Proximal Optimization Technique (POT) Puff sign as an indicator for left main stem stent optimization in acute coronary disease.

Abstract

Objective: To assess the impact of Optimal POT and its clinical importance in left main stem stenting as well as to explore its potential advantages in guiding clinical decisions to enhance procedural success and patient outcomes. Study Design: Retrospective Analysis. Setting: Peshawar Institute of Cardiology, Peshawar. Period: January 2023 to January 2024. Methods: Data was extracted from the Hospital Information Management System (HMIS) and Electronic Medical Records (EMR) of patients aged 18 and above who presented with either acute coronary syndrome (ACS) or stable ischemic heart disease (SIHD) and had Distal Left Main Stem Severe Disease not a Surgical Candidate. The procedure was done in a stepwise manner, beginning with loading patients with aspirin, clopidogrel or ticagrelor, and heparin and PCI steps. Results: The study included 119 patients who underwent stenting with the POT Puff technique. The presence of the POT puff sign during balloon inflation was found to be a significant indicator for optimizing stent deployment, with no contrast leakage observed in adequately sized balloons. The results highlight the potential of the POT puff sign in guiding effective stent optimization, improving procedural outcomes. Conclusion: Our findings suggest that the POT Puff sign, as visualized through advanced imaging modalities, provides an essential step in confirming effective proximal optimization, ultimately leading to better short and long-term clinical outcomes.