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