Mechanistic Insights Into How Rewiring and Bifurcation Angle Affect DK-Crush Stent Deployment

Area of Science:

• Cardiovascular Interventions
• Biomedical Engineering
• Computational Modeling

Background:

• Double kissing crush (DKC) is a standard two-stent technique for complex coronary bifurcation lesions.
• Proximal cell rewiring is recommended to minimize technical failure in DKC.
• Current DKC protocols may not be universally optimal across diverse bifurcation anatomies.

Purpose of the Study:

• To investigate the impact of bifurcation angle on DKC outcomes.
• To identify optimal rewiring configurations based on specific coronary anatomy.
• To challenge the one-size-fits-all approach in DKC procedures.

Main Methods:

• Computational modeling simulated 12 DKC procedures.
• Simulations covered three left main bifurcation angles (45°, 70°, 100°).
• Four rewiring configurations (P-P, P-D, D-P, D-D) were evaluated using metrics like stent malapposition and ostial clearance.

Main Results:

• Wide bifurcations (100°) showed significantly worse outcomes (e.g., 18% malapposition, 23% clearance).
• Narrower angles (45°, 70°) generally yielded better results.
• Optimal rewiring strategies varied by angle; proximal approaches were best at 70°, distal at 45°.

Conclusions:

• DKC procedural success is angle-dependent, necessitating tailored rewiring strategies.
• Anatomy-specific planning, potentially guided by intravascular imaging, can optimize DKC outcomes.
• Findings provide a mechanistic basis for refining clinical decision-making in bifurcation stenting.