POKI: A New Bifurcations Strategy

This scientific article we briefly discuss the POKI technique, a new stent optimization strategy for bifurcation lesions.

Coronary bifurcations represent 20 to 25% of percutaneous coronary interventions (PCI) and continue to be a real challenge at present; the different available treatment strategies are used to correct bifurcation carina after stenting seeing as incomplete strut apposition might lead to restenosis and, less frequently, stent thrombosis. 

POKI: una nueva estrategia en bifurcaciones

Even though there are different techniques to improve bifurcation stenting, there is high restenosis stent depending of bifurcation type and lesion characteristics.

This summary looks at a new strategy called POKI (proximal optimization with kissing balloon), developed to improved stent apposition and achieve better side branch performance. 

It involves the following steps:

  1. POT with non-compliant balloon.
  2. Guidewire re-crossing of side branch.
  3. Kissing balloon with non-compliant balloon to the side branch with distal marker positioned in front of the SB, before the carina, and a non-compliant balloon with distal marker in parallel to distal carina edge.  

Bench tests were carried out and there was no stent deformation in the main vessel. 

41 patients were looked at, with 41 bifurcations that were treated with this strategy.

Read also: FRAME-AMI: FFR vs. Angiography of Non-Culprit Vessel in ACS.

Mean age was 72, 24 were men, all presenting hypertension. 13 had diabetes and 11 prior MI. Most of them had chronic stable angina and conserved left ventricular systolic function.

PCI was most often done to the anterior descending (AD) (26 patients), followed by the left main (9 patients) and less frequently in the circumflex and right coronary arteries. In 26 cases, bifurcation was 1.1.1. Medina classification, and 1.5 stents per person were used. 

The POKI strategy was used in all patients. After PCI, residual diameter was 11.5%±15.4% at main vessel proximal level, 6.6%± 9.3% at distal main vessel level and 22.9%±28.5% in the side branch. 

Read also: Resistant Obstructive Hypertrophic Cardiomyopathy: Myomectomy or Septal Ablation?

There was angiographic procedural success in all study subjects. 


POKI is a new stenting optimization strategy for bifurcations. This analysis has shown this technique is feasible and successful both at bench testing and in-vivo.

Dr. Carlos Fava - Consejo Editorial SOLACI

Dr. Carlos Fava.
Member of the Editorial Board of SOLACI.org.

Original Title: A novel technique of proximal optimization with kissing balloon inflation in bifurcation lesions.

Reference: Dobrin Vassilev, et al. Cardiology Journal 2022, Vol. 29, No. 6, 899–905.

Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology