Crush is superior to Culotte in two-stent strategy for treatment of left main coronary artery bifurcations: A systematic review and meta-analysis

Abstract

Purpose: Crush and Culotte techniques have been used increasingly to treat
 patients with complex unprotected left main coronary artery bifurcation lesions.
 This article compares published data on these two techniques.
 
 Methods: Databases, including PubMed, Embase, Cochrane Library, Wanfang Data and China National Knowledge Infrastructure, were searched for articles published before Aug 21, 2019 to identify all relevant studies on left main coronary artery bifurcation lesions treated by Crush versus Culotte techniques. The pooled data were analyzed using either fixed- or random-effects model depending on heterogeneity (assessed via the I2 index). The endpoints were major adverse cardiac events, target lesion revascularization, cardiac death, stent thrombosis, myocardial infarction and target vessel revascularization.
 
 Results: Eight articles with a total of 1,283 patients were included, and 710 patients were treated with Crush, and 573 ones with Culotte. Crush group was trend to decreased major adverse cardiac event compared with Culotte group [Relative ratio (RR) 0.63,95% confidence interval(CI) 0.39-1.04, I2 =72.7%], mainly driven by decreased cardiac death [RR 0.49, 95% CI(0.25-0.99), I2 =0%], decreased myocardial infarction [RR 0.40, 95% CI(0.21-0.76), I2 =21.6%],and lower stent thrombosis [RR 0.39, 95% CI(0.16-0.98), I2 =39.4%]. There was no significant difference in target lesion revascularization and target vessel revascularization between Crush and Culotte [RR 0.77, 95% CI 0.46-1.28, I2=61.1%; RR 0.78, 95% CI (0.30-2.02), I2 =73.1%, respectively].
 
 Conclusion: Crush was superior to Culotte for treatment of left main coronary artery bifurcation lesions with a trend of lower incidence of long-term major adverse cardiac events, mainly derived from decreased myocardial infarction, stent thrombosis and cardiac death.

A Review of Double Kissing Crush Stenting in Coronary Bifurcation Lesions

“…In another network meta-analysis by Chiabrando et al, [24] who studied 4285 patients in 14 studies, DK crush stenting and mini-crush stenting were shown to be associated with less MACE or complications when compared to other techniques including PS. Chen et al [22] published a recent meta-analysis which also suggested the clinical benefits of lower MACE from DK crush stenting than the other 2-stent strategies.…”

“…Several meta-analyses consistently demonstrated that DK crush was associated with fewer coronary events and complications than bifurcation techniques. [22][23][24][25] In a recent network meta-analysis, Di Gioia et al [23] analyzed 21 randomized studies of 5711 patients, which showed that the DK-crush stenting technique was associated with less occurrence of MACE than those treated using PS mainly driven by a reduction in TLR. More specifically, no significant differences among techniques were observed in cardiac death, MI, and stent thrombosis.…”

“…[32][33][34] DEFINITION II, a randomized controlled study, enrolled complex patients and compared the 2-stent strategy with majority DK crush stenting and provisional stenting. [35] Several other meta-analyses were conducted recently [22][23][24][25] ; the details of all these studies have been summarized below.…”

“…In recent times, an abundance of scientific and clinical evidence has been obtained to demonstrate the effectiveness and safety of this specific 2-stent technique. [14–27]…”

“…In recent times, an abundance of scientific and clinical evidence has been obtained to demonstrate the effectiveness and safety of this specific 2-stent technique. [14][15][16][17][18][19][20][21][22][23][24][25][26][27] How does DK crush differ from the classic crush stenting techniques?…”