Double Kissing Crush Technique Compared to Provisional Stenting for Bifurcation Lesions

January 30, 2017—The 5-year follow-up results from the DKCRUSH-II study were published online by Shao-Liang Chen, MD, et al in Circulation: Cardiovascular Interventions. The multicenter DKCRUSH-II randomized study is evaluating the double kissing crush technique versus provisional stenting technique for coronary artery bifurcation lesions.

As summarized in Circulation: Cardiovascular Interventions, the analysis was composed of 370 patients with coronary bifurcation lesions who were randomly assigned to either the double kissing crush or provisional stenting groups in the DKCRUSH-II study and followed for 5 years.

The primary endpoint was the occurrence of a major adverse cardiac event at 5 years. Patients were classified by simple and complex bifurcation lesions according to the DEFINITION criteria (Definitions and Impact of Complex Bifurcation Lesions on Clinical Outcomes After Percutaneous Coronary Intervention Using Drug-Eluting Stents). At 5 years, the major adverse cardiac event rate (23.8%) in the provisional stenting group was insignificantly different to that of the double kissing group (15.7%; P = .051). However, the difference in the target lesion revascularization (TLR) rate between the two groups was sustained through the 5-year follow-up (16.2% vs 8.6%; P = .027). The definite and probable stent thrombosis rate was 2.7% in each group (P = 1.0).

Complex bifurcation was associated with a higher rate of TLR (21.6%) at 5 years compared with 11.1% in patients with a simple bifurcation (P = .037), with an extremely high rate in the provisional stenting group (36.8% vs 12.5%; P = .005) mainly because of final kissing balloon inflation (19.4% vs 5.2%; P = .036).

The study concluded that the double kissing crush stenting technique for coronary bifurcation lesions is associated with a lower rate of TLR. The optimal stenting approach based on the lesions’ complexity may improve the revascularization for patients with complex bifurcations, advised the investigators in Circulation: Cardiovascular Interventions.