The Bifurcation Center

The T and small protrusion (TAP) technique is a modification of provisional T-stenting aimed at optimising implantation of a second stent in bifurcated coronary lesions treated using the provisional pathway.¹
The stent from the SB is intentionally positioned with a small (1–2 mm) protrusion in the MV, to fully cover the ostium area and is deployed simultaneously with a balloon positioned in the MV.¹
TAP- stenting was developed and reported by Burzotta et al in 2007, with the aim of improving the T-stenting technique to ensure full ostial coverage, where bifurcation geometry prevents perfect alignment of stents and to provide a strategy to facilitate final KBI. 

¹ Burzotta F, Džavík V, Ferenc M, et al. Technical aspects of the T And small Protrusion (TAP) technique. EuroIntervention 2015;11 Suppl V:V91-5.
 

See the publication Webinar: Reducing Metallic Neo-carina Risk in T and TAP

Click here to visit the Bifurcation Exploration website

Explore more bifurcation techniques:

Provisional Stenting | Culotte Overview | DK Crush | Visible Heart Lab

Culotte may be practiced in both intentional double-stenting procedures and in provisional procedures when a second stent is required. The main limitation of Culotte stenting is the possible presence of major mismatch between the size of the proximal MV and SB. Thus, two aspects are recognised as critical, the stent platform selection and the application of POT during the procedural flow.¹

Culotte

• Is associated with high procedural success and relatively low risk of angiographic restenosis
• In bifurcations with narrow angles
• In bifurcations with similar diameters

¹Lassen JF, Holm NR, Banning A, et al. Percutaneous coronary intervention for coronary bifurcation disease: 11th consensus document from the European Bifurcation Club. EuroIntervention 2016;12:38–46.

Click here to visit the Bifurcation Exploration website

Webinar: Culotte Technique in Everyday Practice

Explore more bifurcation techniques:

Provisional Stenting | T and TAP in Practice | DK Crush | Visible Heart Lab

This technique is a true intentional upfront two stent approach in the treatment of complex bifurcation lesions (CBL) with extensive side branch disease. It will always end with two stents and maximum metallic coverage of the bifurcation.

DK Crush belongs to the “S” family of the MADS-2 classification of bifurcation stenting techniques and is always finalised with 2 stents in the bifurcation. The first stent is implanted in the side branch.    


Lassen JF, Albiero R, Johnson TW, et al. Treatment of coronary bifurcation lesions, part II: implanting two stents. The 16th expert consensus document of the European Bifurcation Club. EuroIntervention 2022;18:457–70.

Click here to visit the Bifurcation Exploration website

Webinar: How Should I Perform a Stepwise DK-Crush to Achieve Optimal Results?

Explore more bifurcation techniques:

Provisional Stenting | T and TAP in Practice | Culotte Overview | Visible Heart Lab

• Exclusive collaboration with Medtronic and ongoing partnerships with the world's leading bifurcation clubs including EBC, JBC, KBC and LATAM, and now emerging US
• Development of educational materials leveraging technique and our unique stent portfolio characteristics (Bifurcation Exploration, Speaker decks and Visible Heart footage)
• Unparalleled multi-modality imaging gives ICs never before seen looks into techniques they perform in their daily practice 

Click here to visit the Bifurcation Exploration website

Webinar: Pitfalls of Bifurcation PCI – Lessons From the Visible Heart Lab

Explore more bifurcation techniques:

Provisional Stenting | T and TAP in Practice | Culotte Overview | DK Crush

Percutaneous coronary intervention for bifurcation coronary lesions: the 15th consensus document from the European Bifurcation Club 

Burzotta F, Lassen JF, Lefèvre T, et al. EuroIntervention 2021;16:1307–17. 

CTO and bifurcation lesions: an expert consensus from the European Bifurcation Club and EuroCTO Club 

Lefèvre T, Pan M, Stankovic G, et al. JACC Cardiovasc Interv 2023;16:2065–82.

European Bifurcation Club white paper on stenting techniques for patients with bifurcated coronary artery lesions 

Burzotta F, Lassen JF, Louvard Y, et al. Catheter Cardiovasc Interv 2020;96:1067–79.

Explore more publications:

Drug-Coated Balloon Publications | Left Main Bifurcation Publications

Drug-coated balloon angioplasty of the side branch during provisional stenting: the multicenter randomized DCB-BIF trial 

Gao X, Tian N, Kan J, et al. J Am Coll Cardiol 2025;85:1–15.

Sirolimus-coated versus paclitaxel-coated balloons for bifurcated coronary lesions in the side branch: the SPACIOUS trial 

Zhou Y, Hu Y, Zhao X, et al. EuroIntervention 2025;21:e307–17.

A prospective randomized open-label trial of sirolimus versus paclitaxel-coated balloons for the side branch of de novo coronary bifurcation lesion 

Gao Q, Liu C, Xu G, et al. J Thorac Dis 2025;17:10869–79.

One-year clinical outcomes of stentless percutaneous coronary intervention using drug-coated balloon for true bifurcation lesions 

Tanaka Y, Nozaki Y, Kitani S, et al. J Soc Cardiovasc Angiogr Interv 2025;4:103941.

Indications for use of drug-coated balloons in coronary intervention: Academic Research Consortium Position Statement 

Fezzi S, Serruys PW, Cortese B, et al. J Am Coll Cardiol 2025;86:1170–202.

Explore more publications:

EBC Consensus Documents | Left Main Bifurcation Publications

Drug-coated balloon-based treatment of left main true bifurcation lesion 

Her AY, Kim TH, Shin ES, et al. Catheter Cardiovasc Interv 2025;105:1024–31.

A comparison of a drug coated balloon with drug eluting stent strategy for treating coronary bifurcation lesions 

Corballis N, Merinopoulos I, Bhalraam U, et al. Catheter Cardiovasc Interv 2026;107:3–14.

Bifurcation PCI with a hybrid strategy with drug- eluting balloons versus a stepwise provisional two- stent strategy: rationale and design of the hybrid DEB study  

Dillen DMM, Vlaar PJ, Vermeer AJE, et al. Am Heart J 2023;266:168–75.

Drug-coated balloons for coronary bifurcation lesions 

Fezzi S, Scheller B, Rissanen TT, et al. EuroIntervention 2025;21:e1177–97.

Drug-coated balloon treatment in coronary artery disease: recommendations from an Asia-Pacific Consensus Group 

Her AY, Shin ES, Bang LH, et al. Cardiol J 2021;28:136–49.

Explore more publications:

EBC Consensus Documents | Left Main Bifurcation Publications

Drug coated balloons and their role in bifurcation coronary angioplasty: appraisal of the current evidence and future directions 

Rathore S, Tehrani S, Prvulovic D, et al. Expert Rev Med Devices 2020;17:1021–33.

Drug-coated balloons for de novo non-aorto-ostial and coronary bifurcation lesions: a systematic review and meta-analysis 

Mariscal ES, Slotwiner A, Karam B, et al. J Soc Cardiovasc Angiogr Interv 2025;4(12):103944.

Drug-coated balloons versus non-coated balloons for side branch treatment in bifurcation lesions: a systematic review and meta-analysis 

Rocchetti M, Tua L, Cereda A, et al. Catheter Cardiovasc Interv 2025;106:530–9.

Application of drug-coated balloons in complex high risk and indicated percutaneous coronary interventions 

Somsen YBO, Rissanen TT, Hoek R, et al. Catheter Cardiovasc Interv 2025;105:494–516.

Explore more publications:

EBC Consensus Documents | Left Main Bifurcation Publications

The European Bifurcation Club Left Main Study (EBC MAIN): rationale and design of an international, multicentre, randomised comparison of two stent strategies for the treatment of left main coronary bifurcation disease 

Chieffo A, Hildick-Smith D. EuroIntervention 2016;12:47–52.

A large, prospective, multicentre study of left main PCI using a latest-generation zotarolimus-eluting stent: the ROLEX study 

Tarantini G, Fovino LN, Varbella F, et al. EuroIntervention 2023;18:e1108–19.

Stepwise provisional versus systematic dual-stent strategies for treatment of true left main coronary bifurcation lesions  

Arunothayaraj S, Egred M, Banning AP, et al. Circulation 2025;151:612–22.

Left main bifurcation stenting: impact of residual ischaemia on cardiovascular mortality  

Wang HY, Zhang R, Dou K, et al. Eur Heart J 2023;44:4324–36.

Optimal minimal stent area and impact of stent underexpansion in left main up-front 2-stent strategy 

Kim JH, Kang DY, Ahn JM, et al. Circ Cardiovasc Interv 2024;17:e013006.

Explore more publications:

EBC Consensus Documents | Drug-Coated Balloon Publications

Impact of calcification location in the left main coronary artery bifurcation on short-term prognosis after left main stenting 

Sasaki K, Sawayama Y, Taninobu N, et al. Circ J 2025;89:1129–36.

OCT-guided distal left main bifurcation PCI: mid-term outcomes from a multicenter South-Asian registry 

Kumar P, Najmy S, Rajendran M, et al. Catheter Cardiovasc Interv 2026;107:477–84.

Real-world experience and outcomes with percutaneous coronary intervention for protected versus unprotected left main coronary artery disease: insights from the Veteran Affairs Clinical Assessment Reporting and Tracking Program 

Gonzalez PE, Hebbe A, Hussain Y, et al. Am J Cardiol 2024;222:39–50.

Long-term clinical outcomes of percutaneous coronary intervention for ostial left main coronary artery disease 

Sui Y, Qian J, Guan C, et al. EuroIntervention 2023;18:1446–55.

Explore more publications:

EBC Consensus Documents | Drug-Coated Balloon Publications

Chinese guidelines for percutaneous coronary intervention in patients with left main bifurcation disease  

Han Y. Eur Heart J 2023;44:709–10.

Antithrombotic therapy after percutaneous coronary intervention of bifurcation lesions 

Zimarino M, Angiolillo DJ, Dangas G, et al. EuroIntervention 2021;17:59–66.

Definitions and standardized endpoints for treatment of coronary bifurcations 

Lunardi M, Louvard Y, Lefèvre T, et al. EuroIntervention 2023;19:e807–31.

Physiological approach for coronary artery bifurcation disease: position statement by Korean, Japanese, and European Bifurcation Clubs 

Lee HS, Kim U, Yang S, et al. JACC Cardiovasc Interv 2022;15:1297–309.

Comparison of stent geometry achieved by different side-branch ballooning techniques for bifurcation provisional stenting: The CRABBIS Trial  

Bianchini F, Romagnoli E, Aurigemma C, et al. JACC Cardiovasc Interv 2025;18:1103–15.

Final kissing balloon dilatation in patients with coronary bifurcation lesions treated with an upfront provisional stenting strategy 

De Filippo O, Kang J, Bruno F, et al. EuroIntervention 2025;21:e318–28.

Benefit of systematic "jailed wire" technique for bifurcation provisional stenting. A CABRIOLET substudy 

Dérimay F, Mercier A, Aminian A, et al. Can J Cardiol 2025;41:871–7.

Jailed pressure wire technique for coronary bifurcation lesions: structural damage and clinical outcomes 

Hidalgo F, González-Manzanares R, Ojeda S, et al. Rev Esp Cardiol (Engl Ed) 2023;76:531–8.

Multimodal comparisons of results achieved by different side branch ballooning techniques for bifurcation provisional stenting 

Bianchini F, Cangemi S, DeVos A, et al. Circ Cardiovasc Interv 2023;16:e012908.

Proximal optimization technique and percutaneous coronary intervention for left main disease: POTENTIAL-LM 

Volet C, Puricel S, Cook ST, et al. Catheter Cardiovasc Interv 2024;103:417–24.

Szabo 2-stent technique for coronary bifurcation lesions: procedural and short-term outcomes 

Yang H, Qian J, Huang Z, Ge J. BMC Cardiovasc Disord 2020;20:325.

OCT or angiography guidance for PCI in complex bifurcation lesions 

Holm NR, Andreasen LD, Neghabat O, et al. N Engl J Med 2023;389:1477–87.

OCT-guided vs angiography-guided coronary stent implantation in complex lesions: an ILUMIEN IV substudy 

Ali ZA, Landmesser U, Maehara A, et al. J Am Coll Cardiol 2024;84:368–78.

Guiding intervention for complex coronary lesions by optical coherence tomography or intravascular ultrasound 

Kang DY, Ahn JM, Yun SC, et al. J Am Coll Cardiol 2024;83:401–13.

Unintended deformation of stents during bifurcation PCI: an OCTOBER trial substudy 

Andreasen LN, Neghabat O, Laanmets P, et al. JACC Cardiovasc Interv 2024;17:1106–15.

Impact of intravascular ultrasound for coronary bifurcations treated with last-generation stents: insights from the ULTRA-BIFURCAT registry 

Bruno F, Choi KH, De Filippo O, et al. Eur Heart J Qual Care Clin Outcomes 2025;11:747–55.

Routine intracoronary imaging-guided left main coronary intervention 

Murasato Y, Nakashima H, Sugino H, et al. Sci Rep 2025;15:9504.

Intravascular imaging for percutaneous coronary intervention on bifurcation and unprotected left main lesions: a systematic review and meta-analysis 

Zito A, Burzotta F, Aurigemma C, et al. Open Heart 2025;12:e003026.

Computational simulations of coronary artery bifurcation stenting using realistic plaque distribution and materials 

Wu W, Zhao S, Bhat RR, et al. Sci Rep 2025;15:34242.

Patient-specific computational simulation of coronary artery bifurcation stenting 

Zhao S, Wu W, Samant S, et al. Sci Rep 2021;11:16486.

3D reconstruction of coronary artery bifurcations from coronary angiography and optical coherence tomography: feasibility, validation, and reproducibility 

Wu W, Samant S, de Zwart G, et al. Sci Rep 2020;10:18049.

3D reconstruction of coronary artery bifurcations from intravascular ultrasound and angiography 

Wu W, Oguz UM, Banga A, et al. Sci Rep 2024;14:6612.

Virtual 2-stent bifurcation percutaneous coronary intervention using the fractional flow reserve computed tomography planner 

Ohashi H, Zivelonghi C, Seki R, et al. JACC Cardiovasc Interv 2023;16:863–4.

Impact of bifurcation lesions on outcomes after FFR-guided PCI or CABG 

Burzotta F, Louvard Y, Lassen JF, et al. Circ Cardiovasc Interv 2025;18:e014610.

Development of a novel BifurcAID risk score to predict MACE following coronary true bifurcation intervention 

Minatoguchi S, Koshy AN, Vengrenyuk Y, et al. JACC Cardiovasc Interv 2025;18:705–16.

A new scoring system predicting side-branch occlusion in patients undergoing left main bifurcation intervention: the LM V-RESOLVE score 

He J, Cai Z, Wang HY, et al. Can J Cardiol 2024;40:1619–31.

Risk assessment of side branch compromise after coronary bifurcation stenting - a substudy of the 3D-OCT Bifurcation Registry 

Akase H, Okamura T, Nagoshi R, et al. Circ J 2024;88:959–69.

Impact of bifurcation angle on side branch occlusion in provisional bifurcation percutaneous coronary intervention: analysis from the PROGRESS-BIFURCATION registry 

Mutlu D, Selim Ser O, Strepkos D, et al. Am J Cardiol 2025;253:41–8.

Long-term prognosis after coronary bifurcation PCI-a nationwide observational study 

Katona A, von Koch S, Andell P, et al. PLoS One 2025;20:e0317628.

Differential prognosis of true bifurcation lesions according to left main versus non-left main location and treatment strategy 

Choi KH, Nam CW, Bruno F, et al. J Am Heart Assoc 2025;14:e037657.

Bifurcation functional significance score as predictor of mortality: a validating study 

Vassilev D, Mileva N, Collet C, et al. Sci Rep 2021;11:24308.

One year clinical outcomes in patients with coronary bifurcation lesions: results from the Resolute Onyx bifurcation study 

Price M, Boutis L, Kirtane A, et al. JACC 2021;77:965.

A technology evaluation of the Onyx Frontier drug-eluting stent 

Leone PP, Assafin M, Scotti A, et al. Expert Opin Drug Deliv 2023;20:689–701.

Long-term outcomes of true versus nontrue coronary bifurcation lesions treated with bioresorbable polymer sirolimus-eluting ultimaster stent under intravascular imaging guidance 

Matsuna N, Kuramitsu S, Tadano Y, et al. Am J Cardiol 2025;239:57–63.

Dedicated bifurcation stents for coronary bifurcation lesions: a systematic review and meta-analysis of randomized-controlled trials 

Mohamed MO, Mamas MA, Nagaraja V, et al. J Invasive Cardiol 2019;31:E344–55.

Clinical outcome after percutaneous coronary intervention with drug-eluting stent in bifurcation and nonbifurcation lesions: a meta-analysis of 23 981 patients 

Burzotta F, Annone U, Paraggio L, et al. Coron Artery Dis 2020;31:438–45.