Drug‐eluting stents for coronary bifurcations: Bench testing of provisional side‐branch strategies

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Abstract
The objective of this study was to bench‐test provisional bifurcation stenting strategies to provide insights on how best to perform these with drug‐eluting stents (DESs). Bifurcation stenting with DESs reduces restenosis compared with bare metal stents (BMSs). Outcomes with a single DES are better than with two DESs but if the main branch is stented, there needs to be a reliable strategy for provisionally stenting the side‐branch with full ostial scaffolding and drug application. Stents were photographed in a phantom after deployment with different strategies. With provisional T‐stenting, placement of the side‐branch stent without gaps is difficult. The internal (or reverse) crush strategy fully scaffolds the side‐branch ostium but is experimental. The culotte technique providing excellent side‐branch ostial coverage is easier to perform with open‐cell or large‐cell stent design. In general, kissing balloon postdilatation improves stent expansion, especially at the ostium, and corrects distortion. However, a main‐branch kissing balloon of smaller diameter than the deploying balloon causes distortion. Final main‐branch postdilatation or sequential postdilatation prevents distortion after the internal crush strategy.