September 14, 2026Circulation Cardiovascular Interventions
Minicrush or T-Stenting and Minimal Protrusion in Complex Coronary Bifurcation Lesions: The Multicenter TREX Registry
Giulio PiedimonteEnrico CerratoLorenzo AzzaliniAlicia QuirósRosanna Di FonzoValerio MaffiManuel BoscoGiampiero VizzariGabriele CarciottoFrancesco MaiellaroRiccardo MangioneDario CalderoneMarco BorgiMassimo LeonciniFrancesco TomassiniCristina RolfoMarco PavaniAlfonso FranzèGreca ZandaSimone ZecchinoAlessio La MannaAlfredo R. GalassiFerdinando Varbella
Key result
Minicrush links to comparable TLF versus TAP but ~86% lower stent thrombosis.
- n=469
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?
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.
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Implication
Minicrush was associated with lower stent thrombosis than TAP without differing target lesion failure; leaves open need for randomized confirmation in bifurcation PCI.
Abstract
BACKGROUND: Percutaneous coronary intervention of complex coronary bifurcation lesions frequently requires an upfront 2-stent strategy. Although the double kissing crush technique has been extensively studied, limited contemporary data are available comparing alternative 2-stent approaches, particularly Minicrush and T-stenting and minimal protrusion (TAP), in complex bifurcation anatomy. This study aimed to compare procedural characteristics and long-term clinical outcomes of Minicrush versus TAP stenting techniques in patients undergoing percutaneous coronary intervention for complex coronary bifurcation lesions. METHODS: The TREX registry is a multicenter, retrospective cohort study including consecutive patients treated with an upfront 2-stent strategy using Minicrush or TAP between November 2015 and April 2025. The primary end point was target lesion failure. Secondary end points included major adverse cardiac events and definite or probable stent thrombosis. Clinical outcomes were assessed for up to 10 years. RESULTS: Among 601 screened patients, 469 (78%) underwent an upfront 2-stent strategy (Minicrush: n=257; TAP: n=212). TLF occurred in 10.4% of patients, with no significant differences between groups at 1, 5, or 10 years. Major cardiovascular event rates were also comparable across all time points. In multivariable analyses, distal left main involvement and severe coronary calcification were the strongest predictors of TLF, whereas reduced left ventricular ejection fraction was the main predictor of major cardiovascular events. Definite or probable stent thrombosis occurred more frequently with TAP than with Minicrush (5.7% versus 0.8%; P <0.01). CONCLUSIONS: Minicrush and TAP provide comparable long-term efficacy in complex coronary bifurcation percutaneous coronary intervention; however, Minicrush is associated with a lower risk of stent thrombosis, suggesting a more favorable safety profile. REGISTRATION: URL: https://clinicaltrials.gov/ ; Unique Identifier: NCT06484647.
Circ CV Interventions · cohort study. In complex bifurcations, Minicrush linked to less stent thrombosis than TAP Minicrush or T-Stenting and Minimal Protrusion in Complex Coronary Bifurcation Lesions: The Multicenter TREX Registry 469 patients: Complex bifurcations treated with upfront 2-stent PCI. Two 2-stent techniques compared: Minicrush vs TAP stenting. 10.4% had TLF: Target lesion failure: no difference up to 10 years. 0.8% stent thrombosis with Minicrush. Versus 5.7% with TAP. What predicted failure and events: Distal left main, Severe calcification, Reduced LVEF. Bottom line: Minicrush linked to less stent thrombosis, similar TLF; needs randomized confirmation.
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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).