Evaluation of Small Vessel Bifurcation Stenting Using the Double‐Kissing Culotte and Culotte Technique in Acute Coronary Syndrome: 12‐Month Clinical Outcomes

Abstract Introduction Patients with small vessels who undergo percutaneous coronary intervention (PCI) with subsequent multiple implantation of drug‐eluting stents remain at a higher risk of unfavorable outcomes. In complex cases where maintaining flow to all side branches is part of contemporary practice, using two‐stent techniques may be appropriate. This study aims to evaluate the efficacy of double‐kissing (DK) culotte technique in comparison to culotte technique in the context of small‐vessel therapy in patients with acute coronary syndrome (ACS). Methods This substudy of the Lower Silesia culotte Bifurcation Registry retrospectively analyzed patients who underwent ACS‐PCI using DK culotte or culotte technique for bifurcation lesions in small vessels, defined as having at least one branch with a diameter of 2.75 mm or less. The primary endpoint was target lesion failure (TLF), a composite of cardiovascular death, target vessel myocardial infarction, or clinically driven target lesion revascularization (TLR) at 1‐year follow‐up. The secondary endpoint included major adverse cardiac events (MACE). Results The DK culotte group ( n = 49) and the culotte group ( n = 52) were compared, with 12‐month follow‐up showing lower TLF in the DK culotte group (8.2% vs. 19.2%, p = 0.082). Similar results were observed for TLR (6.1% vs. 13.5%; p = 0.161), stent restenosis (4.1% vs. 9.6%; p = 0.203), and MACE (18.4% vs. 25%; p = 0.344). Conclusion For bifurcation lesions with a small‐diameter artery, the DK culotte technique may reduce TLF and MACE compared to the culotte technique. However, given the limited sample size and the absence of statistical significance, these findings remain preliminary and require further investigation.