We read with great interest the article reported by Lee et al., which was published in the most recent issue of the American Journal of Cardiology. We appreciate the authors for this meticulously prepared meta-analysis, which investigates the clinical outcomes of side branch protection techniques during provisional stenting. However, we believe there are several key points that need to be addressed.
First of all, although provisional stenting is the gold standard treatment method for most bifurcation lesions, side branch (SB) occlusion is the Achilles’ heel of this strategy. Therefore, various SB protection techniques have been described in the literature to prevent SB loss during provisional stenting. In general, SB protection strategies are divided into two categories: jailed balloon (JBT) (active SB) and jailed wire techniques (JWT) (conventional). In 2020, CIT-RESOLVE investigators demonstrated that an active SB protection strategy (JBT) was superior to JWT in reducing SB occlusion when treating bifurcation lesions with a V-RESOLVE (Visual Prediction for Side Branch Occlusion Risk in Coronary Bifurcation Intervention) score >12. Patients with a V-RESOLVE score >12 (high risk) are associated with a higher risk for SB occlusion, and if SB occlusion occurs, it can lead to worse cardiovascular outcomes. Furthermore, some modifications and iterations have been made since the definition of JBT. , Therefore, in this meta-analysis, it can be expected that different JBTs may create differences in SB restenosis and stent optimization, which may affect clinical outcomes. For readers, especially interventional cardiologists, it would be beneficial to support the study results with subgroup analysis for different JBTs for SB protection strategies in the authors’ study, and this would provide valuable data for the management of high-risk patient populations.
Second, the authors did not provide comprehensive angiographic data on the anatomical features of bifurcation disease, such as calcification, plaque burden, tortuosity, bifurcation angle, pre-procedural predictive factors for SB occlusion using the V-RESOLVE scores, proximal optimization technique (POT), POT-side-POT, and POT-kissing-POT techniques. These parameters may be valuable data for study outcomes and have the potential to influence SB occlusion.
CRediT authorship contribution statement
Ezgi Gültekin Güner: Investigation, Conceptualization, Data curation, Writing– original draft. Koray Çiloğlu: Investigation, Writing– original draft. Aybüke Şimşek: Investigation, Visualization. Fatih Furkan Bedir: Data curation, Investigation. Ahmet Güner: Writing– review & editing.
Declaration of competing interest
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