Randomized Comparison of the Crush Versus the Culotte Stenting for Coronary Artery Bifurcation Lesions

Zheng, Xiu Ting; Zhao, Dongzhi; Peng, Hongyu; Fan, Qingyu; Ma, Qin; Xu, Zhenye; Fan, Chao; Liu, Liyu; Liu, Jinghua

doi:10.4103/0366-6999.176997

Cited by 26 publications

(20 citation statements)

References 20 publications

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“…[1] In the crush-treated patients, three layers of struts covering the SB ostium make the rewiring and balloon insertion through stent struts laborious. [18] Our study also found that the two failure cases were all in the crush subgroup and had a lower KB rate. However, the double-kissing crush technique is reported to significantly improve the kissing rate and outcomes.…”

Section: Discussionsupporting

confidence: 70%

In-stent Anchoring Facilitating Side-branch Balloon Delivery for Final Kissing

Zhou

Han

Wang

et al. 2016

Chinese Medical Journal

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Background:Recrossing the compromised side branch (SB) with a balloon is sometimes technically challenging. The aim of this study was to evaluate whether in-stent anchoring (ISA) is safe and effective to facilitate SB balloon delivery for final kissing.Methods:One hundred and fifty-nine consecutive patients were included (166 bifurcation lesions) in this prospective, single-center registry. ISA was used as a bailout method after unsuccessful SB crossing using conventional techniques, including low-profile balloons. Technique success was defined as SB balloon delivery and final kissing.Results:Kissing-balloon delivery was successfully performed with conventional strategies in 149 of 166 lesions (89.8%). In the remaining 17 lesions (10.2%), recrossing of the main vessel stent strut was not successful; therefore, ISA was attempted. The balloon successfully crossed the stent struts, and final kissing was achieved in 15 of 17 lesions (88.2%). Total final kissing was achieved in 164 of 166 lesions (98.8%), with success rates of 100% in the single-stent group and 97.6% in the two-stent group. Two cases without balloon delivery had complex bifurcation lesions with severe calcification. There was no vessel dissection in the anchoring zone.Conclusions:ISA is safe and effective for recrossing stent struts when conventional low-profile balloons have failed. However, large-scale trials are warranted for further evaluation.

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Section: Discussionsupporting

confidence: 70%

In-stent Anchoring Facilitating Side-branch Balloon Delivery for Final Kissing

Zhou

Han

Wang

et al. 2016

Chinese Medical Journal

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“…[1] Despite that the simple strategies, especially provisional side-branch (SB) stenting, are generally recommended for the majority of CBLs by guidelines or consensus, [2] such simple strategies for true or complex CBLs may not be technically safe and clinically effective due to the potential risk of intraprocedural occlusion of significant branches as well as poor capability of maintaining long-term patency of branches. Therefore, to achieve satisfactory results as treating complex CBLs, complex dual-stenting techniques remain mandatory, [3,4] among which the stenting techniques of Crush and Culotte are the commonest options.…”

Section: Introductionmentioning

confidence: 99%

“…With modification of the conventional techniques of Crush and Culotte, both approaches have been broadly used clinically and many clinical studies have confirmed their own safety and efficacy in treatment of complex CBLs. [4–10] Nevertheless, as a dual-stenting technique, Crush or Culotte is technically complicated and the treatment results may be affected by many factors such as stenting technique per se, operator's experience, device's performance, cardiovascular imaging evaluation, patients’ characteristics, and so on. [11–13] Here raises a question whether Crush and Culotte are equally effective or not.…”

Section: Introductionmentioning

confidence: 99%

Crush versus Culotte stenting techniques for coronary bifurcation lesions

2019

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“…The Nordic Stent Technique Study and Zheng et al randomized patients to stenting with the crush vs culotte technique. In both trials, rates of MACE and ST were similar between the 2 techniques, but the crush groups had higher restenosis rates.…”

Section: Is There a Best Technique Among The Various Complex Strategies?mentioning

confidence: 99%

Percutaneous Coronary Intervention for Bifurcation: How Can We Outperform the Provisional Strategy?

Jim

2016

Clinical Cardiology

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In the era of drug-eluting stents, the provisional stenting strategy has been established as the default strategy in percutaneous coronary intervention for bifurcation lesions. However, emerging evidence shows that, in selected situations, the complex strategy of stenting both vessels regardless could reduce side-branch restenosis without penalty. In particular, the double kissing crush technique has been proven to outperform the provisional strategy and other complex strategies in randomized trials. In this review, we present the evidence comparing the 2 strategies and individual stenting techniques and discuss the roles of other optimization techniques such as final kissing balloon inflation, proximal optimization technique, intravascular ultrasonography, and optical coherence tomography. Finally, we suggest a practical approach for choosing the optimal strategy for intervention with coronary bifurcation lesions. K E Y W O R D SCoronary artery disease, Coronary bifurcation lesion, Percutaneous coronary intervention | INTRODUCTIONCoronary bifurcation lesions are encountered in 15% to 20% of all percutaneous coronary interventions (PCI). 1 Various PCI techniques for bifurcation lesions have been summarized previously. 2 These techniques are categorized into (1) the provisional strategy, where 1-stent stenting to the main vessel (MV) is followed by additional bailout stenting to the side branch (SB) only when the SB is compromised (hereafter referred to as the provisional strategy); and (2) the complex strategy, where both the MV and SB are stented, regardless, usually beginning with SB stenting (hereafter referred to as the complex strategy).In this article we evaluate the clinical evidence for various strategies and techniques. We also describe the roles of other optimization techniques and propose our practical approach. | PROVISIONAL STRATEGY ESTABLISHED AS THE DEFAULT STRATEGY FOR BIFURCATION INTERVENTIONIn the era of drug-eluting stents (DES), numerous randomized studies have established the provisional strategy as the preferred strategy in PCI for bifurcation lesions (Table 1). 1,[3][4][5][6][7][8][9][10][11][12] The provisional strategy has the advantage of shorter procedural and fluoroscopy times, smaller contrast volumes, and lower rates of procedure-related increases in biomarkers of myocardial injury. 1,4,13 In a meta-analyses of 9 randomized trials, 6 the provisional strategy, compared with the complex strategy, was associated with a reduced risk of either early or follow-up myocardial infarction (MI) and with comparable risks of SB restenosis, target-lesion revascularization, and target-vessel revascularization (TVR). On the contrary, the complex strategy failed to consistently demonstrate its theoretical benefit of reduced major adverse cardiovascular events (MACE; Table 1). As a result, many authorities have recommended the provisional strategy as the default strategy for bifurcation intervention. 14 Reasons for the lack of additional benefits from the complex strategy: (1) The majority of SBs hav...

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Randomized Comparison of the Crush Versus the Culotte Stenting for Coronary Artery Bifurcation Lesions

Cited by 26 publications

References 20 publications

In-stent Anchoring Facilitating Side-branch Balloon Delivery for Final Kissing

In-stent Anchoring Facilitating Side-branch Balloon Delivery for Final Kissing

Crush versus Culotte stenting techniques for coronary bifurcation lesions

Percutaneous Coronary Intervention for Bifurcation: How Can We Outperform the Provisional Strategy?

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