Are Ultrathin Stents Optimal for Bifurcation Lesions? Insights from Computational Modelling of Provisional and DK-Crush Techniques

TL;DR

This study uses computational modeling to compare ultrathin and thin stents in bifurcation lesions, revealing how design influences mechanical and hemodynamic outcomes in different stenting techniques.

Contribution

It provides a detailed analysis of how stent design affects deployment performance and blood flow in bifurcation interventions, guiding device selection and procedural strategies.

Findings

Orsiro stent shows better ostium clearance and flow conditions in PSB.

Differences between stents diminish in DKC technique.

Stent design impacts outcomes more in PSB than in DKC.

Abstract

Complex coronary bifurcation lesions remain challenging in percutaneous coronary intervention, with stent design and deployment strategy influencing clinical outcomes. This study compares the mechanical and hemodynamic performance of the ultrathin-strut Orsiro and thin-strut Xience Sierra stent in Provisional Side Branch (PSB) and Double Kissing Crush (DKC) techniques. We used finite element analyses of bifurcation stent deployment to assess malapposition, ostium clearance, and arterial wall stress for both techniques. Computational fluid dynamics simulations quantified the luminal exposure to low Time-Averaged Endothelial Shear Stress (TAESS below 0.4 Pa) and high shear rates (above 1000 1/s). In PSB, Orsiro showed higher malapposition (13.0% vs 9.6%) but improved SB ostium clearance (77% vs 64%) and lower low-TAESS exposure (30.3% vs 33.6%) compared to Xience. Orsiro also produced higher arterial wall stresses, particularly during kissing balloon inflation. In DKC, differences in malapposition and ostium clearance diminished between stents, though Orsiro retained a hemodynamic advantage with lower low-TAESS (28.2% vs 36.3%).Stent design influenced outcomes more strongly in PSB, where anatomical interaction and platform-specific behavior impacted both structural and hemodynamic results. In DKC, procedural complexity minimized those differences, making the stenting technique the primary performance driver. Nonetheless, Orsiro consistently preserved more favorable flow conditions. These findings highlight the need to match device selection with lesion characteristics in PSB, while in DKC, optimizing procedural steps may have a greater impact than the choice of stent platform.