Double Kiss Squeeze Technique And Improvisation Stenting Of Coronary Bifurcation Lesions

Objective To investigate the differences between the double kissing crush (DK ) and provisional stenting technique(PT) for the treatment of bifurcation lesions, with the guidance of intravascular ultrasound(IVUS).Methods From August 2006 to October 2007, eighty acute coronary syndrome patients with true coronary bifurcation lesions(side branch diameter >2.0mm by visual estimation) were enrolled into this study .Forty patients received provisional stenting technique,(PT group )and the other 40 patients were assigned to DK group. Rapamycin eluting-stents were allowed to be implanted . Quantitative angiography analysis (QCA) was underwent before and immediately after PCI as well as at 6-9 months follow-up. QCA parameters were described as follows Minimal lumen diameter (MLD), Reference vessel diameter(RVD ), Diameter stenosis(DS%), Acute gain and Late lumen loss(LLL). IVUS measurements Post-intervention and at Follow-up were performed in 31patients with left anterior descending artery—diagonal artery (LAD-D) bifurcation lesions(21 in DK and 10 in PT group), including proximal minimal stent area(MSA), crushed segment MSA and MSA in distal main vessel as well as MSA in the proximal and the distal side branch. Endpoint was MACE, defined as cardiac death, non-fatal myocardial infarction, and target vessel revascularization with 6-9 months.Results Patients in the DK group, compared to PT group ,were characterized by larger MLD at side branch ostium (2.14±0.29mm vs. 1.76±0.45mm,P< 0.01) and lower DS at ostial side branch (10.9%±5.2% vs. 22.13%±13.4%,P < 0.01)immediately after PCI. At angiographic follow-up(243±22 days), When comparing the results at the level of the side branch between the 2 groups, patients from DK group had a smaller DS than those from PT group (11.1%±7.4% vs.29.1%±22.6%, P<0.01)and larger MLD (2.0±0.25mm vs. 1.54±0.56mm, P< 0.01).In terms of LLL , there was no significant difference between two groups ,but it tented to be higher in PT group compared with DK group (0.15±0.27mm vs. 0.20±0.46mm P =0.57).No differences were found in majority of the IVUS parameters .Nevertheless, patients from DK group provided larger proximal MSA in main vessel than those from PT group(7.34±1.59mm~2 vs.6.02±1.48 mm~2, P =0.04)immediately after PCI. The proportion of MSA < 5mm~2 was 38.1% in DK group and 80% in PT group, respectively. At 6-9 months IVUS follow-up, all values mentioned above did not dramatically changed. One patient in PT group died but no death occurred in DK group during hospitalization. During 8 months clinical follow-up, the incidence of MACE was 20% in PT group and 2.5% in DK group(P =0.01), respectively.Conclusion DK crush technique can provide advantages over the provisional stenting technique in terms of short-term clinical outcome for the treatment of bifurcation lesions. The smallest MLA appeared at SB ostium, which may contribute to in-stent restenosis at this location.