Benefit of Systematic “Jailed Wire” Technique for Bifurcation Provisional Stenting. A CABRIOLET Substudy

Background

Jailed wire (JW) in the side branch (SB) is recommended during coronary bifurcation provisional stenting, but there is uncertainty about the real benefit. Our objective was to evaluate the benefit of a JW technique in the Coronary Artery Bifurcation Revascularization Without kIssing ballOon infLation by rEpoT (CABRIOLET) registry.

Methods

In CABRIOLET, which included 500 patients, we compared the primary composite end point of a poor final SB angiographic result (of Thrombolysis in Myocardial Infarction (TIMI) flow < III, dissection grade > B, thrombosis, residual stenosis > 70%, or additional SB stenting) whether JW was performed or not. On the basis of the usual operator practice, 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 compared with those who received no JW. JW was associated with higher primary end point (15.1% vs 8.4%; P < 0.05), and increased fluoroscopy time and contrast volume (15.9 ± 7.3 minutes and 181 ± 62 mL vs 13.3 ± 6.5 minutes and 161 ± 74 mL; P < 0.05). JW was performed in 12.1% of patients (26 of 214) in the conditional JW group and 78.7% (225 of 286) in systematic group. The primary end point 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 minutes vs 162 ± 79 mL and 13.7 ± 6.1 minutes; P < 0.05). There was no difference in 1-year major adverse cardiovascular events depending on whether 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 results were similar between conditional or systematic JW strategies.