Randomized Comparison of Final Kissing Balloon Dilatation Versus No Final Kissing Balloon Dilatation in Patients With Coronary Bifurcation Lesions Treated With Main Vessel Stenting: The Nordic-Baltic Bifurcation Study III

Study Questions:

Should final kissing balloon angioplasty be performed in all patients who undergo bifurcation stenting using a strategy of only main vessel stenting?


The authors randomized 477 patients with a bifurcation lesion to final kissing balloon dilatation (FKBD) (n = 238) or no FKBD (n = 239) after main vessel stenting. All patients were treated with a stent to the main branch and had Thrombolysis in Myocardial Infarction (TIMI) 3 flow in the side branch at the end of the procedure. The primary endpoint was a composite of cardiac death, nonprocedure-related index lesion MI, target lesion revascularization, or stent thrombosis within 6 months.


All patients were treated with a sirolimus-eluting stent. There was no difference in the primary endpoint at 6 months (2.1% in the FKBD vs. 2.5% in the non-FKBD arm, p = 1.00). As expected, use of FKBD increased fluoroscopic time and the volume of contrast used. In a subset of 326 patients who underwent angiographic follow-up, the rate of binary restenosis was nonsignificantly higher in the no-FKBD arm (17.3% vs. 11.0%, p = 0.11). Restenosis was more common with the no-FKBD strategy in the side branch (15.4% vs. 7.9%, p = 0.039). The incidence of restenosis in the main branch was low (2.5% vs. 3.1%, p = 0.68).


The authors concluded that a strategy of routine final kissing angioplasty in patients undergoing bifurcation stenting appears to reduce angiographic restenosis without impacting clinical endpoints.


This study suggests that the simpler strategy of stenting the main branch only, with predilatation of the side branch if needed, is suitable for treating most coronary bifurcations. In this study, routine final kissing angioplasty did not provide any clinical benefit, suggesting that this should only be reserved for patients where the side branch needs to be stented due to a suboptimal angiographic result.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention

Keywords: Incidence, Myocardial Infarction, Follow-Up Studies, Thrombosis, Dilatation, Sirolimus, Angioplasty, Angioplasty, Balloon, Coronary, Stents

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