Durable Lesion Outcomes but Progressive Disease After Dedicated Bifurcation PCI: 24-Month Results from a Dual-Centre Registry.

Research Article | DOI: https://doi.org/10.31579/2641-0419/581

Durable Lesion Outcomes but Progressive Disease After Dedicated Bifurcation PCI: 24-Month Results from a Dual-Centre Registry.

  • Raymundo Ocaranza-Sánchez *
  • Blanca Estela Fernández-Candelario
  • Juan Carlos Betancourt-Aldana Villarruel
  • Carlos De la Fuente-Macip
  • Rodrigo Alvarez-Calderon
  • Francisco Lozano-Fuantos
  • Juan Carlos Pérez-Alva

Instituto Cardiovascular de Puebla (ICVP), Puebla, Mexico.

*Corresponding Author: Raymundo Ocaranza-Sánchez, MD, PhD, Instituto Cardiovascular de Puebla (ICVP) Puebla, Mexico.

Citation: Ocaranza-Sánchez R, Fernández-Candelario BE, Aldana Villarruel JCB, Carlos De la Fuente-Macip, Rodrigo A. Calderon, et al., (2026), Durable Lesion Outcomes but Progressive Disease After Dedicated Bifurcation PCI: 24-Month Results from a Dual-Centre Registry, J Clinical Cardiology and Cardiovascular Interventions, 9(9); DOI:10.31579/2641-0419/581

Copyright: © 2026, Raymundo Ocaranza-Sánchez. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Received: 07 August 2026 | Accepted: 10 June 2026 | Published: 10 August 2026

Keywords: coronary bifurcation lesions; dedicated bifurcation stent; biomime branch; bifurcation pci; target lesion revascularization; long-term outcomes

Abstract

Background: Coronary bifurcation lesions remain among the most challenging subsets in contemporary percutaneous coronary intervention (PCI), particularly true bifurcation lesions requiring a planned two-stent strategy, and are frequently associated with increased procedural complexity and adverse clinical outcomes. Although dedicated bifurcation stents were developed to simplify complex procedures, optimize bifurcation scaffolding, and improve procedural reproducibility, evidence regarding their long-term clinical performance remains scarce, especially in patients with anatomically complex true bifurcation lesions. Consequently, the durability of lesion-specific outcomes following dedicated bifurcation PCI remains incompletely understood.

Methods: This prospective dual-centre registry included 80 consecutive patients with Medina 1,1,1 bifurcation lesions treated with the Biomime Branch™ dedicated bifurcation stent using a standardised modified implantation technique. The primary endpoint was major adverse cardiovascular events (MACE) at 24 months, defined as all-cause death, myocardial infarction (MI), or clinically driven target lesion revascularisation (TLR). Kaplan–Meier analyses were performed.

Results: Procedural success was achieved in 98.7% of cases. At 24 months, all-cause mortality was 6.5%, MI 11.6%, TLR 5.7%, and overall MACE 29.4%. Kaplan–Meier analyses demonstrated low and stable TLR over time, with no evidence of late catch-up beyond 12 months. In contrast, MI and overall adverse events progressively increased during follow-up.

Conclusion: Dedicated bifurcation PCI using a modified implantation technique provides durable lesion-specific outcomes with low long-term TLR. However, late clinical events appear predominantly driven by progression of coronary artery disease rather than failure of the treated lesion.

Introduction

Coronary bifurcation lesions account for approximately 15–20% of all percutaneous coronary interventions and remain one of the most technically demanding subsets in contemporary interventional cardiology [1]. The inherent anatomical complexity, including carina shift, plaque distribution asymmetry, and side branch compromise, contributes to increased procedural failure and adverse clinical outcomes compared with non-bifurcation lesions [2].

Current guidelines recommend a provisional stenting approach as the default strategy; however, this paradigm is not universally applicable, particularly in true bifurcation lesions (Medina 1,1,1), where side branch significance necessitates a more complex two-stent strategy [3]. While techniques such as culotte, T-stenting, and double kissing crush have improved outcomes, they remain associated with procedural variability and increased technical complexity [4-6].

Dedicated bifurcation stents were developed to address these limitations by providing simultaneous scaffolding of both branches while preserving procedural simplicity. Nevertheless, previous studies evaluating these devices have yielded heterogeneous results, and long-term outcome data remain limited [7-9].

The Biomime Branch™ stent represents a novel dedicated bifurcation platform incorporating ultra-thin struts and a hybrid design enabling controlled side branch scaffolding and main vessel access. In the initial report of this registry, we demonstrated high procedural success and favourable acute outcomes using a modified implantation technique [3].

However, whether these acute procedural advantages translate into sustained long-term clinical benefit remains uncertain.

The present study provides the extended 24-month follow-up, focusing on durability, clinical outcomes, and mechanistic insights into device performance.

Study design and setting

This study represents a prospective, observational, dual-centre registry conducted at two high-volume tertiary institutions in Spain and Mexico. The registry was specifically designed to evaluate the feasibility, safety, and long-term clinical outcomes of a dedicated bifurcation stent in a real-world population using a standardised implantation technique.

Materials and Methods

Study population

Consecutive patients referred for coronary angiography due to suspected or confirmed ischaemic heart disease were screened for inclusion.

Inclusion criteria

True coronary bifurcation lesions (Medina 1,1,1), main branch diameter between 2.25 and 4.5 mm, side branch diameter ≥2.25 mm, planned two-stent strategy

Exclusion criteria

Non-significant side branch disease not requiring treatment, inability to achieve complete revascularisation

This selection ensured inclusion of patients with anatomically complex bifurcation lesions representative of routine clinical practice.

Device and implantation technique

All procedures were performed using the Biomime Branch™ dedicated bifurcation stent (Meril Lifesciences), a device specifically designed to provide simultaneous scaffolding of both the main vessel and side branch.

A standardised modified implantation technique was applied in all cases across both centres, ensuring procedural consistency [3].

Key procedural steps included:

Systematic lesion preparation with predilatation, precise stent positioning guided by radiopaque markers, proximal optimisation technique (POT) to ensure adequate stent expansion, maintenance of the main vessel guidewire (KIO concept) to preserve access, controlled rewiring of the side branch to optimise stent apposition and final kissing balloon inflation (FKBI) to ensure optimal bifurcation geometry.

This structured approach aimed to minimise technical variability and optimise procedural outcomes.

Endpoints and definitions

Primary endpoint

Major adverse cardiovascular events (MACE) at 24 months, defined as the composite of:

All-cause mortality, myocardial infarction (MI), target lesion revascularisation (TLR), secondary endpoints, non-target vessel revascularisation

Definitions:

Procedural success was defined as successful stent implantation with adequate angiographic result and absence of in-hospital major complications. Myocardial infarction (MI) was defined according to the Fourth Universal Definition of Myocardial Infarction. Clinically driven target lesion revascularisation (TLR) was defined as any repeat revascularisation of the target lesion associated with symptoms or objective evidence of ischaemia.

Clinical follow-up was achieved in 99% of patients at 24 months, ensuring robust assessment of long-term outcomes.

Statistical analysis

Time-to-event outcomes were analysed using Kaplan–Meier survival estimates. Event rates are presented as cumulative incidence over 24 months.

Results

Baseline characteristics

A total of 80 patients were included in the analysis. The study population exhibited a high prevalence of cardiovascular risk factors, reflecting a complex real-world cohort typically encountered in contemporary PCI practice.

Procedural outcomes

Procedural success was achieved in 98.7% of cases, with a very low rate of intraprocedural complications. These findings confirm the feasibility and reproducibility of the modified implantation technique when applied in a standardised manner across centres.

Long-term clinical outcomes

Kaplan–Meier analysis

Major adverse cardiovascular events (Figure 1)

Figure 1: Kaplan-Meier curve showing cumulative incidence of major adverse cardiovascular events (MACE) at 24 months.

Kaplan–Meier analysis demonstrated a progressive increase in the cumulative incidence of composite events over time, reaching 29.4% at 24 months. This pattern reflects the expected evolution of adverse cardiovascular events in a high-risk population undergoing complex PCI.

Target lesion revascularisation (Figure 2)

Figure 2: Kaplan-Meier curve showing target lesion revascularisation (TLR) at 24 months.

Target lesion revascularisation remained low at 5.7% and, importantly, showed no significant increase between 12 and 24 months.

This represents the most clinically relevant finding of the study, indicating sustained efficacy of the device and durability of the treated lesion over time. Myocardial infarction (Figure 3)

Figure 3: Kaplan-Meier curve showing myocardial infarction (MI) at 24 months.

The incidence of myocardial infarction increased progressively throughout follow-up, reaching 11.6% at 24 months. This temporal pattern suggests a contribution from ongoing disease progression rather than failure of the treated segment.

Temporal pattern of events

A distinct divergence in outcome trajectories was observed:

  • Stable TLR over time, indicating durable local treatment
  • Progressive increase in MI, reflecting systemic disease evolution
  • Increase in non-target revascularisation, consistent with progression of atherosclerosis in untreated segments

Discussion

Principal Findings

The present extended 24-month analysis of a prospective dual-centre registry provides important insights into the long-term performance of a dedicated bifurcation stent in complex coronary anatomy. Three key findings emerge from this study:

First, the procedural success achieved in the initial phase of the registry is sustained over time, confirming the reproducibility and reliability of the modified implantation technique.

Second, the rate of target lesion revascularisation remains remarkably low (5.7%) and stable between 12 and 24 months, suggesting durable lesion scaffolding and favourable vascular healing.

Third, late adverse events, including myocardial infarction and non-target revascularisation, increase over time, reflecting the natural progression of coronary artery disease rather than failure of the implanted device.

Mechanistic Interpretation of Long-Term Outcomes

The stability of TLR beyond the first year represents one of the most relevant findings of the present study. In contemporary PCI, late TLR is often driven by factors such as stent underexpansion, malapposition, or neointimal proliferation. The absence of a temporal increase in TLR in our cohort strongly suggests that the combination of device design and procedural optimisation resulted in adequate stent expansion, optimal apposition, and sustained vessel patency.

The Biomime Branch™ platform incorporates ultra-thin struts and a hybrid architecture specifically designed to facilitate side branch scaffolding while maintaining main vessel integrity. These features, together with the systematic use of proximal optimisation technique (POT) and controlled rewiring, likely contributed to the observed durability.

In contrast, the progressive increase in myocardial infarction and non-target revascularisation aligns with previous observations in complex PCI populations, particularly those with high burden of diffuse atherosclerosis and multivessel disease [10-12].

This divergence between lesion-specific and patient-level outcomes underscores a fundamental concept in contemporary interventional cardiology:

The low rate of target lesion revascularisation suggests optimal device performance, whereas long-term events appear primarily driven by disease progression rather than stent-related failure.

This distinction is crucial, as it reinforces the notion that long-term prognosis in these patients is determined not only by procedural success but also by the underlying systemic disease.

Comparison with Contemporary Evidence

The present findings are consistent with contemporary bifurcation trials and registries.

In the DKCRUSH-V trial, double kissing crush demonstrated superiority over provisional stenting in distal left main bifurcation lesions, primarily through reductions in target lesion failure. [4] However, the complexity of DKCRUSH and its dependence on operator expertise may limit broader reproducibility. In contrast, the present study achieved a clinically driven TLR rate of only 5.7% at 24 months using a dedicated bifurcation platform implanted through a highly standardised modified technique.

Similarly, the EBC MAIN trial found no significant advantage of a routine two-stent strategy over a provisional approach in left main bifurcation disease. [5] More recently, the DEFINITION II trial demonstrated improved outcomes with systematic two-stent strategies in anatomically complex bifurcation lesions, supporting the concept that lesion complexity should guide treatment selection. [13,14]

The latest European Bifurcation Club recommendations continue to emphasise procedural optimisation, including proximal optimisation technique (POT), appropriate side-branch rewiring and final kissing balloon inflation. [15] These steps were systematically incorporated in all procedures within the present registry and may have contributed to the favourable long-term outcomes observed.

Previous studies evaluating dedicated bifurcation stents have reported heterogeneous outcomes due to differences in device design and implantation techniques. [7-9] Contemporary reviews suggest that dedicated bifurcation platforms may offer advantages in selected complex anatomies when combined with rigorous implantation protocols.[16] The favourable outcomes observed in our registry support this concept and reinforce the importance of procedural standardisation.

Furthermore, when compared with historical PCI trials involving complex coronary artery disease, including SYNTAX and EXCEL, the observed rates of myocardial infarction and repeat revascularisation fall within expected ranges. [11,12] Importantly, the persistently low TLR observed in our cohort suggests that late adverse events were predominantly driven by progression of coronary artery disease rather than failure of the treated lesion.

Clinical Implications

The results of this study have several important clinical implications.

First, they support the use of dedicated bifurcation stents as a viable and effective alternative to conventional two-stent techniques in true bifurcation lesions. The low TLR rate and high procedural success suggest that this approach may simplify complex procedures without compromising outcomes.

Second, the findings emphasise the critical role of procedural optimisation. The consistent application of POT, controlled rewiring, and final kissing balloon inflation appears to be essential in achieving durable results. This reinforces the concept that outcomes in bifurcation PCI are highly dependent on technique rather than device alone.

Third, the divergence between lesion-specific outcomes and overall clinical events highlights the need for comprehensive secondary prevention strategies in this high-risk population. Optimal medical therapy, aggressive risk factor control, and close follow-up remain essential components of patient management.

Finally, the inclusion of a substantial proportion of left main and calcified lesions in this registry suggests that this strategy may be particularly relevant in complex anatomical subsets, where conventional approaches are often suboptimal.

Novel Contributions of the Present Study

Unlike previous reports focused primarily on procedural feasibility and short-term outcomes, the present study provides one of the longest available follow-ups for a dedicated bifurcation platform using a standardised implantation technique. The findings demonstrate a clear dissociation between lesion-related outcomes and patient-level outcomes. While durable lesion scaffolding was reflected by persistently low TLR rates, long-term adverse events were mainly associated with progression of coronary artery disease. This observation may have important implications for patient management after complex bifurcation PCI and reinforces the need for aggressive secondary prevention beyond procedural optimisation.

Limitations

This study has several limitations. First, its observational non-randomised design precludes definitive comparisons with alternative bifurcation strategies. Second, the sample size was relatively modest and all procedures were performed by a highly experienced operator, potentially limiting generalisability. Third, intravascular imaging was not systematically performed and therefore mechanistic explanations regarding stent expansion and apposition remain speculative. Fourth, the absence of an external control group prevents direct comparison with conventional two-stent techniques. Finally, despite the excellent follow-up rate, residual confounding inherent to registry studies cannot be excluded.

The divergence observed between lesion-specific durability and progressive patient-level events is summarised in the Central Illustration, highlighting that long-term outcomes after dedicated bifurcation PCI are influenced not only by local procedural success but also by the systemic progression of atherosclerotic disease. (Central Illustration) 

Recommendations for Clinical Management

Patients undergoing complex bifurcation PCI should receive intensive secondary prevention strategies, including high-intensity lipid-lowering therapy, strict blood pressure control, diabetes optimisation, smoking cessation and prolonged surveillance for progression of coronary artery disease. The present findings suggest that successful treatment of the target lesion alone may not be sufficient to prevent long-term adverse cardiovascular events.

Conclusions

This extended 24-month analysis demonstrates that dedicated bifurcation stenting using a modified implantation technique is associated with high procedural success and durable long-term outcomes in patients with true coronary bifurcation lesions.

The persistently low rate of target lesion revascularisation supports sustained device performance and effective lesion treatment, while the progressive increase in myocardial infarction and non-target revascularisation reflects the natural evolution of coronary artery disease in a high-risk population.

These findings reinforce the concept that optimal outcomes in bifurcation PCI are achieved through the combination of advanced device technology and meticulous procedural technique, and position dedicated bifurcation stenting as a compelling strategy in the management of complex coronary anatomy.

Impact on Daily practice

Dedicated bifurcation stenting using a standardised implantation technique provides durable lesion-specific outcomes in true bifurcation lesions. However, long-term prognosis is largely driven by progression of coronary artery disease, highlighting the need for aggressive secondary prevention strategies in this high-risk population.

Conflicts of Interest

The authors declare no conflicts of interest related to this manuscript.

Funding

No specific funding was received for this study.

Ethics Statement

The study was conducted in accordance with the principles of the Declaration of Helsinki and was approved by the institutional ethics committees of both participating centres. All patients provided informed consent.

Data Availability Statement

The data underlying this study are available from the corresponding author upon reasonable request.

ORCID

Raymundo Ocaranza-Sánchez: 0000-0002-7035-861X

Acknowledgements

The authors would like to acknowledge the catheterisation laboratory staff at both participating centres for their technical support and contribution to this study.

References

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Dr Susan Anne Smith

Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.

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Dr Victor Olagundoye

Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.

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Dr Farahnaz Fallahian

Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.

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Dr Susan Anne Smith

Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.

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Dr Oleg Golyanovski

To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina

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Dr Elvira Farina

My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.

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Gertraud Teuchert-Noodt

We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.

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Dr David Vinyes

Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.

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Dr Anyuta Ivanova

I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.

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Dr Farooq Wandroo

"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".

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Dr Shweta Tiwari

To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.

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Dr Tewodros Kassahun Tarekegn

I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.

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Cristina Berriozabal

Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."

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Thomas Urban

I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.

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Zhao Jia

My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.

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Luiz Sellmann

My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.

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Sonila Qirko

My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.

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Lin-Show Chin

Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner

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Dr Susan Weiner

Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”

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Zsuzsanna Bene

Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.

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Dr Maria Regina Penchyna Nieto

Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.

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Dr Maria Dolores Gomez Barriga

Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.

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Maria Dolores Gomez Barriga

The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.

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Lin Shaw Chin

Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.

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Gomez Barriga Maria Dolores

Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.

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Khurram Arshad

Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.

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Rui Tao

“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.

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George Varvatsoulias

Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.

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Tania Munoz

I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.

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S Munshi

I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.

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Husain Taha Radhi

I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.

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Dr Tong Ming Liu

We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.

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Dr Griffith

I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.

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Douglas Miyazaki

"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".

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Jesus Simal-Gandara

I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!

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Baheci Selen

Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.

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Bruno Chauffert

Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.

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Dr Suramya Dhamija

International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.

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Andreas Filippaios

Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.

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Raed Mualem

As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.

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Dr Shiming Tang

Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.

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Hao Jiang

This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.

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Prof Sherif W Mansour

Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.

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Bernard Terkimbi Utoo

Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.

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Pedro Marques Gomes

Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.

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Anthony Kodzo-Grey Venyo

Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.

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Katarzyna Byczkowska

Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.

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Orlando Villarreal

The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.

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Sing-yung Wu

We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.

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Layla Shojaie

Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.

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Mina Sherif Soliman Georgy

Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.

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Ziemlé Clément Méda

Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.

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Delcio G Silva Junior

Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.

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Virginia E. Koenig