Challenges and outcomes of the double kissing crush stenting technique: Insights from the PROGRESS-BIFURCATION registry (2022)

Background: Although the double kissing (DK) crush stenting technique can provide excellent outcomes in percutaneous coronary intervention (PCI) of bifurcation lesions, it can be challenging to perform. Methods: We examined the clinical and angiographic characteristics, challenges encountered, and procedural outcomes of bifurcation PCI with DK crush in Prospective Global Registry of Percutaneous Coronary Intervention in Bifurcation Lesions (PROGRESS-BIFURCATION, NCT05100992). Results: DK crush was used in 48 of 435 bifurcation lesions (11%). Technical success was 100%, procedural success was 96%, and the incidence of in-hospital major adverse cardiovascular events was 4%. Challenges while performing DK crush were encountered in 26 lesions (54%): (1) difficulty in side branch (SB)first rewiring (38%) that was overcome with the use of a new guidewire (30%) or a microcatheter (15%); (2) inability to deliver balloon to an SB for the first kiss (54%) that was overcome with the use of a smaller balloon (86%), rewiring (29%), microcatheter (14%), and increased support 7%; (3) difficulty in SB second rewiring (19%) that was overcome with the use of a new guidewire (80%) and/or microcatheter (60%). DK crush was more often performed in left main and proximal left anterior descending artery lesions (70% vs. 50%, p = 0.014). DK crush cases required more contrast (198 ± 84 ml vs. 163 ± 70 ml, p = 0.003), fluoroscopy time (35 ± 20 min vs. 25 ± 21 min, p = 0.004), and lasted longer (137 ± 69 min vs. 99 ± 66 min, p = 0.001) compared with non-DK crush techniques. Conclusions: While challenges are common when performing DK crush bifurcation stenting, success rates are high and complication rates are low.

Original languageEnglish (US)
JournalCatheterization and Cardiovascular Interventions
DOIs
StateAccepted/In press - 2022
Externally publishedYes
  • DK crush
  • bifurcation PCI
  • complex PCI
  • percutaneous coronary intervention
  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine
  • APA
  • Standard
  • Harvard
  • Vancouver
  • Author
  • BIBTEX
  • RIS

Simsek, B., Kostantinis, S., Karacsonyi, J., Vemmou, E., Nikolakopoulos, I., Assali, M., Burke, M. N., Garcia, S., Wang, Y., Chavez, I., Goessl, M., Sorajja, P., Mooney, M., Poulose, A., Traverse, J., Rangan, B. V. (Accepted/In press). Challenges and outcomes of the double kissing crush stenting technique: Insights from the PROGRESS-BIFURCATION registry. Catheterization and Cardiovascular Interventions. https://doi.org/10.1002/ccd.30135

(Video) Single vs. two-stent techniques in left main: the impact of EBC MAIN - EuroPCR 2021

Challenges and outcomes of the double kissing crush stenting technique : Insights from the PROGRESS-BIFURCATION registry. / Simsek, Bahadir; Kostantinis, Spyridon; Karacsonyi, Judit et al.

In: Catheterization and Cardiovascular Interventions, 2022.

Research output: Contribution to journalArticlepeer-review

Simsek, B, Kostantinis, S, Karacsonyi, J, Vemmou, E, Nikolakopoulos, I, Assali, M, Burke, MN, Garcia, S, Wang, Y, Chavez, I, Goessl, M, Sorajja, P, Mooney, M, Poulose, A, Traverse, J, Rangan, BV 2022, 'Challenges and outcomes of the double kissing crush stenting technique: Insights from the PROGRESS-BIFURCATION registry', Catheterization and Cardiovascular Interventions. https://doi.org/10.1002/ccd.30135

Simsek B, Kostantinis S, Karacsonyi J, Vemmou E, Nikolakopoulos I, Assali M et al. Challenges and outcomes of the double kissing crush stenting technique: Insights from the PROGRESS-BIFURCATION registry. Catheterization and Cardiovascular Interventions. 2022. https://doi.org/10.1002/ccd.30135

Simsek, Bahadir ; Kostantinis, Spyridon ; Karacsonyi, Judit et al. / Challenges and outcomes of the double kissing crush stenting technique : Insights from the PROGRESS-BIFURCATION registry. In: Catheterization and Cardiovascular Interventions. 2022.

@article{af02d4b4c204428ba4fd01ad51ab4dff,

title = "Challenges and outcomes of the double kissing crush stenting technique: Insights from the PROGRESS-BIFURCATION registry",

(Video) Challenges of Calcified Bifurcations: Treating a Rock in a Hard Place

abstract = "Background: Although the double kissing (DK) crush stenting technique can provide excellent outcomes in percutaneous coronary intervention (PCI) of bifurcation lesions, it can be challenging to perform. Methods: We examined the clinical and angiographic characteristics, challenges encountered, and procedural outcomes of bifurcation PCI with DK crush in Prospective Global Registry of Percutaneous Coronary Intervention in Bifurcation Lesions (PROGRESS-BIFURCATION, NCT05100992). Results: DK crush was used in 48 of 435 bifurcation lesions (11%). Technical success was 100%, procedural success was 96%, and the incidence of in-hospital major adverse cardiovascular events was 4%. Challenges while performing DK crush were encountered in 26 lesions (54%): (1) difficulty in side branch (SB)first rewiring (38%) that was overcome with the use of a new guidewire (30%) or a microcatheter (15%); (2) inability to deliver balloon to an SB for the first kiss (54%) that was overcome with the use of a smaller balloon (86%), rewiring (29%), microcatheter (14%), and increased support 7%; (3) difficulty in SB second rewiring (19%) that was overcome with the use of a new guidewire (80%) and/or microcatheter (60%). DK crush was more often performed in left main and proximal left anterior descending artery lesions (70% vs. 50%, p = 0.014). DK crush cases required more contrast (198 ± 84 ml vs. 163 ± 70 ml, p = 0.003), fluoroscopy time (35 ± 20 min vs. 25 ± 21 min, p = 0.004), and lasted longer (137 ± 69 min vs. 99 ± 66 min, p = 0.001) compared with non-DK crush techniques. Conclusions: While challenges are common when performing DK crush bifurcation stenting, success rates are high and complication rates are low.",

keywords = "DK crush, bifurcation PCI, complex PCI, percutaneous coronary intervention",

author = "Bahadir Simsek and Spyridon Kostantinis and Judit Karacsonyi and Evangelia Vemmou and Ilias Nikolakopoulos and Maen Assali and Burke, {M. Nicholas} and Santiago Garcia and Yale Wang and Ivan Chavez and Mario Goessl and Paul Sorajja and Michael Mooney and Anil Poulose and Jay Traverse and Rangan, {Bavana V.} and Brilakis, {Emmanouil S.}",

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year = "2022",

doi = "10.1002/ccd.30135",

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AU - Kostantinis, Spyridon

(Video) CHIP Part 3

AU - Karacsonyi, Judit

AU - Vemmou, Evangelia

AU - Nikolakopoulos, Ilias

AU - Assali, Maen

AU - Burke, M. Nicholas

AU - Garcia, Santiago

AU - Wang, Yale

AU - Chavez, Ivan

AU - Goessl, Mario

AU - Sorajja, Paul

AU - Mooney, Michael

AU - Poulose, Anil

AU - Traverse, Jay

AU - Rangan, Bavana V.

AU - Brilakis, Emmanouil S.

N1 - Publisher Copyright:© 2022 Wiley Periodicals LLC

PY - 2022

Y1 - 2022

(Video) Advancement in bifurcation and renal denervation - The right procedure for the right patient?

N2 - Background: Although the double kissing (DK) crush stenting technique can provide excellent outcomes in percutaneous coronary intervention (PCI) of bifurcation lesions, it can be challenging to perform. Methods: We examined the clinical and angiographic characteristics, challenges encountered, and procedural outcomes of bifurcation PCI with DK crush in Prospective Global Registry of Percutaneous Coronary Intervention in Bifurcation Lesions (PROGRESS-BIFURCATION, NCT05100992). Results: DK crush was used in 48 of 435 bifurcation lesions (11%). Technical success was 100%, procedural success was 96%, and the incidence of in-hospital major adverse cardiovascular events was 4%. Challenges while performing DK crush were encountered in 26 lesions (54%): (1) difficulty in side branch (SB)first rewiring (38%) that was overcome with the use of a new guidewire (30%) or a microcatheter (15%); (2) inability to deliver balloon to an SB for the first kiss (54%) that was overcome with the use of a smaller balloon (86%), rewiring (29%), microcatheter (14%), and increased support 7%; (3) difficulty in SB second rewiring (19%) that was overcome with the use of a new guidewire (80%) and/or microcatheter (60%). DK crush was more often performed in left main and proximal left anterior descending artery lesions (70% vs. 50%, p = 0.014). DK crush cases required more contrast (198 ± 84 ml vs. 163 ± 70 ml, p = 0.003), fluoroscopy time (35 ± 20 min vs. 25 ± 21 min, p = 0.004), and lasted longer (137 ± 69 min vs. 99 ± 66 min, p = 0.001) compared with non-DK crush techniques. Conclusions: While challenges are common when performing DK crush bifurcation stenting, success rates are high and complication rates are low.

AB - Background: Although the double kissing (DK) crush stenting technique can provide excellent outcomes in percutaneous coronary intervention (PCI) of bifurcation lesions, it can be challenging to perform. Methods: We examined the clinical and angiographic characteristics, challenges encountered, and procedural outcomes of bifurcation PCI with DK crush in Prospective Global Registry of Percutaneous Coronary Intervention in Bifurcation Lesions (PROGRESS-BIFURCATION, NCT05100992). Results: DK crush was used in 48 of 435 bifurcation lesions (11%). Technical success was 100%, procedural success was 96%, and the incidence of in-hospital major adverse cardiovascular events was 4%. Challenges while performing DK crush were encountered in 26 lesions (54%): (1) difficulty in side branch (SB)first rewiring (38%) that was overcome with the use of a new guidewire (30%) or a microcatheter (15%); (2) inability to deliver balloon to an SB for the first kiss (54%) that was overcome with the use of a smaller balloon (86%), rewiring (29%), microcatheter (14%), and increased support 7%; (3) difficulty in SB second rewiring (19%) that was overcome with the use of a new guidewire (80%) and/or microcatheter (60%). DK crush was more often performed in left main and proximal left anterior descending artery lesions (70% vs. 50%, p = 0.014). DK crush cases required more contrast (198 ± 84 ml vs. 163 ± 70 ml, p = 0.003), fluoroscopy time (35 ± 20 min vs. 25 ± 21 min, p = 0.004), and lasted longer (137 ± 69 min vs. 99 ± 66 min, p = 0.001) compared with non-DK crush techniques. Conclusions: While challenges are common when performing DK crush bifurcation stenting, success rates are high and complication rates are low.

KW - DK crush

KW - bifurcation PCI

KW - complex PCI

KW - percutaneous coronary intervention

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