Can the T and Minimal Protrusion (TAP) Technique be Considered as an Up‐Front 2‐Stent Strategy for True Distal Left Main Stem Bifurcation?

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.