Abstract
INTRODUCTION: This study aims to investigate the impact of different double-stent methods on the structure and mechanics of coronary bifurcation lesions, providing reference indicators for clinicians in selecting an appropriate interventional procedure. METHODS: Three-dimensional reconstruction of coronary Computed Tomography Angiography (CTA) image data of a patient with coronary bifurcation disease was performed. Two types of double-stent (Cullotte and Crush) procedures were simulated, and their effects were evaluated using Finite element analysis. Intravascular Ultrasound (IVUS) validation and retrospective clinical analysis were performed to support computational findings. RESULTS: The stress distribution following the Cullotte stent was concentrated in the SB, whereas the stress after the Crush procedure was localized at the overlap with the proximal main vessel three-layer stent. Compared with the Crush procedure, the Culotte approach resulted in a lower percentage of double-stent malapposition, better dilation of vascular stenosis, and less narrowing of the SB stent, suggesting a more favorable clinical outcome. IVUS validation and retrospective clinical analysis were performed to support computational findings. DISCUSSION: Culotte stenting resulted in better stent-vessel conformity and more favorable stress distribution. The findings support FEA as a valuable tool in procedural planning. CONCLUSION: The findings suggest that the Culotte technique may offer mechanical advantages over the Crush technique, potentially improving long-term clinical outcomes. These results emphasize the role of computational modeling in optimizing interventional strategies.