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Side Branch Protection in Coronary Bifurcation Stenting: A Systematic Review & Meta-Analysis of Jailed Wire versus Jailed Balloon Technique.

J. V. Lee,M. Emmanuela,Andrew Patricio,D. A. Theja,J. B. Lee,N. A. Fahendra,N. Wahjoepramono

Published 2026 in American Journal of Cardiology

ABSTRACT

Bifurcation Percutaneous Coronary Intervention (PCI) remains technically challenging and considered high risk to procedural complications, particularly Side Branch (SB) occlusion. The Jailed Wire Technique (JWT) is commonly recommended for SB protection; however, it does not fully prevent the complication. The Jailed Balloon Technique (JBT) was introduced to provide more active protection, but previous evidence has been inconsistent. This study aimed to provide updated evidence on the effectiveness of JBT versus JWT for SB protection during bifurcation PCI. PubMed, ScienceDirect, and the Cochrane Library were searched for randomized trials and cohort studies comparing JBT and JWT in patients undergoing bifurcation PCI. The primary endpoints were procedure-related adverse events, including SB occlusion, coronary dissection, and peri-procedural Myocardial Infarction (MI). Secondary endpoints included all-cause mortality, cardiac death, Target-lesion Revascularization (TLR), and Major Adverse Cardiovascular Events (MACE). Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated as a measure. Study quality was assessed using the Newcastle-Ottawa Scale and RoB 2.0 tool. Ten studies involving 2,329 patients were included (793 JBT and 1,536 JWT). The risk of SB occlusion was lower in JBT group compared to JWT group (OR = 0.31, 95% CI 0.20-0.48; p < 0.00001). There were no significant differences between the two techniques in coronary dissection, peri-procedural MI, all-cause mortality, cardiac death, TLR, or MACE. All studies were considered good quality. In conclusion, the use of JBT was associated with a reduced risk of SB occlusion during bifurcation PCI, while both techniques demonstrated comparable outcomes for other procedural and long-term clinical outcomes.

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