Bifurcation coronary lesions treated with the "crush" technique: an intravascular ultrasound analysis

Ricardo A Costa, Gary S Mintz, Stephane G Carlier, Alexandra J Lansky, Issam Moussa, Kenichi Fujii, Hideo Takebayashi, Takenori Yasuda, Jose R Costa, Yoshihiro Tsuchiya, Lisette O Jensen, Ecaterina Cristea, Roxana Mehran, George D Dangas, Sriram Iyer, Michael Collins, Edward M Kreps, Antonio Colombo, Gregg W Stone, Martin B Leon, Jeffrey W Moses
Journal of the American College of Cardiology 2005 August 16, 46 (4): 599-605

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 mm2 vs. 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 mm2 in 8% of lesions and <5 mm2 in 20%. For the SB, a minimum stent area <4 mm2 was found in 44%, and a minimum stent area <5 mm2 in 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.

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