FKB, a technique where both the main and side branches are dilated simultaneously, remains debated. This study utilised the ULTRA-BIFURCAT registry, combining data from 5,607 patients treated with provisional stenting. Propensity score matching (PSM) generated 1,784 pairs of patients who underwent FKB versus those who did not. The primary outcome was MACE, a composite of all-cause death, myocardial infarction, target lesion revascularisation, or stent thrombosis. Secondary outcomes included LOCO, a composite of target vessel myocardial infarction, or target lesion revascularisation, and subgroup analyses based on bifurcation site, side branch involvement, diameter, and lesion length.
Over a follow-up period of 800 days, MACE rates were similar between the FKB and no FKB groups (9.0% vs 8.6%; p=0.68). However, FKB use was associated with lower LOCO rates (1.9% vs 2.9%; p=0.04), driven by reductions in target vessel myocardial infarction (0.2% vs 0.5%; p=0.03) and target lesion revascularisation (1.8% vs 2.6%; p=0.14). These benefits were most pronounced in patients with true bifurcation lesions and side branches larger than 2.5 mm in diameter.
These findings suggest that while FKB does not significantly affect broader clinical outcomes such as MACE, it may offer advantages in reducing lesion-specific complications like TVMI and TLR, particularly in certain subgroups of patients. Clinicians should consider the anatomical characteristics of bifurcation lesions when deciding whether to perform FKB during provisional stenting procedures. Future research should focus on refining patient selection criteria and evaluating long-term impacts of FKB on clinical outcomes to optimise treatment strategies for coronary bifurcation lesions.
Reference
De Filippo O et al. Final kissing balloon dilatation in patients with coronary bifurcation lesions treated with an upfront provisional stenting strategy. EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. 2025;21(6):e318-28.
