Unprotected Left Main PCI
The ideal revascularization technique for distal bifurcation disease of the ULMCA requiring 2 stents is unknown. Unlike the "crush" technique or the culotte technique, simultaneous kissing stenting does not require rewiring the side branch for final kissing balloons. Simultaneous kissing stenting was performed in 150 consecutive unselected patients with ULMCA disease. The rate of ischemia-driven target lesion revascularization was 4.3% at 1 year and 6.2% at 2 years. This represents a simple, feasible, effective, and durable option for patients with ULMCA disease that requires a 2-stent strategy.
The DKCRUSH (Double Kissing Crush Versus Culotte Stenting for the Treatment of Unprotected Distal Left Main Bifurcation Lesions)-III study compared culotte and double kissing (DK) crush techniques for the treatment of distal bifurcation disease and demonstrated a reduction in 1-year MACE in the crush group, driven primarily by a reduction in repeat revascularization. The rate of MACE at 1 year was 6.2% in the DK crush group vs 16.3% in the culotte group (P=.001). The 1-year target lesion revascularization rate was 2.4% in the DK crush group compared with 6.7% in the culotte group (P=.04).
Bifurcation Stenting Strategies
The ideal revascularization technique for distal bifurcation disease of the ULMCA requiring 2 stents is unknown. Unlike the "crush" technique or the culotte technique, simultaneous kissing stenting does not require rewiring the side branch for final kissing balloons. Simultaneous kissing stenting was performed in 150 consecutive unselected patients with ULMCA disease. The rate of ischemia-driven target lesion revascularization was 4.3% at 1 year and 6.2% at 2 years. This represents a simple, feasible, effective, and durable option for patients with ULMCA disease that requires a 2-stent strategy.
The DKCRUSH (Double Kissing Crush Versus Culotte Stenting for the Treatment of Unprotected Distal Left Main Bifurcation Lesions)-III study compared culotte and double kissing (DK) crush techniques for the treatment of distal bifurcation disease and demonstrated a reduction in 1-year MACE in the crush group, driven primarily by a reduction in repeat revascularization. The rate of MACE at 1 year was 6.2% in the DK crush group vs 16.3% in the culotte group (P=.001). The 1-year target lesion revascularization rate was 2.4% in the DK crush group compared with 6.7% in the culotte group (P=.04).
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