title: Crush, culotte, T and protrusion: which 2-stent technique for treatment of true bifurcation lesions? - insights from in vitro experiments and micro-computed tomography.
abstract: BACKGROUND
  Percutaneous coronary intervention of complex true bifurcation lesions often fails to ensure continuous stent coverage and strut apposition in both the side branch and main vessel. Struts left unopposed floating in the lumen disturb blood flow and are increasingly recognized as increasing the risk of stent thrombosis.
  
  
  RESULTS
  In this study, we compared the results of different bifurcation treatment strategies: Crush (n=5); Culotte (n=3); T-/T with Protrusion (TAP) (n=4) using drug-eluting stents deployed in-vitro in representative coronary bifurcation models. After final kissing balloon post-dilatation, the rate of malapposition within the bifurcation quantified from micro-computed tomography scanning was on average 41.5 ± 8.2% with the Crush technique, reduced to respectively 31.4 ± 5.2% with Culotte and 36.7 ± 8.0% with T-/TAP approach. Overlaying layers of struts in the Crush and Culotte techniques lead to a significantly higher rate of strut malapposition in the proximal vessel than with the T-/TAP technique (Crush: 39.1 ± 10.7%, Culotte: 26.1 ± 7.7%, TAP: 4.2 ± 7.2%, P<0.01). Maximal wall-malapposed strut distance was also found on average to be higher with the Crush (1.36 ± 0.4mm) and Culotte techniques (1.32 ± 0.1mm) than with T-/TAP (1.08 ± 0.1mm, P=0.04).
  
  
  CONCLUSIONS
  In this model, the Crush technique resulted in a higher risk of malapposition than either the Culotte or T-/TAP technique.
authors.affiliation: International Centre for Circulatory Health, NHLI and Imperial College, London. nicolas.foin@gmail.com
authors.forename: Nicolas
authors.initials: N
authors.lastname: Foin
authors.forename: Eduardo
authors.initials: E
authors.lastname: Alegria-Barrero
authors.forename: Ryo
authors.initials: R
authors.lastname: Torii
authors.forename: Pak H
authors.initials: PH
authors.lastname: Chan
authors.forename: N
authors.initials: N
authors.lastname: Viceconte
authors.forename: Justin E
authors.initials: JE
authors.lastname: Davies
authors.forename: Carlo
authors.initials: C
authors.lastname: Di Mario
mesh_terms: D054855:Drug-Eluting Stents; D006801:Humans; D008955:Models, Cardiovascular; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods*; D055114:X-Ray Microtomography