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DK crush (double-kissing and double-crush) technique for treatment of true coronary bifurcation lesions: illustration and comparison with classic crush.

BACKGROUND
Classic crush has a lower success rate compared to final kissing balloon inflation (FKBI). We previously reported the double-kissing (DK) crush technique that involves double-kissing along with double-crushing for the treatment of true bifurcation coronary lesions in 2005.


METHODS AND RESULTS
This is a consecutive, nonrandomized, open-label study. Eighty-eight consecutive patients with single, true coronary bifurcation lesions according to Lefevre Classification2 and side branch diameter >2.0 mm were enrolled. The first 44 patients (from October 2004 to January 2005) were assigned to the classic crush treatment arm and the next 44 patients (from February 2005 to June 2005) were assigned to the DK crush technique arm, respectively. Data within 30 days were analyzed. Patients in the DK crush group, compared to those in classic crush group, were characterized by longer lesion length in the side branch (13.5 +/- 3.4 mm vs 7.8 +/- 3.1 mm; p <0.05), shorter procedural time (44 +/- 12 minutes vs 68 +/- 17 minutes; p <0.05 ), higher success rate of FKBI (100% vs 70%; p <0.01), and lower contrast volume required (102 +/- 38 mm vs 176 +/- 46 mm; p <0.05). There was a trend toward a larger distal angle between the main vessel and the side branch (57 +/- 180 vs 47 +/- 150) in the DK crush group, as well as longer lesion length in the main vessel (24.3 +/- 8.6 mm vs 21.1 +/- 7.3 mm), though without significant differences (p >0.05). Subacute stent thrombosis was detected in 2 patients with failure of FKBI in the classic crush group (4.3%). In addition, patients in the classic crush group were characterized by a smaller minimum lumen diameter (MLD) at the side branch ostium (2.74 +/- 0.12 mm vs 3.01 +/- 0.13 mm; p <0.01) and had a higher degree of residual stenosis at the ostial side branch (17.4 +/- 11.2% vs 7.3 +/- 8.6%; p <0.05).


CONCLUSIONS
Compared with classic crush, DK crush has the potential to improve the clinical outcome in patients with coronary bifurcation lesions. Further randomized, prospective, multicenter studies are required to confirm these differences between the classic crush and DK crush techniques.