Minicrush or T-Stenting and Minimal Protrusion in Complex Coronary Bifurcation Lesions: The Multicenter TREX Registry

BACKGROUND: Percutaneous coronary intervention of complex coronary bifurcation lesions frequently requires an upfront 2-stent strategy. Although the double kissing crush technique has been extensively studied, limited contemporary data are available comparing alternative 2-stent approaches, particularly Minicrush and T-stenting and minimal protrusion (TAP), in complex bifurcation anatomy. This study aimed to compare procedural characteristics and long-term clinical outcomes of Minicrush versus TAP stenting techniques in patients undergoing percutaneous coronary intervention for complex coronary bifurcation lesions. METHODS: The TREX registry is a multicenter, retrospective cohort study including consecutive patients treated with an upfront 2-stent strategy using Minicrush or TAP between November 2015 and April 2025. The primary end point was target lesion failure. Secondary end points included major adverse cardiac events and definite or probable stent thrombosis. Clinical outcomes were assessed for up to 10 years. RESULTS: Among 601 screened patients, 469 (78%) underwent an upfront 2-stent strategy (Minicrush: n=257; TAP: n=212). TLF occurred in 10.4% of patients, with no significant differences between groups at 1, 5, or 10 years. Major cardiovascular event rates were also comparable across all time points. In multivariable analyses, distal left main involvement and severe coronary calcification were the strongest predictors of TLF, whereas reduced left ventricular ejection fraction was the main predictor of major cardiovascular events. Definite or probable stent thrombosis occurred more frequently with TAP than with Minicrush (5.7% versus 0.8%; P <0.01). CONCLUSIONS: Minicrush and TAP provide comparable long-term efficacy in complex coronary bifurcation percutaneous coronary intervention; however, Minicrush is associated with a lower risk of stent thrombosis, suggesting a more favorable safety profile. REGISTRATION: URL: https://clinicaltrials.gov/ ; Unique Identifier: NCT06484647.