Clinical Research
Focus Issue: Treatment of Bifurcation Lesions
Bifurcation Coronary Lesions Treated With the “Crush” Technique: An Intravascular Ultrasound Analysis

https://doi.org/10.1016/j.jacc.2005.05.034Get rights and content
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Objectives

We report intravascular ultrasound (IVUS) findings after crush-stenting of bifurcation lesions.

Background

Preliminary results with the crush-stent technique are encouraging; however, isolated reports suggest that restenosis at the side branch (SB) ostium continues to be a problem.

Methods

Forty patients with bifurcation lesions underwent crush-stenting with the sirolimus-eluting stent. Postintervention IVUS was performed in both branches in 25 lesions and only the main vessel (MV) in 15 lesions; IVUS analysis included five distinct locations: MV proximal stent, crush area, distal stent, SB ostium, and SB distal stent.

Results

Overall, the MV minimum stent area was larger than the SB (6.7 ± 1.7 mm2vs. 4.4 ± 1.4 mm2, p < 0.0001, respectively). When only the MV was considered, the minimum stent area was found in the crush area (rather than the proximal or MV distal stent) in 56%. When both the MV and the SB were considered, the minimum stent area was found at the SB ostium in 68%. The MV minimum stent area measured <4 mm2in 8% of lesions and <5 mm2in 20%. For the SB, a minimum stent area <4 mm2was found in 44%, and a minimum stent area <5 mm2in 76%, typically at the ostium. “Incomplete crushing”—incomplete apposition of SB or MV stent struts against the MV wall proximal to the carina—was seen in >60% of non-left main lesions.

Conclusions

In the majority of bifurcation lesions treated with the crush technique, the smallest minimum stent area appeared at the SB ostium. This may contribute to a higher restenosis rate at this location.

Abbreviations and Acronyms

CSA
cross-sectional area
DS
diameter stenosis
IVUS
intravascular ultrasound
LM
left main artery
MLD
minimum lumen diameter
MSA
minimum stent area
MV
main vessel
PCI
percutaneous coronary intervention
QCA
quantitative coronary angiography
SB
side branch

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