Key result
DK nano-culotte stenting yields a ~2% 1-year target lesion failure rate in bifurcation lesions.
Why the study?
The optimal two-stent strategy for PCI of coronary bifurcation lesions has yet to be established. A technique that minimizes stent overlap while ensuring complete side branch osteal scaffolding may improve procedural and clinical outcomes.
What are the feasibility, procedural performance, and 1-year target lesion failure rates of the novel double kissing nano-culotte stenting technique in patients with true de novo coronary bifurcation lesions?
Cohort (n=43)
No
What are the feasibility, procedural performance, and 1-year target lesion failure rates of the novel double kissing nano-culotte stenting technique in patients with true de novo coronary bifurcation lesions?
First-in-human evaluation of the DK nano-culotte bifurcation stenting technique demonstrates 100% procedural success and a low 2.38% 1-year target lesion failure rate, warranting larger multicenter trials.
Answers are grounded in this paper and cite their sources.
Does not yet support routine adoption; leaves open comparative efficacy in randomized bifurcation trials.
BACKGROUND: Percutaneous coronary intervention (PCI) of coronary bifurcation lesions (CBL) remains one of the most technically demanding procedures in interventional cardiology, and the optimal two-stent stratgy has yet to be established. A technique that minimizes stent overlap while ensuring complete side branch osteal scaffolding may improve procedural and clinical outcomes. AIMS: Our aim in this study is to evaluate the feasibility, procedural performance, and 1-year clinical outcomes of the novel double kissing (DK) nano culotte technique for the treatment of CBL. METHODS: In this prospective, single-center observational study, 43 patients with true de novo CBLs underwent PCI using the DK nano-culotte technique, with OCT guidance used in 30 patients (69.7%). Eligible lesions had distal main-vessel and side-branch reference diameters ≥ 2.5 and ≥ 2.25 mm, respectively. Bench testing preceded first-in-human application, and computational fluid dynamics (CFD) analysis was performed. The primary endpoint was 1-year target lesion failure (TLF), defined as the composite of target lesion revascularization (TLR), target vessel myocardial infarction (TVMI), and cardiac death. RESULTS: Procedural and technical success were achieved in 100.0% and 97.6% of cases, respectively, with a mean procedure time of 48.0 ± 14.9 min. Residual diameter stenosis remained low across all treated segments, and no significant stent malapposition (> 500 μm) was identified by OCT. CFD demonstrated favorable post-procedural hemodynamic remodeling with significant improvement in time-averaged wall shear stress. At 1 year, TLF occurred in one patient (2.38%) owing to silent ischemia associated with in-stent restenosis requiring repeat revascularization. No TVMI, cardiac death, or stent thrombosis was observed. CONCLUSIONS: The DK nano culotte technique demonstrated excellent procedural feasibility, precise stent optimization, favorable flow dynamics, and encouraging 1-year clinical outcomes. These findings support further evaluation of this OCT-guided bifurcation strategy in larger multicenter studies (DK Nano-Culotte Stenting For Coronary Bifurcation Lesion; NCT05406284).
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Kahraman et al. (2026) conducted a cohort in True de novo coronary bifurcation lesions (n=43). Double kissing (DK) nano-culotte PCI technique was evaluated on 1-year target lesion failure (TLF), defined as the composite of target lesion revascularization (TLR), target vessel myocardial infarction (TVMI), and cardiac death. The double kissing nano-culotte PCI technique achieved 100% procedural success and a 2.38% 1-year target lesion failure rate in de novo coronary bifurcation lesions.
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