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September 15, 2026Circulation Cardiovascular Interventions

Minicrush or T-Stenting and Minimal Protrusion in Complex Coronary Bifurcation Lesions: The Multicenter TREX Registry

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Why the study?

Limited contemporary data exist comparing alternative upfront 2-stent approaches, particularly Minicrush versus TAP stenting, in complex coronary bifurcation lesions.

Does the Minicrush stenting technique reduce target lesion failure compared to T-stenting and minimal protrusion (TAP) in patients undergoing percutaneous coronary intervention for complex coronary bifurcation lesions?

Population

469 patients undergoing PCI for complex coronary bifurcation lesions with an upfront 2-stent strategy

Comparison

Minicrush vs TAP stenting techniques

Design

Multicenter, retrospective cohort study

Follow-up

Up to 10 years

Key result

In patients with complex coronary bifurcation lesions, Minicrush and TAP had comparable target lesion failure rates, but Minicrush had lower stent thrombosis (0.8% vs 5.7%; P<0.01).

Authors

GPGiulio PiedimonteECEnrico CerratoLALorenzo Azzalini

Discussion

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Overview

Minicrush was associated with lower stent thrombosis than TAP without differing target lesion failure; leaves open need for randomized confirmation in bifurcation PCI.

Key Points

  • To compare the procedural characteristics and long-term clinical outcomes of Minicrush versus T-stenting and minimal protrusion techniques in patients undergoing percutaneous coronary intervention for complex coronary bifurcation lesions.
  • Multicenter interventional study (NCT06484647) evaluating 469 patients treated with an upfront 2-stent strategy using Minicrush (n=257) or TAP (n=212) between November 2015 and April 2025.
  • Assessed patients for up to 10 years for the primary endpoint of target lesion failure and secondary endpoints of major adverse cardiac events and stent thrombosis.
  • Target lesion failure occurred in 10.4% of patients overall, with no significant differences observed between the Minicrush and TAP cohorts at 1, 5, or 10 years.
  • Definite or probable stent thrombosis occurred significantly less frequently with Minicrush than with TAP (0.8% vs 5.7%, P < 0.01).
  • Distal left main involvement and severe coronary calcification independently predicted target lesion failure, whereas reduced left ventricular ejection fraction predicted major adverse cardiac events.

Study Design

Type

Cohort (n=469)

Multicenter

Yes

Structured PICO

Does the Minicrush stenting technique reduce target lesion failure compared to T-stenting and minimal protrusion (TAP) in patients undergoing percutaneous coronary intervention for complex coronary bifurcation lesions?

P
Population
469 patients with complex coronary bifurcation lesions treated with an upfront 2-stent strategy using Minicrush or TAP, followed for up to 10 years.
E
Exposure
Minicrush stenting technique
C
Comparator
T-stenting and minimal protrusion (TAP) technique
O
Outcome
Target lesion failure (TLF) assessed for up to 10 yearscomposite

Minicrush and TAP stenting techniques offer comparable long-term efficacy for complex coronary bifurcation lesions, but Minicrush is associated with a significantly lower risk of stent thrombosis.

Cite This Study

Piedimonte et al. (2026) conducted a cohort in Complex coronary bifurcation lesions (n=469). Minicrush vs. T-stenting and minimal protrusion (TAP) was evaluated on Target lesion failure. In patients with complex coronary bifurcation lesions, Minicrush and TAP had comparable target lesion failure rates, but Minicrush had lower stent thrombosis (0.8% vs 5.7%; P<0.01).

synapsesocial.com/papers/6aa90187eed42882c1fc19afhttps://doi.org/10.1161/circinterventions.126.016666
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