Clinical Outcome of Double Kissing Crush Versus Provisional Stenting of Coronary Artery Bifurcation Lesions

Abstract

Background—Provisional stenting is effective for anatomic simple bifurcation lesions. Double kissing crush stenting reduces the 1-year rate of target lesion revascularization. This study aimed to investigate the 5-year clinical results of the DKCRUSH-II study (Randomized Study on Double Kissing Crush Technique Versus Provisional Stenting Technique for Coronary Artery Bifurcation Lesions).Methods and Results—A total of 370 patients with coronary bifurcation lesions who were randomly assigned to either the double kissing crush or provisional stenting group in the DKCRUSH-II study were followed for 5 years. The primary end point was the occurrence of a major adverse cardiac event at 5 years. Patients were classified by simple and complex bifurcation lesions according to the DEFINITION criteria (Definitions and Impact of Complex Bifurcation Lesions on Clinical Outcomes After Percutaneous Coronary Intervention Using Drug-Eluting Stents). At 5 years, the major adverse cardiac event rate (23.8%) in the provisional stenting group was insignificantly different to that of the double kissing group (15.7%; P=0.051). However, the difference in the target lesion revascularization rate between 2 groups was sustained through the 5-year follow-up (16.2% versus 8.6%; P=0.027). The definite and probable stent thrombosis rate was 2.7% in each group (P=1.0). Complex bifurcation was associated with a higher rate of target lesion revascularization (21.6%) at 5 years compared with 11.1% in patients with a simple bifurcation (P=0.037), with an extremely high rate in the provisional stenting group (36.8% versus 12.5%, P=0.005) mainly because of final kissing balloon inflation (19.4% versus 5.2%; P=0.036).Conclusions—The double kissing crush stenting technique for coronary bifurcation lesions is associated with a lower rate of target lesion revascularization. The optimal stenting approach based on the lesions’ complexity may improve the revascularization for patients with complex bifurcations.Clinical Trial Registration—URL: http://www.chictr.org. Unique identifier: ChiCTR-TRC-0000015.

Modified double-stent strategy may be an optimal choice for coronary bifurcation lesions

“…Interestingly, this study demonstrated that the risk of cardiac death that reached a statistical difference was limited to trials with a follow-up duration ≤6 months. However, there were no significant difference in cardiac death between both difference strategies when the follow-up duration was extended to more than 6 months, which also was similar to the study of Chen et al [30] (2.2% vs. 3.3%, P = .513). Among the different studies included in this meta-analysis, only trial of Chen et al demonstrated that there was no significant difference in late-term cardiac death between the 2 stenting and provisional stenting strategies.…”

“…This study showed that there was no significant difference in stent thrombosis between both strategies. Similar to this study, Chen et al [30] and Maeng et al [31] also reported no significant difference in long-term stent thrombosis (0% vs. 1.1%, 1.5% vs. 3%) between conventional stenting (crush and culotte) and provisional stenting during the follow-up of 5 years. The standard of dual antiplatelet therapy after PCI is 12 months at least; discontinuous antiplatelet therapy may be the important reason for stent thrombosis event.…”

Stenting techniques for coronary bifurcation lesions: Evidence from a network meta‐analysis of randomized clinical trials

“…When performing meta regression for acute coronary syndrome (ACS) patients, provisional stenting actually reported harm. This was confirmed in the DK Crush II trial 22 …”

“…Both DK crush and Mini‐crush techniques involve stenting the side branch initially. This is done to protect from abrupt occlusion and is likely beneficial in severe SB disease 7‐9,21‐23 …”

The Proximal Optimisation Technique for Intervention of Coronary Bifurcations

“…Indeed, some of the best clinical results have been obtained from the double kissing strategy of the DK-crush technique. [25][26][27] Figure 5 illustrates the principle of incorporating POT during two-stent bifurcation procedures. The first POT is performed after the first stent has been implanted, to appose the stent in the proximal main vessel and open the struts to facilitate optimal guidewire re-crossing.…”