{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T17:20:31Z","timestamp":1763572831290,"version":"3.44.0"},"reference-count":19,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T00:00:00Z","timestamp":1748304000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T00:00:00Z","timestamp":1748304000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4tsklinikum Freiburg"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J. Cardiovasc. Transl. Res."],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:p>Whether culotte or double kissing (DK)-crush stenting is the superior systematic 2-stent technique in non-left main bifurcation lesions is unclear. The BBK-3 (unique identifier NCT 04192760) is a multicenter, prospective, randomized controlled trial to test the hypothesis that culotte stenting reduces maximal percent diameter restenosis at 9-month follow-up compared to DK-crush stenting in de-novo non-left main coronary bifurcation lesions using approved, third-generation drug-eluting stents (DES). A total of 400 patients will be randomized in a 1:1 ratio to receive a two-stent strategy. The primary study endpoint is the maximal percent diameter in-stent restenosis within the bifurcation at 9\u00a0months, assessed by quantitative coronary angiography. Secondary endpoints include target lesion revascularization (TLR), the composite of death and myocardial infarction, emergent cardiac bypass surgery and TLR (MACE) at 12\u00a0months. BBK-3 will assist in the identification of the preferable, contemporary 2-stent strategy in the treatment of de-novo non-left main coronary bifurcation lesions.<\/jats:p>\n          <jats:p>\n            <jats:bold>Graphical Abstract<\/jats:bold>\n          <\/jats:p>","DOI":"10.1007\/s12265-025-10626-x","type":"journal-article","created":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T11:59:25Z","timestamp":1748347165000},"page":"1005-1012","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Randomised Comparison of Culotte- versus Double Kissing Crush Stenting in de novo non-left Main Coronary Bifurcation Lesions: Rationale and Design of the Bifurcation Bad Krozingen trial-3 (BBK-3)"],"prefix":"10.1007","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-3553-9088","authenticated-orcid":false,"given":"Faridun","family":"Rahimi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nikolaus","family":"L\u00f6ffelhardt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan","family":"Minners","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philipp","family":"Breitbart","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kilian","family":"Franke","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tau Sarra","family":"Hartikainen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Valina","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Constantin v. Zur","family":"M\u00fchlen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"N\u00fchrenberg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adnan","family":"Kastrati","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Felix","family":"Woitek","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Albrecht","family":"Elsaesser","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamed","family":"Abdel-Wahab","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samuel","family":"Sossalla","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Willibald","family":"Hochholzer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dirk","family":"Westermann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Franz-Josef","family":"Neumann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoph","family":"Olivier","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miroslaw","family":"Ferenc","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,5,27]]},"reference":[{"key":"10626_CR1","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1093\/eurheartj\/ehy394","volume":"40","author":"F-J Neumann","year":"2019","unstructured":"Neumann F-J, Sousa-Uva M, Ahlsson A, et al. 2018 ESC\/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2019;40:87\u2013165. https:\/\/doi.org\/10.1093\/eurheartj\/ehy394.","journal-title":"Eur Heart J"},{"key":"10626_CR2","doi-asserted-by":"publisher","first-page":"362","DOI":"10.4244\/EIJ-D-22-00165","volume":"18","author":"R Albiero","year":"2022","unstructured":"Albiero R, Burzotta F, Lassen JL, et al. Treatment of coronary bifurcation lesions, part I: implanting the first stent in the provisional pathway. The 16th expert consensus document of the European Bifurcation Club. EuroIntervention. 2022;18:362\u201376. https:\/\/doi.org\/10.4244\/EIJ-D-22-00165.","journal-title":"EuroIntervention"},{"key":"10626_CR3","doi-asserted-by":"publisher","first-page":"914","DOI":"10.1016\/j.jacc.2010.10.023","volume":"57","author":"S-L Chen","year":"2011","unstructured":"Chen S-L, Santoso T, Zhang J-J, et al. A randomized clinical study comparing double kissing crush with provisional stenting for treatment of coronary bifurcation lesions: results from the DKCRUSH-II (Double Kissing Crush versus Provisional Stenting Technique for Treatment of Coronary Bifurcation Lesions) trial. J Am Coll Cardiol. 2011;57:914\u201320. https:\/\/doi.org\/10.1016\/j.jacc.2010.10.023.","journal-title":"J Am Coll Cardiol"},{"key":"10626_CR4","doi-asserted-by":"publisher","first-page":"2605","DOI":"10.1016\/j.jacc.2017.09.1066","volume":"70","author":"S-L Chen","year":"2017","unstructured":"Chen S-L, Zhang J-J, Han Y, et al. Double Kissing Crush Versus Provisional Stenting for Left Main Distal Bifurcation Lesions. J Am Coll Cardiol. 2017;70:2605\u201317. https:\/\/doi.org\/10.1016\/j.jacc.2017.09.1066.","journal-title":"J Am Coll Cardiol"},{"key":"10626_CR5","doi-asserted-by":"publisher","first-page":"3399","DOI":"10.1093\/eurheartj\/ehw345","volume":"37","author":"M Ferenc","year":"2016","unstructured":"Ferenc M, Gick M, Comberg T, et al. Culotte stenting vs. TAP stenting for treatment of de-novo coronary bifurcation lesions with the need for side-branch stenting: the Bifurcations Bad Krozingen (BBK) II angiographic trial. Eur Heart J. 2016;37:3399\u2013405. https:\/\/doi.org\/10.1093\/eurheartj\/ehw345.","journal-title":"Eur Heart J"},{"key":"10626_CR6","doi-asserted-by":"publisher","first-page":"1482","DOI":"10.1016\/j.jacc.2013.01.023","volume":"61","author":"S-L Chen","year":"2013","unstructured":"Chen S-L, Xu B, Han Y-L, et al. Comparison of Double Kissing Crush Versus Culotte Stenting for Unprotected Distal Left Main Bifurcation Lesions. J Am Coll Cardiol. 2013;61:1482\u20138. https:\/\/doi.org\/10.1016\/j.jacc.2013.01.023.","journal-title":"J Am Coll Cardiol"},{"key":"10626_CR7","doi-asserted-by":"publisher","first-page":"1335","DOI":"10.1016\/j.jcin.2015.05.017","volume":"8","author":"S-L Chen","year":"2015","unstructured":"Chen S-L, Xu B, Han Y-L, et al. Clinical Outcome After DK Crush Versus Culotte Stenting of Distal Left Main Bifurcation Lesions. JACC Cardiovasc Interv. 2015;8:1335\u201342. https:\/\/doi.org\/10.1016\/j.jcin.2015.05.017.","journal-title":"JACC Cardiovasc Interv"},{"key":"10626_CR8","doi-asserted-by":"publisher","first-page":"e724","DOI":"10.4244\/EIJ-D-20-00130","volume":"16","author":"GG Toth","year":"2020","unstructured":"Toth GG, Sasi V, Franco D, et al. Double-kissing culotte technique for coronary bifurcation stenting. EuroIntervention. 2020;16:e724\u201333. https:\/\/doi.org\/10.4244\/EIJ-D-20-00130.","journal-title":"EuroIntervention"},{"key":"10626_CR9","doi-asserted-by":"publisher","unstructured":"Kahraman S, Cizgici AY, Guner A, et al. Clinical Outcomes of Double-Kissing Crush or Double-Kissing Culotte in Nonleft Main Bifurcation Lesions: The ROUTE Trial. Circ Cardiovasc Interv 2024:e014616. https:\/\/doi.org\/10.1161\/CIRCINTERVENTIONS.124.014616.","DOI":"10.1161\/CIRCINTERVENTIONS.124.014616"},{"key":"10626_CR10","doi-asserted-by":"publisher","first-page":"1067","DOI":"10.1002\/ccd.29071","volume":"96","author":"F Burzotta","year":"2020","unstructured":"Burzotta F, Lassen JF, Louvard Y, et al. European Bifurcation Club white paper on stenting techniques for patients with bifurcated coronary artery lesions. Catheter Cardiovasc Interv. 2020;96:1067\u201379. https:\/\/doi.org\/10.1002\/ccd.29071.","journal-title":"Catheter Cardiovasc Interv"},{"key":"10626_CR11","doi-asserted-by":"publisher","first-page":"1266","DOI":"10.1016\/j.jcin.2014.04.026","volume":"7","author":"S-L Chen","year":"2014","unstructured":"Chen S-L, Sheiban I, Xu B, et al. Impact of the complexity of bifurcation lesions treated with drug-eluting stents: the DEFINITION study (Definitions and impact of complEx biFurcation lesIons on clinical outcomes after percutaNeous coronary IntervenTIOn using drug-eluting steNts). JACC Cardiovasc Interv. 2014;7:1266\u201376. https:\/\/doi.org\/10.1016\/j.jcin.2014.04.026.","journal-title":"JACC Cardiovasc Interv"},{"key":"10626_CR12","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.118.008730","volume":"7","author":"TJ Ford","year":"2018","unstructured":"Ford TJ, McCartney P, Corcoran D, et al. Single- Versus 2-Stent Strategies for Coronary Bifurcation Lesions: A Systematic Review and Meta-Analysis of Randomized Trials With Long-Term Follow-up. J Am Heart Assoc. 2018;7: e008730. https:\/\/doi.org\/10.1161\/JAHA.118.008730.","journal-title":"J Am Heart Assoc"},{"key":"10626_CR13","doi-asserted-by":"publisher","first-page":"1923","DOI":"10.1093\/eurheartj\/ehw170","volume":"37","author":"MW Behan","year":"2016","unstructured":"Behan MW, Holm NR, De Belder AJ, et al. Coronary bifurcation lesions treated with simple or complex stenting: 5-year survival from patient-level pooled analysis of the Nordic Bifurcation Study and the British Bifurcation Coronary Study. Eur Heart J. 2016;37:1923\u20138. https:\/\/doi.org\/10.1093\/eurheartj\/ehw170.","journal-title":"Eur Heart J"},{"key":"10626_CR14","doi-asserted-by":"publisher","first-page":"1427","DOI":"10.1136\/heartjnl-2016-310929","volume":"103","author":"R Nairooz","year":"2017","unstructured":"Nairooz R, Saad M, Elgendy IY, et al. Long-term outcomes of provisional stenting compared with a two-stent strategy for bifurcation lesions: a meta-analysis of randomised trials. Heart. 2017;103:1427\u201334. https:\/\/doi.org\/10.1136\/heartjnl-2016-310929.","journal-title":"Heart"},{"key":"10626_CR15","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.116.004497","volume":"10","author":"S-L Chen","year":"2017","unstructured":"Chen S-L, Santoso T, Zhang J-J, et al. Clinical Outcome of Double Kissing Crush Versus Provisional Stenting of Coronary Artery Bifurcation Lesions: The 5-Year Follow-Up Results From a Randomized and Multicenter DKCRUSH-II Study (Randomized Study on Double Kissing Crush Technique Versus Provisional Stenting Technique for Coronary Artery Bifurcation Lesions). Circ Cardiovasc Interv. 2017;10: e004497. https:\/\/doi.org\/10.1161\/CIRCINTERVENTIONS.116.004497.","journal-title":"Circ Cardiovasc Interv"},{"key":"10626_CR16","doi-asserted-by":"publisher","first-page":"1927","DOI":"10.1016\/j.jcin.2019.04.056","volume":"12","author":"X Chen","year":"2019","unstructured":"Chen X, Li X, Zhang J-J, et al. 3-Year Outcomes of the DKCRUSH-V Trial Comparing DK Crush With Provisional Stenting for Left Main Bifurcation Lesions. JACC Cardiovasc Interv. 2019;12:1927\u201337. https:\/\/doi.org\/10.1016\/j.jcin.2019.04.056.","journal-title":"JACC Cardiovasc Interv"},{"key":"10626_CR17","doi-asserted-by":"publisher","DOI":"10.1136\/openhrt-2018-000947","volume":"7","author":"I Kumsars","year":"2020","unstructured":"Kumsars I, Holm NR, Niemel\u00e4 M, et al. Randomised comparison of provisional side branch stenting versus a two-stent strategy for treatment of true coronary bifurcation lesions involving a large side branch: the Nordic-Baltic Bifurcation Study IV. Open Heart. 2020;7: e000947. https:\/\/doi.org\/10.1136\/openhrt-2018-000947.","journal-title":"Open Heart"},{"key":"10626_CR18","doi-asserted-by":"publisher","first-page":"2537","DOI":"10.1093\/eurheartj\/ehaa559","volume":"41","author":"M Ferenc","year":"2020","unstructured":"Ferenc M, Neumann F-J. Towards a lesion-specific approach to percutaneous coronary intervention for bifurcation lesions. Eur Heart J. 2020;41:2537\u201340. https:\/\/doi.org\/10.1093\/eurheartj\/ehaa559.","journal-title":"Eur Heart J"},{"key":"10626_CR19","doi-asserted-by":"publisher","first-page":"845","DOI":"10.4244\/EIJV12I7A139","volume":"12","author":"P Medrano-Gracia","year":"2016","unstructured":"Medrano-Gracia P, Ormiston J, Webster M, et al. A computational atlas of normal coronary artery anatomy. EuroIntervention. 2016;12:845\u201354. https:\/\/doi.org\/10.4244\/EIJV12I7A139.","journal-title":"EuroIntervention"}],"container-title":["Journal of Cardiovascular Translational Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12265-025-10626-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s12265-025-10626-x\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12265-025-10626-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T14:02:26Z","timestamp":1757944946000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s12265-025-10626-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,27]]},"references-count":19,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,8]]}},"alternative-id":["10626"],"URL":"https:\/\/doi.org\/10.1007\/s12265-025-10626-x","relation":{},"ISSN":["1937-5387","1937-5395"],"issn-type":[{"type":"print","value":"1937-5387"},{"type":"electronic","value":"1937-5395"}],"subject":[],"published":{"date-parts":[[2025,5,27]]},"assertion":[{"value":"14 March 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 May 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 May 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All procedures followed are in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent is obtained from all patients previous to being included in the study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Human Subjects\/Informed Consent Statement"}},{"value":"F. R. receives speaker honoraria and consultancy fees from Boston, Cordis and Shockwave Medical. P.B. receives speaker honoraria and consultancy fees from AstraZeneca, BMS, Daiichi Sankyo, Novo Nordisk, Pfizer and Sanofi Aventis, and institutional grants from the German Heart Foundation. T.N. is an employee of Novartis Pharma AG. A.K. is one of the inventors in a patent application related to drug-eluting stent technology from his institution of employment. S.T.S. recieved speakers\/consulting honoraria from Astra Zeneca, Novartis, Berlin-Chemie, DAIICHI SANKYO, Bristol-Myers-Squibb, Pfizer, Boehringer Ingelheim, Lilly. W. H. received consultancy fees or speaker honoraria from Daiichi Sankyo, Novartis, and Bayer. D.W. received fees from Abiomed, AstraZeneca, Bayer, Boehringer Ingelheim, Berlin-Chemie, Edwards Lifescience, Medtronic, and Novartis. F.J.N. received consultancy honoraria from Novartis and Meril, speaker honoraria from Boston, Amgen, Daiichi-Sankyo and Meril and reports speaker honoraria paid to his institution from BMS\/Pfizer, Daiichi-Sankyo, Boston, Siemens, Amgen as well as research grants paid to his institution from Boston and Abbott. CBO reports research support from Deutsche Forschungsgemeinschaft, Deutsche Herzstiftung, University of Freiburg, Else Kr\u00f6ner-Fresenius Stiftung, and Haemonetics; Honoraria: Bayer Vital GmbH, BMS, B\u00f6hringer Ingelheim, Daiichi Sankyo, Ferrer, Idorsia, and Janssen. M. F. receives speaker honoraria and consultancy fees from Boston, Medtronic and Shockwave Medical. Other authors have nothing to disclose.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interests"}}]}}