Modified TAP versus TAP stenting by IVUS guidance in patients with coronary bifurcation lesions

In patients with coronary bifurcation lesions (CBLs), main vessel (MV) stenting with provisional side-branch (SB) stenting is a standard technique. T and small protrusion (TAP) stenting is commonly used for bailout side-branch stenting, but it is a suboptimal technique. The modified TAP (mTAP) stenting technique might overcome the limitations of TAP stenting.

We investigated the stenting and procedural outcomes of the mTAP versus TAP techniques by intravascular ultrasound (IVUS) guidance in patients with CBLs.

A total of 101 patients with non-left main CBLs underwent MV stenting. Of these, 36 patients developed SB dissection, SB ostium stenosis >70%, or reduced flow and underwent SB stenting using mTAP (20 patients) or TAP (16 patients) stenting guided by IVUS.

Minimum stent area at the bifurcation segment and at the SB ostium was larger after mTAP versus TAP stenting (6.39 ± 0.30 vs. 5.15 ± 0.20 mm²; 3.9 ± 0.46 vs. 3.36 ± 0.30 mm², respectively; P < 0.01). The neocarina length was shorter and the SB ostium stent coverage was higher after mTAP versus TAP stenting (1.5 ± 0.39 vs. 3.6 ± 0.31 mm; 100% vs. 81%, respectively; P < 0.05). The procedure time was shorter, and contrast volume and air Kerma rate were lower in the mTAP versus TAP stenting (77 ± 14 vs. 92 ± 24 minutes; 110 ± 25 vs. 143 ± 40 mL; and 0.88 ± 0.20 vs. 1.2 ± 0.47 Gray, respectively; P < 0.05).

We have provided the first evidence that IVUS-guided mTAP stenting achieves a significantly greater stent area and a shorter neocarina than TAP stenting, while also providing better SB ostium coverage and reduction in procedure time, contrast media usage, and radiation exposure.