Side Branch Research Articles

Morphologic evolution of bifurcated reaches in a macrotidal estuary with mountain streams

A macrotidal estuary with mountain streams (MEMS) is characterized by rapidly rising and falling flood peaks and large tidal ranges and is a typical estuary type with strong flow dynamics that is found worldwide. Understanding the morphodynamic evolution of MEMSs has great significance for river management. The roles of the mountain stream river flood process and macrotides on the morphology evolution still needs further quantitative study. Taking the Oujiang Estuary as an example, the evolution mechanisms of bifurcated reaches of a MEMS are studied by analyzing the hydrologic and topographic data and using a two-dimensional numerical model for flow-sediment transport. The results show that (1) under the combined actions of runoff and macrotides, sediment transport is active and morphological evolution is intensive, the main branch and subbranch historically switch frequently, and erosion generally occurs in wet years, while deposition occurs in dry years. (2) The river flood process of mountain streams causes rapid erosion, which rises and falls rapidly with a kurtosis index (K) of approximately 2.9. There is a logarithmic relation between the sediment transport load and K. The volume of sediment transport will be 40% larger than the river flood process with K = 1.2 as for the Yangtze River. (3) Macrotides with large tidal ranges could enhance the discharge asymmetry (ψ). When the ψ is greater than 1, the side branches are dominated by flood tides. Although the current study is site specific, the results are expected to provide a valuable reference for sustainable management in similar estuaries.

The K89 capsular polysaccharide produced by Acinetobacter baumannii LUH5552 consists of a pentameric repeat-unit that includes a 3-acetamido-3,6-dideoxy-d-galactose residue

Acinetobacter baumannii isolate LUH5552 carries the KL89 capsule biosynthesis gene cluster. Capsular polysaccharide (CPS) isolated from LUH5552 was analyzed by sugar analysis, Smith degradation, and one- and two-dimensional 1H and 13C NMR spectroscopy. The K89 CPS structure has not been seen before in A. baumannii CPS structures resolved to date and includes a 3-acetamido-3,6-dideoxy-d-galactose (d-Fucp3NAc) residue which is rare amongst A. baumannii CPS. The K89 CPS has a →3)-α-d-GalpNAc-(1→3)-β-d-GlcpNAc-(1→ main chain with a β-d-Glcp-(1→2)-β-d-Fucp3NAc-(1→6)-d-Glcp side branch that is α-(1→4) linked to d-GalpNAc. The roles of the Wzy polymerase and the four glycosyltransferases encoded by the KL89 gene cluster in the biosynthesis of the K89 CPS were assigned. Two glycosyltransferases, Gtr121 and Gtr122, link the d-Fucp3NAc to its neighboring sugars.

The hemodynamic effect of eccentricity in visceral branched aneurysms with multilayer stents.

It is preliminarily acknowledged that multilayer stent (MS) is a promising alternative technology in the treatment of visceral branched aneurysms, but hemodynamic consequences of eccentricity in such aneurysms with MS are less examined. In this work, we performed a time-dependent simulation of branched aneurysms of various eccentricities with different stent layers, and thrombosis-related parameters, such as time-averaged wall shear stress (TAWSS), oscillating shear index (OSI), and relative residence time (RRT), were also analyzed. Our results revealed that MS can generally restore laminar flow inside the stent, and allow proper perfusion to vital organs while also fostering a relatively secluded hemodynamic environment for thrombosis formation. Particularly, a flow in the aneurysm sac communicating between the main artery and side branch forms at early systole. However, MS fails to completely eliminate detrimental flow impingement after peak systole, which may hinder aneurysm recovery, especially in the cases of eccentric aneurysms. Therefore, saccular aneurysms should be treated with more caution than fusiform aneurysms. And further therapeutic attempts to keep both perfusion in the proximal region of the aneurysm and isolation in the distal region of the aneurysm should be considered.

Investigating the Equivalent Plastic Strain in a Variable Ring Length and Strut Width Thin-Strut Bioresorbable Scaffold

PurposeThe ArterioSorb^{rm{{TM}}} bioresorbable scaffold (BRS) developed by Arterius Ltd is about to enter first in man clinical trials. Previous generations of BRS have been vulnerable to brittle fracture, when expanded via balloon inflation in-vivo, which can be extremely detrimental to patient outcome. Therefore, this study explores the effect of variable ring length and strut width (as facilitated by the ArterioSorb^{rm{{TM}}} design) on fracture resistance via analysis of the distribution of equivalent plastic strain in the scaffold struts post expansion. Scaffold performance is also assessed with respect to side branch access, radial strength, final deployed diameter and percentage recoil.MethodsFinite element analysis was conducted of the crimping, expansion and radial crushing of five scaffold designs comprising different variations in ring length and strut width. The Abaqus/Explicit (DS SIMULIA) solution method was used for all simulations. Direct comparison between in-silico predictions and in-vitro measurements of the performance of the open cell variant of the ArterioSorb^{rm{{TM}}} were made. Paths across the width of the crown apex and around the scaffold rings were defined along which the plastic strain distribution was analysed.ResultsThe in-silico results demonstrated good predictions of final shape for the baseline scaffold design. Percentage recoil and radial strength were predicted to be, respectively, 2.8 and 1.7 times higher than the experimentally measured values, predominantly due to the limitations of the anisotropic elasto-plastic material property model used for the scaffold. Average maximum values of equivalent plastic strain were up to 2.4 times higher in the wide strut designs relative to the narrow strut scaffolds. As well as the concomitant risk of strut fracture, the wide strut designs also exhibited twisting and splaying behaviour at the crowns located on the scaffold end rings. Not only are these phenomena detrimental to the radial strength and risk of strut fracture but they also increase the likelihood of damage to the vessel wall. However, the baseline scaffold design was observed to tolerate significant over expansion without inducing excessive plastic strains, a result which is particularly encouraging, due to post-dilatation being commonplace in clinical practice.ConclusionTherefore, the narrow strut designs investigated herein, are likely to offer optimal performance and potentially better patient outcomes. Further work should address the material modelling of next generation polymeric BRS to more accurately capture their mechanical behaviour. Observation of the in-vitro testing indicates that the ArterioSorb^{rm{{TM}}} BRS can tolerate greater levels of over expansion than anticipated.

Tuned two-dimensional vocal tracts with piriform fossae for the finite element simulation of vowels

The piriform fossae are two small side branches of the vocal tract that are located close to the larynx. They act as quarter wave resonators and introduce two deep dips around 5 kHz in the voice spectrum. These two cavities acoustically interact, which produce a significant shift in the antiresonance frequencies. Three-dimensional (3D) models can naturally account for these effects but at the price of a high computational cost, whereas the most common alternative, the one-dimensional (1D) approaches, speed up simulations but cannot deal with this interaction. In this work, these two cavities are incorporated in 2D tuned vocal tracts of vowel sounds, which have shown to provide a good balance between computational costs and accuracy in the numerical simulation of vowels and diphthongs. The 2D tuning methodology is thus extended to mimic the acoustic behaviour of a 3D vocal tract of circular-cross sections that also has the two piriform fossae. This methodology consists in introducing proper modifications on the vocal tract shape, wall losses and glottal flow so as to tune the location, bandwidth and energy of the planar mode resonances of the main tract (formants in the speech community) and the antiresonances generated by the piriform fossae. The finite element method (FEM) is used to perform the 3D and 2D simulations. Results are also compared against a 1D approach based on the transfer matrix method (TMM).

Seaweed and Dendritic Growth in Unsaturated Fatty Acid Monolayers.

The lateral movement in lipid membranes depends on their diffusion constant within the membrane. However, when the flux of the subphase is high, the convective flow beneath the membrane also influences lipid movement. Lipid monolayers of an unsaturated fatty acid at the water–air interface serve as model membranes. The formation of domains in the liquid/condensed coexistence region is investigated. The dimension of the domains is fractal, and they grow with a constant growth velocity. Increasing the compression speed of the monolayer induces a transition from seaweed growth to dendritic growth. Seaweed domains have broad tips and wide and variable side branch spacing. In contrast, dendritic domains have a higher fractal dimension, narrower tips, and small, well-defined side branch spacing. Additionally, the growth velocity is markedly larger for dendritic than seaweed growth. The domains’ growth velocity increases and the tip radius decreases with increasing supersaturation in the liquid/condensed coexistence region. Implications for membranes are discussed.

Abdominal Aortic Aneurysm Shrinkage up to 2 Years Following Endovascular Repair with PEmbolization for Preventing Type 2 Endoleak: A Retrospective Single Center Study

The aim of the present study was to evaluate the efficacy of preemptive embolization of aneurysm side branches that cause type 2 endoleak (T2EL). We performed a retrospective review of consecutive patients who underwent endovascular aneurysm repair (EVAR) in our facility between April 2009 and April 2019. All the patients underwent the preemptive embolization for preventing T2EL since April 2014. The patients were divided into the nonembolization group (between April 2009 and May 2014) or the embolization group (between April 2014 and April 2019). We used a support wire to improve a success rate of the preemptive embolization. The aneurysm sac shrinkage (≧5mm), freedom from all-cause death and aneurysm-related death, T2EL-related reinterventions, aneurysm sac enlargement (≧5mm), and complications related to the endovascular procedure were compared between the 2 groups. Two-hundred patients with abdominal aortic aneurysm were included. They were divided into the nonembolization group (N=103) and the embolization group (N=97). We successfully embolized 89% of all the patent aneurysm side branches in the embolization group. The characteristics of the 2 groups were similar except for hypertension, patent lumbar arteries, and the use of Zenith, Excluder, and Endurant. The preemptive embolization group showed better aneurysm sac shrinkage (73% vs. 42%; P<0.0001), no aneurysm sac enlargement (0% vs. 5%; P<0.05), and lower T2EL-related reintervention rate (hazard ratio, 0.11; 95% confidence interval, 0.0061-0.60; P<0.01) up to 2years after EVAR. There were no significant differences in freedom from all-cause death, aneurysm-related death, and complications between the 2 groups. The present study showed the high success rate of preemptive embolization of aneurysm side branches resulting in better anatomical changes in the aneurysm sac and lower T2EL-related intervention rate in the embolization group up to 2years after EVAR.

Hangover after Side Branch Stenting: The Discomfort Comes Afterwards.

The authors report on a patient with recurrent angina at rest and on exertion 2 years after percutaneous revascularisation of the first diagonal branch (D1). Invasive coronary angiography with full functional testing was planned with the tentative diagnosis of coronary vascular dysfunction. Coronary angiography with functional testing revealed a haemodynamically significant intermediate stenosis at the D1–left anterior descending artery bifurcation. Optical coherence tomography demonstrated neointimal bridging and accelerated downstream atherosclerosis that was induced by protrusion of the previously implanted stent into the main branch. Although the overhanging stent was considered insignificant at first, it caused significant discomfort after 2 years. After provisional stenting of the main branch with crushing of the protruding stent and continuous medical treatment, the patient remained free of recurrent angina.

Ventricular fibrillation count by noise oversensing in a cardiac resynchronization therapy-defibrillator induced by side branch protection during percutaneous coronary intervention.

Ventricular fibrillation count by noise oversensing in a cardiac resynchronization therapy-defibrillator induced by side branch protection during percutaneous coronary intervention.

Utilizing the balloon anchoring technique to improve device deliverability during stent revascularization for atherosclerotic renal artery stenosis.

The stent revascularization for severely calcified renal artery lesions can be challenging, due to a deficiency in back-up force provided by the guide catheter. The aim of this report is to describe the use of the balloon anchoring technique to increase device maneuverability and deliverability after the failure of conventional renal artery revascularization. This technique was adopted in a patient with subtotal occlusive and severely calcified lesion in the proximal portion of the right main renal artery. Two guidewires were separately introduced into the proximal side branch (SB) and main branch (MB) of the renal artery. Anchor balloon inflated at low pressure in SB, anchoring the MB-wire and the guide catheter, thus giving us the ability to cross the tight calcified proximal cap of the MB lesion with a non-compliant balloon. After performing pre-dilatations and retrieving the anchor balloon, we implanted a balloon-expandable stent and achieved optimal final angiographic results. The balloon anchoring technique can improve device maneuverability and deliverability during various catheterization procedures. Our report firstly demonstrates how to perform the balloon anchoring technique in renal angioplasty treatment and then explains its effectiveness in revascularization of the renal artery with challenging anatomies.

Comparison of Sequential POT-Side-POT and Kissing Balloon Techniquesin Patientswith Coronary Bifurcation Lesions Treatedwith Single-Stent Strategy; Which One is Simple and Safe? Propensity Score Analysis.

Background:It is unknown whether the novel POT-side-POT technique is more useful than the commonly preferred kissing balloon inflation in patients with non-complex coronary bifurcation lesions treated with a single-stent strategy. The aim of this study was to compare the efficacy of POT-side-POT and kissing balloon inflation techniques in one-stent strategy for non-complex coronary bifurcation lesions.Methods:In this study, 283 patients were retrospectively analyzed (POT-side-POT group, n = 149; KBI group, n = 134). Primary endpoints of the study were defined as follows: in-hospital and 30-day mortality, contrast-induced acute kidney injury, stent thrombosis, side branch dissection, and need for side-branch stenting. Characteristics of patients at baseline were balanced by using propensity score inverse probability weighting.Results:Procedure time (minute, 30.6 ± 8.5 vs. 34.3 ± 11.6; P = .003) and contrast volume (milliliter, 153.7 ± 42.4 vs. 171.1 ± 58.2; P = .004) were significantly lower in POT-side-POT group. Besides, side branch residual stenosis and number of patients with >50% side branch residual stenosis remained significantly higher in POT-side-POT group both in general and true bifurcation subgroup analysis (20.3 ± 19.8% vs. 16.5 ± 16.4%, P = .022; 11.9% vs. 5.7%, P = .013 and 24.1 ± 23.2% vs. 18.8 ± 18.7%, P = .033; 17.6% vs. 6.6%, P = .005; respectively). Combined clinical adverse outcomes were similar between groups. Side branch dissection (10.2% vs. 20.1%, P = .001) and need for side branch stenting (12.6% vs. 19%, P = .040) reached statistically significance in kissing balloon inflation group after adjustment.Conclusion:POT-side-POT may be a simple and safe technique with a shorter procedure time and lower incidence of adverse clinical events in non-complex coronary bifurcation lesions treated with single-stent strategy.

The interna of the rhizocephalan Peltogaster reticulata: Comparative morphology and ultrastructure

Specialized morphology of diverse parasitic crustaceans reflects their adaptations to an endoparasitic lifestyle. Rhizocephalan barnacles are one of the most highly modified obligatory parasites of other crustaceans. Comprehension of the functional morphology of rhizocephalans could elucidate the main evolutionary trends not only inside parasitic barnacles, but in parasitism as a whole. Despite that, the available morphological information on the rhizocephalans is very fragmented. In this study, we examined the organization and ultrastructural features in different parts of the interna of Peltogaster reticulata (fam. Peltogastridae). The main trunk cuticle is much thicker than that of the side branches due to the different functions of these body parts. The central lumen in the main trunk is lined by an extracellular matrix, while the side branches are not. Muscular fibers are only present in the body wall of the main trunk, where they are organized as a “wicker basket”. Furthermore, functional differentiation can be found at the ultrastructural level in the cells of the rootlets: there are distinct cell types both in hypodermal and axial cell layers. The rootlets of P. reticulata are covered by a network of the host's neurons and capillaries.

Drug-Coated Balloons for Side Branches of Coronary Bifurcation Lesions Assessed by Cardiac Computed Tomography

Drug-Coated Balloons for Side Branches of Coronary Bifurcation Lesions Assessed by Cardiac Computed Tomography

Side Branch Late Thrombosis After Left Main Coronary Artery Crossover Stenting.

BackgroundWith the established use of crossover stenting technique in bifurcation coronary artery lesions, added clinical benefit of final kissing of the side branch remains debatable. We report a case of a stenosis and thrombus formation of an ostial side branch after crossover stenting.Case SummaryA 38-year-old man was admitted with acute coronary syndrome complicated by acute pulmonary oedema. He was treated with stenting of the left descending artery (LAD) into the left main coronary artery (LMCA) 12 months earlier. Coronary angiography showed a filling defect in the ostial left circumflex coronary artery (LCX). Optical coherence tomography revealed neointimal growth of the LAD stent resulting in narrowing the LCX orifice and a large thrombus behind stent struts. After treatment of the lesion and optimised implantations of drug-eluting stents, the patient was transferred to the intensive care unit and monitored closely. Given his advanced ischaemic cardiomyopathy, the patient is being evaluated for heart transplantation eligibility.DiscussionStent struts across a bifurcated major side branch after crossover stenting could risk late stenosis and thrombus formation of the side branch. The clinical usefulness of routine imaging-guided kissing techniques even with good angiographic results in these cases should be evaluated.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40119-022-00270-w.

Tooth recognition of 32 tooth types by branched single shot multibox detector and integration processing in panoramic radiographs.

Purpose: The purpose of our study was to analyze dental panoramic radiographs and contribute to dentists' diagnosis by automatically extracting the information necessary for reading them. As the initial step, we detected teeth and classified their tooth types in this study. Approach: We propose single-shot multibox detector (SSD) networks with a side branch for 1-class detection without distinguishing the tooth type and for 16-class detection (i.e., the central incisor, lateral incisor, canine, first premolar, second premolar, first molar, second molar, and third molar, distinguished by the upper and lower jaws). In addition, post-processing was conducted to integrate the results of the two networks and categorize them into 32 classes, differentiating between the left and right teeth. The proposed method was applied to 950 dental panoramic radiographs obtained at multiple facilities, including a university hospital and dental clinics. Results: The recognition performance of the SSD with a side branch was better than that of the original SSD. In addition, the detection rate was improved by the integration process. As a result, the detection rate was 99.03%, the number of false detections was 0.29 per image, and the classification rate was 96.79% for 32 tooth types. Conclusions: We propose a method for tooth recognition using object detection and post-processing. The results show the effectiveness of network branching on the recognition performance and the usefulness of post-processing for neural network output.

Role of transperineal ultrasound in evaluation of patients with perianal inflammatory disorders

BackgroundThe aim of this study was to study the degree of accuracy of transperineal ultrasound (TPUS) in pre-operative evaluation and follow-up of cases with perianal inflammatory disorders in relation to MRI findings. Thirty patients with symptoms and signs of perianal inflammatory disorders underwent TPUS and pelvic MRI examinations. The radiologist who performed the TPUS was blinded to MR findings and was asked to comment on the site of the internal opening and extension of the tract, any related side branches or collections.ResultsThe overall accuracy of TPUS in detection of the site of internal opening of perianal tracts was 83.33%, with sensitivity of 91.30%. TPUS showed sensitivity, specificity and accuracy of 100% in detection of horseshoe collections. The overall accuracy of TPUS in detection of perianal abscesses was 93.33% with specificity of 100%. TPUS showed sensitivity of 50.00%, specificity of 92.31% and accuracy of 86.67% in visualization of side branches. TPUS showed sensitivity of 33.33%, specificity of 88.89% and overall accuracy of 83.33% in detection of supralevator extension of perianal tracts. TPUS correctly classified (23/30) perianal tracts with accuracy of 76.7%.ConclusionsTPUS can be used as a first diagnostic tool in patients with perianal inflammatory disorders and related pathologies, particularly horseshoe collections which can change the operative decision made by the surgeon. TPUS can be used in repeated follow-up during the course of management of perianal inflammatory disorders or when other imaging modalities are unavailable or contra-indicated.

Clinical Implications of Phenotypes of Hemodialysis Patients With Central Venous Occlusion or Central Venous Stenosis Defined by Cluster Analysis.

ObjectiveThis study aims to investigate the association between clinical factors of patients with central (superior vena cava, brachiocephalic, or subclavian) venous occlusion or central venous stenosis (CVO/CVS) and the difficulty of interventional recanalization as well as the duration of postoperative patency.MethodsA total of 103 hemodialysis patients with CVO/CVS treated with endovascular treatment were enrolled. The two-step cluster analysis was selected to differentiate the cases into distinct phenotypes automatically. Differences in characteristics, the difficulty of interventional recanalization, and the duration of postoperative primary patency time between the two clusters were statistically compared.ResultsThe 103 cases were divided into distinct two clusters by the two-step cluster analysis with 48 (46.6%) in cluster 1 and 55 (53.4%) in cluster 2. Compared to cluster 2, patients in cluster 1 have a higher proportion of blunt stump, side branches, occlusion lesions >2 cm, calcification, or organization. Moreover, the above four factors were, in turn, the most critical four predictors distinguishing 103 patients into two clusters. The remaining six factors were, in turn, occlusion located in the superior vena cava (SVC), duration of central venous catheterization (CVC), lesion location, vessel diameter, number of CVC, and previously failed lesion. Of the four most important factors, with the exception of occlusion lesions exceeding 2 cm, there were significant differences in the length of procedure time between the groups grouped by the remaining three factors. And there was a significant difference in the primary patency rate between the group with blunt stump and the group without blunt stump and also between the group with occlusion lesions ≥ 2 cm and the group with occlusion lesions <2 cm. The operation time of cluster 1 was longer than that of cluster 2. In terms of postoperative patency time, the primary patency time was significantly longer in the patients of cluster 2 compared with cluster 1 (P = 0.025).ConclusionPatients were divided into distinct two clusters. CVO/CVS of patients in cluster 1 was more challenging to be recanalized than that in cluster 2, and the primary patency time was significantly longer in the patients of cluster 2 compared with cluster 1. Blunt stump, side branches, occlusion lesions exceeding 2 cm, and calcification or organization are the four most critical predictors distinguishing 103 patients into two clusters.

Parent Artery Complex Coil Protection for Side-Branched Wide-Neck Aneurysms.

This study aimed to validate the usefulness of parent artery complex coil protection for the treatment of wide-neck, side-branched, and ruptured aneurysms. A microcatheter was first introduced into the aneurysmal sac, and another microcatheter was introduced into the parent artery or near the orifice of the branch artery. A framing coil was deployed partially from the first microcatheter, and a protection coil was deployed from the second microcatheter to prevent protrusion of the first framing coil to the parent artery and side branches. After the first framing coil insertion, the protection coil was withdrawn to confirm the stability of the framing coil and blood flow. The procedures with this technique were successful for 3 patients. Parent artery complex coil protection can be an effective and safe coil embolization technique for the preservation of parent and side branch arteries and an alternative method for emergent ruptured cases.

Comparison of adenosine-independent pressure indices to fractional flow reserve in stent-jailed bifurcation side branches.

This study aims to evaluate whether the high correlation and classification agreement of the instantaneous wave-free ratio (iFR) and the resting distal coronary to aortic pressure ratio (Pd /Pa ) with the fractional flow reserve (FFR) can be confirmed in stent-jailed side branches (J-SB). Consecutive patients (n = 49) undergoing provisional stenting were prospectively enrolled and a physiological assessment of the J-SB (n = 51) was performed. FFR, iFR, and Pd /Pa were measured and the hemodynamic relevance was determined using cutoff values of ≤0.80, ≤0.89, and ≤0.92, respectively. Both iFR (r = 0.75) and Pd /Pa (r = 0.77) correlated closely with FFR. Classification agreement with FFR was 78% for iFR (81% sensitivity, 77% specificity) and 75% for Pd /Pa (63% sensitivity and 80% specificity). However, angiographic diameter stenosis and pressure indices correlated poorly. For a threshold of ≥70% stenosis, agreement concerning hemodynamic relevance was found in 59% for FFR, 69% for iFR, and 61% for Pd /Pa . As reported for other lesion types, FFR and the adenosine-independent pressure indices iFR and Pd /Pa show close correlation and a high classification agreement of approximately 75%-80% in J-SB. Therefore, iFR can be regarded as a recommendable alternative to FFR for the guidance of provisional stenting in bifurcation lesions.

Systematic Review and Network Meta-Analysis Comparing Bifurcation Techniques for Percutaneous Coronary Intervention.

BackgroundBifurcation lesions account for 20% of all percutaneous coronary interventions and represent a complex subset which are associated with lower procedural success and higher rates of restenosis. The ideal bifurcation technique, however, remains elusive.Methods and ResultsExtensive search of the literature was performed to pull data from randomized clinical trials that met predetermined inclusion criteria. Conventional meta‐analysis produced pooled relative risk (RR) and 95% CI of 2‐stent technique versus provisional stent on prespecified outcomes. Both frequentist and Bayesian network meta‐analyses were performed to compare bifurcation techniques. A total of 8318 patients were included from 29 randomized clinical trials. Conventional meta‐analysis showed no significant differences in all‐cause mortality, cardiac death, major adverse cardiac events, myocardial infarction, stent thrombosis, target lesion revascularization, and target vessel revascularization between 2‐stent techniques and provisional stenting. Frequentist network meta‐analysis revealed that double kissing crush was associated with lower cardiac death (RR, 0.57; 95% CI, 0.38–0.84), major adverse cardiac events (RR, 0.50; 95% CI, 0.39–0.64), myocardial infarction (RR, 0.60; 95% CI, 0.39–0.90), stent thrombosis (RR, 0.50; 95% CI, 0.28–0.88), target lesion revascularization, and target vessel revascularization when compared with provisional stenting. Double kissing crush was also superior to other 2‐stent techniques, including T‐stent or T and protrusion, dedicated bifurcation stent, and culotte.ConclusionsDouble kissing crush was associated with lower risk of cardiac death, major adverse cardiac events, myocardial infarction, stent thrombosis, target lesion revascularization, and target vessel revascularization compared with provisional stenting and was superior to other 2‐stent techniques. Superiority of 2‐stent strategy over provisional stenting was observed in subgroup meta‐analysis stratified to side branch lesion length ≥10 mm.