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T and Small Protrusion (TAP) vs Double-Kissing Crush Technique: Insights From In Vitro Models

Paradies, V; Ng, J; Lu, S; Bulluck, H; Burzotta, F; Chieffo, A; Ferenc, M; ... Ang, H; + view all (2021) T and Small Protrusion (TAP) vs Double-Kissing Crush Technique: Insights From In Vitro Models. Cardiovascular Revascularization Medicine , 24 pp. 11-17. 10.1016/j.carrev.2020.09.013. Green open access

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Abstract

Background: Percutaneous coronary interventions on complex bifurcation lesions may require implantation of two stents to appropriately treat diffuse side-branch (SB) disease. Comparisons among different bifurcation stenting techniques are continuously attempted by various study designs (bench tests, computer simulations, clinical studies). Among different techniques, double kissing crush (DKC) represents the last evolution for “crushing” while T and small Protrusion (TAP) represents the evolution of “T stenting”. Both techniques are actually gaining popularity, but head-to-head comparisons are lacking. / Methods and results: Two last generation drug-eluting stents (Synergy™, Boston Scientific, MA, USA and Ultimaster™,Terumo Corp., Japan) were implanted in left main bifurcation bench models using TAP (n = 6 sets) and DKC (n = 6 sets) techniques. A peristaltic pump with fresh porcine blood was used to perfuse the blood through the silicone model at a flow rate of 200 ml/min for 4 min. Optical coherence tomography (OCT) was used to assess stent struts geometry and thrombus formation. SB cross sectional area as well as SB obstruction did not significantly differ between the two techniques. Numerical (but not statistically significant) differences were found in terms of malapposed struts (fewer with TAP) and floating struts (fewer with DKC). Thrombus formation after blood perfusion was similar between TAP and DKC technique (1.53 ± 1.12 vs. 1.20 ± 1.01 mm2, p = 0.6). / Conclusion: The result of the present in-vitro study shows the absence of significant difference between TAP and DKC in terms of stent struts apposition and acute thrombus formation potential. Despite the completely different technical steps required, both techniques have similar performance according to such articulated pre-clinical evaluation. / What is already known about this subject? Due to its limited complexity, T and Protrusion (TAP) technique is considered the to-go technique for bifurcation lesions with good long-term results. Recently, double kissing crush (DKC) technique has been gaining popularity and demonstrated promising results in randomized clinical trials. / What does this study add? This in-vitro bench test study provides a unique detailed OCT comparison and local hemodynamic environment analysis of the two techniques. / How might this impact on clinical practice? New insights of acute thrombogenicity and computational flow model simulation may guide percutaneous therapeutic strategies of bifurcation lesions.

Type: Article
Title: T and Small Protrusion (TAP) vs Double-Kissing Crush Technique: Insights From In Vitro Models
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.carrev.2020.09.013
Publisher version: https://doi.org/10.1016/j.carrev.2020.09.013
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Bifurcation lesions, Double stenting, Thrombogenicity, In-vitro models
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Pre-clinical and Fundamental Science
URI: https://discovery.ucl.ac.uk/id/eprint/10113007
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