Abstract: Side-branch, piercing stents and corresponding methods are provided. The stent body has apically controllably movable leaves that have a closed state and an open state, and at least one of the leaves has an apical piercing tip that is controllably moveable from a contracted state to an extended, piercing state, in which it pierces an apically adjacent element such as a main stent graft, an aneurism or a blood vessel, creates an opening therein, enables insertion of the apical tip of the side -branch stent and allows for spreading the leaves to anchor them within the element and ensure blood flow between the volume of the element and the side branches. Controlling element(s) control the movements of the tip(s) and the leaves to enable controlled and accurate positioning of the side-branch stent, its attachment to the main element and its anchoring therein.

Abstract: A stent graft provides for a fenestration to be created by a side branch fenestration creation device. A kit comprises a side branch fenestration creation device and a stent graft in which a fenestration may be created thereby.