Pitfalls and Bailout Strategies for Coronary Bifurcations Treated With T-and-Small Protrusion Technique—A Systematic Bench Test Overview

Provisional stenting is the preferred percutaneous coronary intervention (PCI) strategy for bifurcation lesions, aiming for a single-stent strategy. When implanting the second stent becomes necessary, T-and-small protrusion (TAP) technique is then one of the recommended provisional two-stent techniques. Accurate positioning of the SB stent is critical for procedural success. Inaccurate deployment may result in either geographic miss at the SB ostium or excessive protrusion into the main branch (MB), potentially compromising long-term outcomes. The present bench study reproduces these technical failures using standardized silicone bifurcation models, latest generation drug-eluting stents (DES), and intravascular imaging guidance and proposes structured bailout strategies. The demonstrated situations included cases where the side-branch stent was implanted either (1) too distally, leaving an ostial gap or (2) with excessive protrusion into the MB stent. We describe the troubleshooting steps required for conversion to (1) drug-coated balloon-facilitated T-stenting or DK-Culotte or (2) internal crush or DK-Culotte. We present a structured framework for correcting technical failures of TAP, while emphasizing the importance of imaging guidance and appropriate stent selection.