Managing bifurcation lesions remains one of the most complex challenges in interventional cardiology. The European Bifurcation Club (EBC) White Paper has provided a structured, evidence-based approach to bifurcation stenting, outlining the optimal step-by-step techniques for both provisional and two-stent strategies. However, translating these recommendations into real-world practice requires visual guidance and hands-on understanding.
To bridge this gap, we have developed a comprehensive instructional video series that follows the precise techniques outlined in the EBC White Paper.
By watching these videos, you may gain a structured, step-by-step guide to mastering bifurcation techniques, ensuring more predictable, reproducible, and successful interventions in your daily practice.
Provisional Bifurcation
Step by Step Technique
A One-Stent Provisional Technique may be applied to many bifurcation anatomies and represents the gold standard for the majority of noncomplex bifurcated lesions.
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A 1-stent technique may be practiced according to “provisional” (more commonly adopted) and “inverted provisional” (selected cases) approach.
The steps recommended by EBC for “provisional” are outlined in this video.
DK-Culotte Bifurcation
Step by Step Technique
The Culotte Technique is a technique to complement the provisional approach when a second stent is required.
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This is also called “classic” culotte. In clinical practice, culotte is often performed by implanting the first stent in the SB and this sequence is usually called “inverted” culotte.
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The technique shown in the video is a DK Culotte, due to the addition of one additional Kissing Balloon Inflation, after MB stenting, prior to SB stenting. This additional KBI may provide better SB scaffolding, easier rewiring, improved stent expansion, and potentially lower restenosis2,3.
The recommended steps for “DK Culotte” are outlined in this video.
DK-Crush Bifurcation
Step by Step Technique
The DK-Crush Technique is an upfront 2-stent technique and has reached a IIb recommendation for the treatment of true Left Main bifurcation lesions in the ESC guidelines (2018).
However, while EBC recognizes the importance of DK-crush, it highlights the potential complexity of the technique, recommending careful lesion selection and advocates appropriate training for interventional cardiologists willing to adopt this technique.
The steps recommended by EBS for “DK-Crush” are outlined in this video.
T - Bifurcation
Step by Step Technique
The T-Bifurcation stent technique is used when a 2nd stent is required during a provisional (or inverted provisional) approach to a bifurcation lesion.
T and TAP stenting represent the easiest way to implant the second stent. Following the provisional stent implant, if the bifurcation angle is close to 90°, the placement of the 2nd stent in a T configuration may be performed. For more acute angles, a TAP technique may be more appropriate.
The steps recommended by EBS for “T-Stenting” are outlined in this video.
TAP Bifurcation
Step by Step Technique
TAP Bifurcation
Step by Step Technique
The TAP Bifurcation stent technique is used when a 2nd stent is required during a provisional (or inverted provisional) approach to a bifurcation lesion.
T and TAP stenting represent the easiest way to implant the second stent. Following the provisional stent implant, if the bifurcation angle is acute, which may increase the limitations of the T technique, the placement of the 2nd stent in a TAP (T and Protrusion) configuration may be considered.
The steps recommended by EBS for “TAP-Stenting” are outlined in this video.
EBC WHITEPAPER
Click below to access the EBC White Paper
European Bifurcation Club white paper on stenting techniques for patients with bifurcated coronary artery lesions1
We extend our deepest gratitude to the European Bifurcation Club for developing this white paper on “Stenting techniques for patients with bifurcation coronary artery lesions”. This invaluable resource has provided the detailed, step-by-step guidance upon which each of the techniques demonstrated has been performed.
A special thanks to Dr. Olivier Darremont (Clinique Saint Augustin, Bordeaux) for his collaboration with the Boston Scientific R&D Team since early 2020. His expertise has been instrumental in performing and guiding each of the techniques shown. As a Board Member and co-founder of the European Bifurcation Club, as well as a co-author of this white paper, his contributions have been truly invaluable.
We also sincerely appreciate Prof. James Spratt (St. George’s University Hospital, London) for giving his invaluable time, guidance, and feedback to the engineering team throughout the development process.
Finally, a heartfelt thank you, to Boston Scientific R&D, BSC EDUCARE & Gosling Creative Teams in Galway, Paris and London. Your technical expertise and unwavering support for clinical education, continue to inspire us every day.
- Burzotta F, Lassen JF, Louvard Y, Lefèvre T, Banning AP, Daremont O, Pan M, Hildick-Smith D, Chieffo A, Chatzizisis YS, Džavík V, Gwon HC, Hikichi Y, Murasato Y, Koo BK, Chen SL, Serruys P, Stankovic G. European Bifurcation Club white paper on stenting techniques for patients with bifurcated coronary artery lesions. Catheter Cardiovasc Interv. 2020 Nov;96(5):1067-1079. doi: 10.1002/ccd.29071. Epub 2020 Jun 24. PMID: 32579300; PMCID: PMC8915133.
- Sheng Tu, et. al. Five-Year Outcomes of Double Kissing Mini-Culotte Stenting vs. Mini-Culotte Stenting Using Drug-Eluting Stents for the Treatment of True Coronary Bifurcation Lesions. Frontiers in Cardiovascular Medicine, 2024. doi: 10.3389/fcvm.2024.1336750
- Sheng-Lin Chen, et. al. Comparison of Double Kissing Crush Versus Culotte Stenting for Unprotected Distal Left Main Bifurcation Lesions: Results From a Multicenter, Randomized, Prospective DKCRUSH-III Study. Journal of the American College of Cardiology, 2013. doi: 10.1016/j.jacc.2013.01.023