Can the T and Minimal Protrusion (TAP) technique be considered as an up-front 2-stent strategy for true distal left main stem bifurcation?
Athukorala, Sampath Mitomo, Satoru Cortese, Bernardo Sharma, Vinoda Choudhry, Anirban Nakamura, Suno Bhatia, Gurbir Freestone, Bethan Lee, Kaeng Pulikal, George
Athukorala, Sampath
Mitomo, Satoru
Cortese, Bernardo
Sharma, Vinoda
Choudhry, Anirban
Nakamura, Suno
Bhatia, Gurbir
Freestone, Bethan
Lee, Kaeng
Pulikal, George
Abstract
Background: The commonly used upfront 2-stent strategies for distal LMS bifurcation are culotte and DK-crush, whereas TAP was designed to convert a provisional to a 2-stent strategy if there was any issue with the side-branch following main-branch stenting. Technically, TAP is much simpler, and the angle in distal-LMS favors the technique.
Aim: The aim of this study was to compare the long-term clinical outcomes between TAP versus non-TAP techniques in distal LMS bifurcation.
Methods and results: All patients treated with 2-stent techniques for distal LMS between 2014 and 2020 at highly experienced centers were included, the patients were divided into two groups: TAP versus non-TAP. The clinical outcomes measured were cardiac death, TVMI, TLR, TVR, and MACE (composite of cardiac death, TVMI, and TLR). During the study period, 541 patients with a mean age of 70.5 ± 10.5 years had PCI to distal-LMS with two stents. Two hundred and eighteen were treated with TAP technique, and 323 patients with non-TAP techniques. Demographic, clinical, and procedural characteristics were well matched except for a higher number of ACS in the TAP group (36% vs. 25%; p = 0.006). In regard to procedural characteristics, use of intravascular imaging was higher in the non-TAP group (64% vs. 51%; p = 0.003). During a median follow-up of almost 5 years, there were no significant differences between the two groups in regards to hard endpoints (death, cardiac death, and TVMI), TLR, and MACE. However, TVR was significantly higher in the non-TAP group. However, in the propensity-matched group, even the TVR did not appear to be significant.
Conclusions: This multicenter registry shows that there were no differences in the long-term clinical outcomes between TAP and non-TAP bifurcation techniques, with an advantage of the former in terms of need for TVR.
Date
2026-04-06
Type
Article
Subject
Stents
Collections
Citation
Athukorala S, Mitomo S, Cortese B, Sharma V, Choudhry A, Nakamura S, Bhatia G, Freestone B, Lee K, Pulikal G, Kumar N, Ment J, Pitt M, Basavarajaiah S. Can the T and Minimal Protrusion (TAP) Technique be Considered as an Up-Front 2-Stent Strategy for True Distal Left Main Stem Bifurcation? Catheter Cardiovasc Interv. 2026 Apr 6. doi: 10.1002/ccd.70588.
Journal / Source Title
Catheterization and Cardiovascular Interventions
DOI
10.1002/ccd.70588
PMID
41940470
Publisher
Wiley-Liss
Publisher’s URL
https://pubmed.ncbi.nlm.nih.gov/41940470/