Crush and Kissing Techniques in DES Implantation Compared

February 15, 2010—Curtiss T. Stinis, MD, et al conducted a study to compare the very long-term clinical outcomes of drug-eluting stent implantation of coronary artery bifurcation lesions using the crush and the simultaneous kissing stent (SKS) techniques. The 3-year outcomes were published in Catheterization and Cardiovascular Interventions (2010;75:309–314).

According to the investigators, a variety of two-stent techniques have been used to treat coronary artery bifurcation lesions in the drug-eluting stent era, but the long-term clinical outcome of these approaches is not known. A total of 74 consecutive patients underwent bifurcation stenting using either the crush or SKS techniques. Mean patient age was 66.91 ± 11.3 years, 26% were diabetic, and the left anterior descending/diagonal bifurcation was the most frequently treated lesion (68%).

The investigators reported that in-hospital outcomes were not significantly different between groups. During a median follow-up of 3.3 years, one patient in the SKS group and three patients in the crush group died (P = NS). Probable stent thrombosis leading to death according to the Academic Research Consortium definition occurred in one patient in the crush group. Mortality in the remaining three patients was noncardiac. Target lesion revascularization (TLR) occurred in 14 patients (40%) in the SKS group and in five patients (12.8%) in the crush group (P = .015). Survival free from major adverse cardiac events was significantly less in the SKS group and was predominantly driven by TLR (60% vs 88%; P = .001).

In conclusion, during a median of 3.3 years of follow-up, TLR and major adverse cardiac event rates were significantly lower in bifurcation lesions treated with the crush technique when compared with the SKS technique. Definite or probable stent thrombosis is rare with either technique, the investigators stated.