Comparison of short-term myocardial perfusion and clinical outcomes between balloon stent kissing technique and junctional wire technique strategies in true bifurcation lesions of the left anterior descending artery and diagonal branch

Abstract

Objectives: To compare the clinical efficacy of the Balloon Stent Kissing Technique (BSKT) and Junctional Wire Technique (JWT) for treating true bifurcation lesions of the coronary left anterior descending artery (LAD) and diagonal branch. Methodology: A retrospective analysis included data from 235 patients who underwent treatment of true bifurcation lesions of the coronary LAD and diagonal branch at Tianjin University Chest Hospital between February 2023 to October 2024. All patients were followed up for one year. Based on the technique, patients were divided into the BSKT (n=111) and the JWT (n=124) groups. Efficacy, safety profiles, and myocardial perfusion parameters were compared between the two groups. Results: In the unadjusted analysis, BSKT was associated with a higher immediate stent implantation success rate and a lower incidence of provisional stenting (PS-T) due to branch compromise. After adjustment for potential confounders, the association with immediate stent implantation success was attenuated and became borderline significant. Prognostic outcomes were comparable between the two groups (P > 0.05). On postoperative Day 1, BNP and cTnT levels remained lower in the BSKT group after correction for repeated longitudinal comparisons, whereas the difference in CK-MB was attenuated after multiple-comparison correction. At six months, the BSKT group showed more favorable selected SPECT-derived parameters, including a lower stress myocardial perfusion score, fewer resting and stress myocardial ischemic segments, and a narrower range of abnormal myocardial perfusion, whereas the resting myocardial perfusion score did not differ significantly between groups. Conclusion: Compared with JWT, BSKT may provide more favorable side-branch protection and selected short-term functional benefits in patients with LAD-diagonal branch true bifurcation lesions, but its long-term clinical benefit remains uncertain.