Jailed balloon versus provisional stenting with drug-coated balloon in true bifurcation lesions

Dafne M. Macías-Argüelles, Servicio de Cardiología, Unidad Médica de Alta Especialidad No. 1 Bajío, Instituto Mexicano del Seguro Social (IMSS), León, Gto., México
Germán R. Bautista-López, Servicio de Cardiología, Unidad Médica de Alta Especialidad No. 1 Bajío, Instituto Mexicano del Seguro Social (IMSS), León, Gto., México
Hilda E. Macías-Cervantes, Servicio de Medicina Interna, Unidad Médica de Alta Especialidad No. 1 Bajío, Instituto Mexicano del Seguro Social (IMSS), León, Gto., México
José M. Sánchez-López, Servicio de Cardiología, Unidad Médica de Alta Especialidad No. 1 Bajío, Instituto Mexicano del Seguro Social (IMSS), León, Gto., México
Mario A. Castillo-Velázquez, Servicio de Cardiología, Unidad Médica de Alta Especialidad No. 1 Bajío, Instituto Mexicano del Seguro Social (IMSS), León, Gto., México
Marco A. Solórzano-Vázquez, Servicio de Cardiología, Unidad Médica de Alta Especialidad No. 1 Bajío, Instituto Mexicano del Seguro Social (IMSS), León, Gto., México
Juan A. Cibrián-Delgado, Servicio de Cardiología, Unidad Médica de Alta Especialidad No. 1 Bajío, Instituto Mexicano del Seguro Social (IMSS), León, Gto., México
Edgar U. Quintana-Ortiz, Servicio de Cardiología, Unidad Médica de Alta Especialidad No. 1 Bajío, Instituto Mexicano del Seguro Social (IMSS), León, Gto., México
Enrique A. Bernal-Ruíz, Servicio de Cardiología, Unidad Médica de Alta Especialidad No. 1 Bajío, Instituto Mexicano del Seguro Social (IMSS), León, Gto., México
Luis M. Vargas-Ramírez, Servicio de Cardiología, Unidad Médica de Alta Especialidad No. 1 Bajío, Instituto Mexicano del Seguro Social (IMSS), León, Gto., México

Background: Coronary bifurcation lesions remain a major challenge in percutaneous coronary intervention because of the risk of side branch compromise or occlusion. Several strategies, including provisional stenting, jailed balloon protection, and drug-coated balloons, have been developed to preserve side branch patency; however, direct comparative evidence in true bifurcation lesions remains limited. Objective: To determine the frequency of side branch compromise in coronary bifurcation lesions treated with jailed balloon technique versus provisional stenting plus drug-coated balloon. Method: Open-label randomized clinical trial conducted at UMAE No. 1 Bajío, IMSS, from April to September 2025. A total of 32 patients with acute or chronic coronary syndrome and true bifurcation lesions (Medina 1-1-1, 1-0-1, 0-1-1) were randomized 1:1 to provisional stenting with drug-coated balloon or jailed balloon. The primary endpoint was side branch compromise (occlusion, > 90% ostial pinching, or dissection > A). Clinical, angiographic, and procedural outcomes were analyzed. Results: Sixteen patients were allocated to each technique. Baseline characteristics were similar. Both strategies achieved universal angiographic success (TIMI 3 flow in all cases). Conversion to two stents was infrequent (three cases). Contrast use per treated vessel was significantly lower with the jailed balloon technique (56.7 vs 115.0 ml; p = 0.0016). No major adverse events were reported during early follow-up. Conclusions: Both strategies proved safe and effective for true bifurcation lesions, even in high-risk patients. The jailed balloon technique offered the additional advantage of significantly reducing contrast use, which may be especially beneficial in patients at risk of contrast-induced nephropathy.

Keywords: Coronary bifurcation. Provisional stenting. Jailed balloon. Drug-coated balloon. Percutaneous coronary intervention.