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February 19, 2026Kardiologia Polska0 citationsOpen Access

Stent geometry achieved by stepwise provisional stenting in left main trifurcation: Bench-test comparison of different side-branch intervention techniques

AMA. MâaroufiMLMattia LunardiJAJudit Andréka

Key Result

In a left main trifurcation bench model, simultaneous trissing improved stent expansion at the polygon of confluence compared to serial kissing ballooning (23.7 vs. 21.1 mm2; P=0.043).

Key Points

  • The aim is to compare the geometric effects of different side-branch stenting techniques in left main trifurcations.
  • Conducted bench-test comparisons of provisional stenting strategies.
  • Evaluated the effect of SB rewiring and ballooning on stent configuration.
  • Measured number and size of fenestrations as primary outcomes.
  • All tested stenting strategies were technically feasible.
  • SB rewiring and ballooning impacted stent geometry, especially fenestrations.
  • Limited effect on overall stent expansion and apposition.

Structured PICO

Do different side-branch rewiring and ballooning techniques influence stent configuration, expansion, and apposition in left main trifurcation provisional stenting?

P
Population
12 3-dimensional printed rubber-like elastomeric silicone left main trifurcation models.
I
Intervention
Stepwise provisional stenting using Ultimaster Nagomi drug-eluting stents with side-branch rewiring (same-cell or neighbouring-cell) and ballooning (simultaneous trissing or serial kissing).
C
Comparator
Comparison among 4 combinations of rewiring (same-cell vs neighbouring-cell) and ballooning (simultaneous trissing vs serial kissing) techniques.
O
Outcome
Stent expansion (minimal stent area) and apposition assessed by optical coherence tomography and micro-computed tomography.surrogate

In a bench model of left main trifurcation, provisional stenting strategies are feasible, and side-branch rewiring and ballooning techniques influence stent fenestration geometry but have limited impact on overall stent expansion and apposition.

Main Result

Absolute Event Rate: 23.7% vs 21.1%

p-value: p=0.043

Limitations

  • Mechanistic bench test design using artificial vessel wall structures
  • Results may not be directly applicable to other stent platforms with different expansion capacities
  • Clinical impact of the observed stent conformations and malapposition remains uncertain
  • Applicability of 3D OCT in the bench model was limited due to the artificial vessel wall structure
  • Mechanistic design (non-clinical investigation)
  • Results may not be directly applicable to other stent platforms (Ultimaster Nagomi used)
  • Artificial vessel wall structure limited 3D OCT applicability

Abstract

All provisional stenting strategies tested were technically feasible for left main trifurcations. SB rewiring and ballooning technique influenced stent configuration, particularly the number and size of fenestrations, but had limited impact on overall stent expansion and apposition.

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Cite This Study

Mâaroufi et al. (2026) studied Left main coronary trifurcation (n=12). Simultaneous trissing ballooning vs. Serial kissing ballooning was evaluated on Minimal stent area at the polygon of confluence (µCT) (p=0.043). In a left main trifurcation bench model, simultaneous trissing improved stent expansion at the polygon of confluence compared to serial kissing ballooning (23.7 vs. 21.1 mm2; P=0.043).

synapsesocial.com/papers/6996a7e3ecb39a600b3ee0c2https://doi.org/10.33963/v.phj.111013
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