Post on 07-Aug-2020
Focus on POT(Proximal Optimization Technique)
Case
Jacques MONSEGU, MD
Cardio Vascular Institute
Grenoble, France
Disclosure Statement of Financial Interest
I, MONSEGU Jacques, DO NOT have a
financial interest/arrangement or
affiliation with one or more organizations
that could be perceived as a real or
apparent conflict of interest in the
context of the subject of this
presentation.
Clinical case
58 years-old man
Smoker and dyslipidemia
Effort chest pain
Normal EKG and rest echo
Stress echo positive in apical
Lesion analysis
0,1,0 Medina lesion
Ostial Diagonal plaque
Positive FFR 0.77 in
distal LAD
Strategy
Provisional side branch stenting
Stent implantation from proximal LAD to
mid LAD
POT
Side branch opening
rePOT
OFDI imaging
Predilatation with 3.5 x 15 mm SC balloon
Stent sizing in provisional technique
1 2
3
D2 has to be reference stent choice diameter
Stents over-expansion capacity
3.6 mm3.3 mm
4.2 mm
4.0 mm 4.0 mm4.3 mm
4.3 mm
4.1 mm
5.7 mm
5.6 mm 5.2 mm5.8 mm5.5 mm 5.8 mm
5.9 mm Foin IJC 2016; 221:171-9
3.5 x 20 mm DES Synergy®
Stent implantation
After stent implantation
POT
POT technique
POT Balloon
position
Finet JACC Interv 2015;8:1308-17
Trek™ Abbott
Maverick™ Boston
Euphora™ Medtronic
Hiryu™ Terumo
4.5 x 10 SC balloon
POT
After POT
Re-crossing
Proximal crossing
Distal crossing
3.0 x 12 mm NC balloon
Side opening
4.5 x 10 SC balloon Diagonal FFR 0.92
Re-POT
POT+SBI+POT = re-POT ‘Superior’
Finet, JACC Interv 2015;8:1308-17
Final result
POT advantages
Distal main vessel diameter respect
Adequate proximal stent apposition
Proximal initial physiologic anatomyreconstruction
Reduce risk of accidental abluminal rewiring
Allow strut protusion into SB
Facilitate easier SB access and distal cellrecrossing
Lowers risk of stent distorsion by cathetercollision
Conclusions
Provisional stent technique
MV distal diameter respect
POT technique has to be a standard step
re-POT for simplification