Optical Coherence Tomography to Assess Proximal Side Optimization Technique in Crush Stenting

Area of Science:

• Interventional Cardiology
• Medical Devices
• Vascular Surgery

Background:

• True bifurcation lesions present complex stenting challenges.
• Optimizing side branch (SB) access and scaffolding is crucial for successful outcomes.
• The DK Crush technique is a standard approach for bifurcation stenting.

Purpose of the Study:

• To evaluate the intraprocedural benefits of the Proximal Side Optimization (PSO) technique.
• To compare the standard DK Crush procedure with a PSO-modified DK Crush technique.
• To assess the impact of PSO on side branch stenting and wiring in true bifurcation lesions.

Main Methods:

• A case series of 10 true bifurcation lesions were randomly assigned to standard DK Crush or PSO-modified DK Crush.
• Optical Coherence Tomography (OCT) was used for intraprocedural assessment.
• Key metrics including proximal SB stent area and Space of Optimal Wiring (SOW) were compared before and after stenting.

Main Results:

• The PSO group demonstrated significantly larger proximal SB stent areas (5.8 vs. 4.5 mm²).
• A greater delta between distal and proximal stent areas was observed before crushing in the PSO group (1.5 vs. 0.6 mm²).
• The PSO group exhibited a larger SOW after crushing (5.3 vs. 2.5 mm²), with no gaps in scaffolding.

Conclusions:

• DK Crush with PSO modification leads to larger SB DES and SOW areas.
• PSO enhances apposition to the vessel wall, creating a funnel shape for the SB DES.
• This modification reduces re-wiring risks, promoting predictable and secure interventional outcomes.