Comparison of long‐term outcomes of double kissing crush versus T and minimal protrusion techniques in complex bifurcation lesions: The EVOLUTE‐CRUSH II registry

Abstract

BackgroundDouble kissing (DK)‐crush and T‐stenting and small protrusion (TAP) techniques are gaining popularity, but the comparison for both techniques is still lacking. This study sought to retrospectively evaluate the long‐term outcomes of DK‐crush and TAP techniques in patients with complex bifurcation lesions.MethodsA total of 255 (male: 205 [80.3%], mean age: 59.56 ± 10.13 years) patients who underwent coronary bifurcation intervention at a single‐center between January 2014 and May 2021 were included. Angiographic features, procedure details, and in‐hospital or long‐term outcomes were assessed. The primary endpoint was target lesion failure (TLF), defined as the combination of cardiac death, target vessel myocardial infarction, or clinically driven‐target lesion revascularization (TLR). The regression models were adjusted applying by the inverse probability weighted (IPW) approach to reduce treatment selection bias.ResultsThe initial management strategy was DK‐crush in 152 (59.6%) patients and TAP in 103 (40.4%) cases. The SYNTAX scores (24.58 ± 7.4 vs. 24.26 ± 6.39, p = 0.846) were similar in both groups. The number of balloon (6.32 ± 1.82 vs. 3.92 ± 1.19, p < 0.001) usage was significantly higher in the DK‐crush group than in the TAP group. The rates of TLF (11.8 vs. 22.3%, p = 0.025) and clinically driven TLR (6.6 vs. 15.5%, p = 0.020) were significantly lower in the DK‐crush group compared to the TAP group. The long‐term TLF was significantly higher in the TAP group compared to the DK‐crush group (unadjusted HR: 1.974, [95% CI: 1.044–3.732], p = 0.035 and adjusted HR [IPW]: 2.498 [95% CI: 1.232–5.061], p = 0.011).ConclusionThe present study showed that the DK‐crush technique of bifurcation treatment was associated with lower long‐term TLF and TLR rates compared to the TAP technique.

Exploring the best strategy for true bifurcation coronary diseases to avoid a “fall between two stools”

“…Uzun et al provided positive evidence of the use of the DK crush technique in PCI for true bifurcation lesions. 1 Although this was a single-center study, the long-term incidence of target lesion failure was lower with the DK crush technique than with T-stenting and small protrusion techniques. Moreover, marked better outcomes with the DK crush technique in later periods, especially more than 2 years, is a peculiar result of this study.…”

The Randomized, Multicenter, Open-Label, Controlled POLBOS 3 Trial Comparing Regular Drug-Eluting Stents and the Sirolimus-Eluting BiOSS LIM C Dedicated Coronary Bifurcation Stent: Four-Year Results

“…Firstly, advancements in newer-generation stents, alongside improved guidewires, support catheters, adjunctive therapies, and imaging modalities, have resulted in enhanced two-stent strategies for managing coronary bifurcation lesions [3]. Secondly, among complex lesion subsets, the DK crush technique emerges as superior to alternative approaches [6,37]. Lastly, while a dedicated two-stent strategy appears more effective than a provisional strategy in treating complex bifurcations, the superiority of a two-stent strategy in "noncomplex" bifurcations remains uncertain [38,39].…”

“…The heightened risk associated with coronary bifurcation lesions has sparked ongoing discussion regarding their management; when is it imperative to address the side branch (SB) alongside the main vessel (MV)? Two approaches are prominent: the provisional stent placement strategy, in which the focus is on treating the MV initially and intervening in the SB only if it faces imminent closure or closure occurs, and the dedicated two-stent strategy which, conversely, entails planning for the simultaneous treatment of both the MV and SB from the very beginning [4][5][6].…”