Related Experiment Video
Updated: Mar 25, 2026
Novel and Innovative Hybrid Technique for Type A Aortic Dissection
Published on: March 28, 2025
Randomized Comparison of the Crush Versus the Culotte Stenting for Coronary Artery Bifurcation Lesions
Xu-Wei Zheng, Dong-Hui Zhao, Hong-Yu Peng
1Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, China.
Insights
The culotte stenting technique for coronary bifurcation lesions showed lower restenosis rates and better flow patterns compared to the crush technique. Both methods demonstrated effective treatment outcomes at 12 months.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomedical Engineering
Background:
- Complex coronary bifurcation lesions pose treatment challenges.
- Both crush and culotte stenting techniques have shown efficacy.
- Comparative performance data between crush and culotte stenting is limited.
Purpose of the Study:
- To compare the clinical and angiographic outcomes of crush versus culotte stenting for complex coronary bifurcation lesions.
- To evaluate major adverse cardiac events (MACE) and index lesion restenosis.
- To assess hemodynamic parameters, specifically wall shear stress, at bifurcation sites.
Main Methods:
- A randomized trial involving 300 patients with coronary bifurcation lesions.
- Patients were assigned to either crush stenting (n=150) or culotte stenting (n=150).
- Primary endpoint: MACE at 12 months. Secondary endpoint: Restenosis and wall shear stress at 12 months.
Main Results:
- No significant difference in MACE rates between crush (6.7%) and culotte (5.3%) groups (P=0.48).
- Significantly lower restenosis rates in the culotte group (6.0%) compared to the crush group (12.7%) (P=0.047).
- Lower surface integrals of time-averaged wall shear stress in the crush group compared to the culotte group (P=0.003).
Conclusions:
- Both crush and culotte stenting provide satisfactory clinical and angiographic results for bifurcation lesions.
- The culotte technique is associated with reduced restenosis rates.
- Culotte stenting demonstrates more favorable hemodynamic flow patterns at bifurcation sites.
Background:
The crush and the culotte stenting were both reported to be effective for complex bifurcation lesion treatment. However, their comparative performance remains elusive.
Methods:
A total of 300 patients with coronary bifurcation lesions were randomly assigned to crush (n = 150) and culotte (n = 150) treatment. The primary endpoint was the occurrence of major adverse cardiac events (MACEs) at 12 months including cardiac death, myocardial infarction, stent thrombosis, and target vessel revascularization. Index lesion restenosis at 12 months was a secondary endpoint. The surface integrals of time-averaged wall shear stress at bifurcation sites were also be quantified.
Results:
There were no significant differences in MACE rates between the two groups at 12-month follow-up: Crush 6.7%, culotte 5.3% (P = 0.48). The rates of index lesion restenosis were 12.7% versus 6.0% (P = 0.047) in the crush and the culotte groups, respectively. At 12-month follow-up, the surface integrals of time-averaged wall shear stress at bifurcation sites in the crush group were significantly lower than the culotte group ([5.01 ± 0.95] × 10-4 Newton and [6.08 ± 1.16] × 10-4 Newton, respectively; P = 0.003).
Conclusions:
Both the crush and the culotte bifurcation stenting techniques showed satisfying clinical and angiographic results at 12-month follow-up. Bifurcation lesions treated with the culotte technique tended to have lower restenosis rates and more favorable flow patterns.
