DK Crush 2-Stent Technique Superior to Provisional Stenting For LM Bifurcation Lesions

The double kissing (DK) crush 2-stent technique is superior to provisional stenting (PS) for treatment of true distal left main (LM) bifurcation lesions, according to results of the DKCRUSH-V trial, presented Oct. 30 at TCT 2017 and published simultaneously in the Journal of the American College of Cardiology.

Shao-Liang Chen, MD, FACC, et al., compared outcomes in 482 patients with true distal LM bifurcation lesions randomized to treatment with DK crush (n = 240) or PS (n = 242). The patients were followed-up with coronary angiography at 13 months after the index procedure. The primary endpoint was target lesion failure (TLF), a composite of cardiac death, target vessel myocardial infarction (TVMI) and clinically-driven TLR at 1-year follow-up.

At 30-day follow-up, TLF had occurred in 2.9 percent of the PS group vs. 0.4 percent of the DK crush group (p = 0.03). The primary endpoint of TLF at 1 year occurred in 10.7 percent of the PS group compared with 5.0 percent of the DK crush group (p = 0.02). Patients in the DK crush group had lower 1-year rates of TVMI and stent thrombosis. Peri-procedural biomarker release was observed in 4.1 percent of PS patients vs. 11.3 percent of DK crush patients (p = 0.004). There was no significant difference in peri-procedural MI rates between the PS (0 percent) and DK crush groups (1.2 percent; p = 0.33).

According to the authors, "a planned DK crush 2-stent strategy reduced TLF at 1 year compared with a PS strategy in patients with true distal LM bifurcation lesions."

In a related editorial, Emmanouil Brilakis, MD, PhD, FACC, et al., wrote that DKCRUSH-V "provides the best evidence to date on treatment of [unprotected] ULM bifurcation lesions, showing that DK crush is superior to provisional stenting." They state further that DKCRUSH-V established DK crush as the third strategy for ULM stenting. "DK crush is a perfect illustration of the 'no pain, no gain' concept: doing DK crush in ULM bifurcation lesions will be more challenging than provisional stenting but will benefit the patients, which is what matters the most," they concluded.


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