BackgrpundTreatment of distal left main coronary artery (LMCA) bifurcation is associated with high procedural complication and restenosis rate. The simultaneous kissing stenting (SKS) involves two stents, one in main vessel and the other in side branch, creating new carina with stent struts. We investigated the SKS with various implantation techniques in two different bifurcation angles, to identify pitfalls and clarify the best implantation technique.Method and resultWe used TAXUS stents (diameter-3.5mm) and bifurcation phantom made of glass for this simulation. The phantom was made of two side arms (diameter-3.5mm) simulating left anterior descending and circumflex artery, which is attached to main arm (diameter-5.0mm) simulating LMCA with two different angles (90째and 50째). Each stage of SKS was photographed in a bifurcation phantom with two different deployment techniques (simultaneous vs. sequential). Simultaneous deployment involves deployment of two stents with simultaneous inflation at 10atm and then deflation. Sequential deployment involves deployment of one stent at 18atm and then deflation, which is followed by deployment of the other stent at 18atm and then deflation. Final simulataneous inflation at 10atm and deflation is followed. In addition to photography, the interior of the stents were evaluated with intravascular ultrasound (IVUS) and analysed at the level of newly developed carina and proximal double barrel of two stents. ConclusionSKS used for LMCA bifurcation demonstrated different degree of stent expansion according to deployment technique. Sequential deployment technique resulted in better stent expansion than simultaneous deployment technique, especially in obtusely angled situation.