Benefit of systematic "jailed wire" technique for bifurcation provisional stenting. A CABRIOLET sub-study.

Abstract

Background: Jailed wire (JW) in the side branch (SB) is recommended during coronary bifurcation provisional stenting, but real benefit is unsure. Our objective was to evaluate benefit of a JW technique in the CABRIOLET registry.

Methods: In CABRIOLET, including 500 patients, we compared the primary composite endpoint poor final SB angiographic result (TIMI flowB, thrombosis, residual stenosis>70%, or additional SB stenting) whether JW was performed or not. Based on the usual operators practices, we also compared a systematic JW strategy: operators known to place JW frequently (>75% performed), to a conditional strategy: selective JW practices (<20% of JW).

Results: JW was performed in 251 patients (50.2%), without significant baseline clinical and angiographic differences with no-JW. JW was associated with higher primary endpoint (15.1% vs 8.4%, p<0.05), increased fluoroscopy time and contrast volume (15.9±7.3 min and 181±62 ml vs. 13.3±6.5 min and 161±74 ml, p<0.05). JW was performed in 12.1% of patients (26/214) in conditional JW group and 78.7% (225/286) in systematic. The primary endpoint was similar in both strategies (11.2% and 12.2%, p=0.78), although with greater fluoroscopy time and contrast volume for systematic JW (180±57 ml and 15.3±7.5 min vs. 162±79 ml and 13.7±6.1 min, p<0.05). There was no difference in 1-year major adverse cardiovascular events depending on JW was performed or not and between conditional or systematic strategies.

Conclusions: In a large registry, JW was associated with poorer final SB angiographic results than no-JW. Final SB angiographic result was similar between conditional or systematic JW strategies.