Proximal Side Optimization: A Modification of the Double Kissing Crush Technique

Area of Science:

• Interventional Cardiology
• Cardiovascular Surgery

Background:

• Coronary bifurcations with large side branch lesions often necessitate complex two-stent techniques.
• Double kissing Crush (DK-Crush) stenting is a preferred method, offering improved outcomes and final kissing balloon inflation.
• A key challenge in Crush techniques is inappropriate guidewire crossing, potentially leading to side branch stent distortion and ostial coverage.

Purpose of the Study:

• To introduce and describe a novel proximal side optimization (PSO) technique as an adjunct to DK-Crush stenting.
• To demonstrate how PSO can mitigate risks associated with guidewire manipulation in complex coronary bifurcations.
• To highlight the benefits of PSO in improving stent apposition and preventing ostial coverage.

Main Methods:

• The study details a step-by-step approach for implementing proximal side optimization (PSO) during DK-Crush stenting.
• PSO involves ensuring appropriate stent sizing and apposition in the proximal segment, particularly at the ostium.
• The technique is designed for ease of performance without increasing procedural time or cost.

Main Results:

• Proximal side optimization (PSO) effectively accommodates stent size to the proximal vessel diameter.
• The technique improves strut apposition to the vessel wall, crucial for the ostial segment.
• PSO reduces or eliminates the risk of side branch stent distortion and inappropriate guidewire advancement, even in challenging anatomies.

Conclusions:

• Proximal side optimization (PSO) is a valuable modification to the established DK-Crush technique for coronary bifurcations.
• This technique enhances safety and efficacy by preventing stent distortion and malapposition.
• PSO offers improved procedural outcomes and potentially better long-term clinical results in complex bifurcation stenting.