Proximal optimisation technique (POT)

Proximal optimisation technique (POT) in bifurcation angioplasty

Proximal optimisation technique (POT) is post dilatation of the proximal portion of the stent in the main vessel, done after kissing balloon dilatation in bifurcation lesions. The post dilatation is done with a balloon diameter 0.5 mm more than that of the stent. This makes the proximal portion of the stent more apposed to the proximal vessel which is having a larger diameter than the distal vessel. The balloon for proximal optimisation is kept in such a way that the distal marker is at the level of the bifurcation.

Though initially planned after a kissing balloon dilatation, disadvantages of kissing balloon technique have been a concern. There is a suggestion that proximal optimisation should be performed first followed by side branch dilatation and finally a re-POT to have good proximal stent apposition [1].

Advantages of this technique are that it reduces the risk of side branch compromise related to shifting of the carina, improves stent apposition in the proximal vessel and facilitates side branch access after implantation of the stent in the main vessel. The technique has been supported by European Bifurcation Club in their consensus statement [2].

References

1. Hoye A. The Proximal Optimisation Technique for Intervention of Coronary Bifurcations. Interv Cardiol. 2017 Sep;12(2):110-115.
2. Lassen JF, Holm NR, Banning A, Burzotta F, Lefèvre T, Chieffo A, Hildick-Smith D, Louvard Y, Stankovic G. Percutaneous coronary intervention for coronary bifurcation disease: 11th consensus document from the European Bifurcation Club. EuroIntervention. 2016 May 17;12(1):38-46.