The Relentless Attempt to Perfect the 2-Stent Technique.

A provisional, single-stent strategy is currently regarded as the default strategy for the treatment of bifurcation lesions, because of beneficial outcomes associated with this technique (1,2). However, this approach cannot be applied broadly across all bifurcation lesions because of the likelihood of side branch (SB) compromise in the presence of high-risk features (e.g. significant SB ostial disease) or because the SB has significant disease extending beyond its ostium requiring treatment (3). In such circumstances, the high risk of SB occlusion (and resultant periprocedural myocardial infarction) or residual critical stenosis on the SB demand the implementation of a 2-stent strategy in a bid to maintain optimal vessel patency and blood flow in both the main branch (MB) and the SB. The ostium of the SB is the weakest segment in bifurcation lesions, being the most common location of restenosis (4). A number of different 2-stent techniques have been described, including T-stenting (5), T and protrusion, crush (6), and culotte stenting (7), in addition to the development of dedicated bifurcation devices (8), in an attempt to optimize the immediate and long-term results of the SB following treatment. However, each of these strategies has limitations, including stent distortion, inadequate ostial coverage, and multiple stent layers that contribute to restenosis.