Wire jailing before main vessel (MV) stenting could prevent side branch (SB) occlusion after the one-stent strategy for bifurcation percutaneous coronary intervention, suggest new real-world data. The study, published online Monday and in the Feb. 28 issue of the JACC: Cardiovascular Interventions, noted that while the one-stent strategy is usually preferred based on clinical data for the treatment of the bifurcation lesion, the benefit of wire jailing at the SB has not been clarified. Led by Yeon-Jik Choi, MD, from Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea, the authors noted that coronary bifurcation lesion is “a challenging field” and is associated with serious adverse clinical events. “Despite the favorable outcomes of the 1-stent strategy for coronary bifurcation lesions, it is associated with SB occlusion, which may lead to serious adverse clinical events,” they said, noting that wire jailing at the SB before MV stenting is often performed to prevent SB occlusion after MV stenting but that the “real benefits” of wire jailing at the SB in “have not been clearly elucidated.”New data from the study, however, show that although there were no significant differences in long-term clinical outcomes, wire jailing at the SB is associated with a lower rate of final SB occlusion in patients with severe stenosis at the SB or MV. Study details Choi and colleagues assessed whether SB wire jailing before MV stenting could prevent SB occlusion after a one-stent strategy for bifurcation PCI using data from the COBIS (Coronary Bifurcation Stenting) III registry, in which 1,890 patients with bifurcation lesions underwent the one-stent strategy using second-generation drug-eluting stents. The team identified and classified patients into two groups according to the use of SB wire jailing: wire jailing (n = 819) and non–wire jailing (n = 1,071), and compared the incidence of SB occlusion (Thrombolysis In Myocardial Infarction flow grade <3) and target lesion failure (cardiac death, myocardial infarction or target lesion revascularization). An analysis of the patient groups revealed that the overall incidence of final SB occlusion was not significantly different between wire jailing (1.8%) vs non–wire jailing (2.9%; P = 0.182). Furthermore, during an average follow-up of 52 months, the incidence of target lesion failure was not significantly different between wire jailing and non–wire jailing (7.6% vs 6.3%; P = 0.343). However, Choi and colleagues noted that wire jailing at the SB was a significant protective factor for SB occlusion after MV stenting on multivariate analysis and was significantly associated with a lower incidence of SB occlusion in patients with significant stenoses (≤60%) at the SB (5.1% vs 11.3%; odds ratio [OR]: 0.42; 95% confidence interval [CI]: 0.19-0.89; P = 0.028) or MV (3.1% vs 6.2%; OR: 0.49; 95% CI: 0.24-0.95; P = 0.039). “Wire jailing at the SB was associated with a lower rate of final SB occlusion following MV stenting in patients with severe stenoses at the SB or MV but not with overall bifurcation lesions,” concluded the team, noting that long-term clinical outcomes were comparable between the two groups. “Thus, routine wire jailing at the SB does not need to be recommended for all bifurcation lesions treated with the 1-stent strategy, but rather only for specific lesion subsets with severe stenoses of the SB or MV,” they said. Statistics are just statistics Writing in an accompanying editorial, David Hildick-Smith, MD, from the Royal Sussex County Hospital, England, noted that wire jail has been “one of the central tenets” of the European Bifurcation Club philosophy since its very first meeting. “It is gratifying to see this strategy vindicated in a large study,” noted the expert commentator, adding that the purpose of leaving the wire in the SB is said to be twofold: first, it helps maintain flow in the SB after MV stent deployment, and second, it aids rewiring of the SB, particularly if flow is diminished or lost. “This theory is generally accepted,” he said. “But some interventionists worry about guide catheter advancement during wire removal, wire reaming, or wire entrapment after high-pressure balloon inflation.” The editorialist noted that 43% of patients had wire jailing while 57% did not, adding that ultimate SB occlusion occurred in 1.8% of those with a jailed wire and 2.9% of those without. “This was not statistically significant but statistics are just statistics, and not necessarily the truth,” he said, noting that 47% of patients who had wire jailing had “true” bifurcations, compared with only 27% of those who did not have wire jailing. “In other words, the wire-jail group had more complex anatomy and yet despite this had a numerically lower rate of side branch occlusion.” Indeed, he noted that a multivariate analysis suggested that SBwire jail was significantly protective. Sources: Choi Y-K, Lee S-J, Kim B-K, et al. Effect of Wire Jailing at Side Branch in 1-Stent Strategy for Coronary Bifurcation Lesions. JACC Cardiovasc Interv 2022;15:443-455. Hildick-Smith D. Coronary Bifurcation Stenting: The Side Branch Wire Points the Way. JACC Cardiovasc Interv 2022;15:456-457. Image Credit: Belezapoy – stock.adobe.com