The aim of the DYNAMITE study is to investigate the (a) acute procedural and (b) 9-month follow-up performance of DynamX Drug-Eluting Coronary Bioadaptor System implantation in complex coronary lesions.

Inclusion Criteria:

Presence of complex coronary lesions defined as follows:

• long lesions (>28 mm);
• CTO, a total occlusion of duration more than 3-months;
• Lesions involving a bifurcation, defined as a division with a side branch large enough to be stented (i.e. >2.25 mm);
• Patients requiring 4 or more stents
• Reference vessel diameter: >2.25 mm to <4.0 mm

Exclusion Criteria:

• Age under 18 years old;
• Significant co-morbidity precluding clinical follow-up;
• A positive pregnancy test in women with child-bearing potential;
• Contra-indication to dual anti-platelet therapy;
• Thrombocytopenia <100,000/uL;
• Major surgery planned which will lead to discontinuation of antiplatelet therapy;
• In-stent restenosis;
• Treatment of saphenous vein graft;
• CTO with long sub-intimal tracking (> 20 mm).

All imaging analyses will be performed at an independent core laboratory (Cardiovascular Department, San Giovanni Addolorata Hospital, Rome, Italy) by experienced operators blinded to procedural data and clinical outcomes.