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Randomized Controlled Trial
. 2025 May 12;18(9):1103-1115.
doi: 10.1016/j.jcin.2025.02.007. Epub 2025 Mar 10.

Comparison of Stent Geometry Achieved by Different Side-Branch Ballooning Techniques For Bifurcation Provisional Stenting: The CRABBIS Trial

Francesco Bianchini  1 , Enrico Romagnoli  2 , Cristina Aurigemma  2 , Lazzaro Paraggio  2 , Antonino Buffon  1 , Francesco Fracassi  2 , Mattia Lunardi  2 , Luigi Cappannoli  1 , Emiliano Bianchini  3 , Andrea Zito  3 , Carlo Trani  1 , Francesco Burzotta  4
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Free article
Randomized Controlled Trial

Comparison of Stent Geometry Achieved by Different Side-Branch Ballooning Techniques For Bifurcation Provisional Stenting: The CRABBIS Trial

Francesco Bianchini et al. JACC Cardiovasc Interv. .
Free article

Abstract

Background: Stepwise provisional stenting is the most adopted approach for percutaneous coronary interventions (PCIs) in bifurcation lesions. During these procedures, the side branch (SB) may deserve treatment, but the best ballooning technique is still undetermined.

Objectives: The study sought to compare the stent configurations obtained by 2 SB ballooning sequences after main vessel (MV) stent implantation: the proximal optimization technique + kissing balloon inflation + final proximal optimization technique (PKP) vs the proximal optimization technique + isolated side branch dilation + final proximal optimization technique (PSP).

Methods: We conducted a 1:1 prospective, randomized, single-center trial to compare bifurcation PCI performed with either PKP or PSP in left main or large (SB diameter >2.75 mm) coronary bifurcations (NCT05559424). The achieved stent configurations (in terms of expansion, apposition, and eccentricity at 5 different bifurcation segments) were evaluated using optical coherence tomography in the MV. The predefined primary study endpoint was minimum stent expansion at the distal MV segment.

Results: A total of 60 patients undergoing bifurcation PCI according to stepwise provisional stenting were enrolled (30 randomized to PKP and 30 to PSP). At postintervention optical coherence tomography, minimum stent expansion at the distal MV segment was significantly higher with PKP as compared with PSP (99.3% ± 12.7% vs 83.8% ± 19.5%; P < 0.001). Additional relevant findings included a higher rate of malapposition in the bifurcation core and distal MV with PSP and improved SB scaffolding with PKP. No significant differences in terms of stent eccentricity were noted between PSP and PKP in all the segments analyzed.

Conclusions: The results of the present randomized trial show that during stepwise provisional stenting in left main or large bifurcations, the PKP ballooning sequence is associated with better stent configuration compared with the PSP.

Keywords: OCT; bifurcation; drug-eluting stent(s); provisional stenting; side branch.

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Conflict of interest statement

Funding Support and Author Disclosures The CRABBIS trial was funded by Academic grants (Bando Linea D.1, Università Cattolica del Sacro Cuore, Rome, Italy) and Italian Ministry of Health, Ricerca Corrente 2025. Dr Bianchini has received research grant support from Abbott. Dr Romagnoli has received speaker fees from Abbott Vascular and Terumo. Dr Aurigemma has received speaker fees from Abbott Vascular, Abiomed, Medtronic, Terumo, and Daiichi-Sankyo. Dr Paraggio has received speaker fees from Abiomed and Terumo. Drs Burzotta and Trani have received speaker fees from Abbott Vascular, Abiomed, Medtronic, and Terumo. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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