Treatment of Coronary Bifurcation Stenoses Using the DK Mini Crush Technique-Analysis of Resources and Technical...

The DK-mini-Crush (DKMC) technique, an established strategy to treat coronary bifurcation stenoses, is known to be complex, with possible strain on time and resources.

To analyze predictors of technical failure as well as time and resourced required for each procedural step of th DKMC technique.

We prospectively enrolled 105 patients scheduled for coronary revascularization using the DKMC technique. Technical failure-defined as the inability to complete all mandatory procedural steps or any switch to other bifurcation stent deployment techniques-occurred in 10% (11/105) of the patients, most commonly due to inability to correctly place the side branch (SB) stent (3/11) or the inability to perform the 1st kissing balloon dilatation (KBD; 4/11). Even procedures with technical success required material that exceeded the base requirement in 83% of cases and the average procedure time was 47:24 min (IQR 39:00-57:09). The most time and resource-intense steps were the placement of the SB balloon for the 1st (additional material 48%; 01:38 min [00:35-03:23]) and the 2nd KBD (additional material 58%; 02:10 min [IQR 01:00-04:18]). Performance of a 1st proximal optimization technique (POT)-following crush of the SB stent-was associated with reduced overall need for additional material (OR 0.164 [95% CI 0.046-0.588], p = 0.006).

Technical failure occurs in approximately 10% of DKMC procedures and is mainly due to challenges in SB stent placement or inability to perform the 1st KBD. Importantly, a 1st POT is associated with reduced resource utilization and might help to simplify this technique.