Proximal Side Optimization: A Modification of the Double Kissing Crush Technique

Coronary bifurcations with significant lesions >10 mm in the side branch (SB) are likely to require two-stent treatment techniques. To date, double kissing Crush (DK-Crush) stenting has demonstrated higher rates of final kissing balloon inflation and better clinical outcomes. The technical iterat...

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Autor principal:	Francesco Lavarra
Formato:	article
Lenguaje:	EN
Publicado:	Radcliffe Medical Media 2020
Materias:	Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/c8228e51fb904ff8a14c75f4bb5da628
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spelling	oai:doaj.org-article:c8228e51fb904ff8a14c75f4bb5da6282021-12-04T16:02:44ZProximal Side Optimization: A Modification of the Double Kissing Crush Technique10.15420/usc.2020.071758-390X1758-3896https://doaj.org/article/c8228e51fb904ff8a14c75f4bb5da6282020-05-01T00:00:00Zhttps://www.uscjournal.com/articleindex/usc.2020.07https://doaj.org/toc/1758-3896https://doaj.org/toc/1758-390XCoronary bifurcations with significant lesions >10 mm in the side branch (SB) are likely to require two-stent treatment techniques. To date, double kissing Crush (DK-Crush) stenting has demonstrated higher rates of final kissing balloon inflation and better clinical outcomes. The technical iterations that lead to optimal clinical outcomes have been attributed to the first kissing balloon that repairs the distorted proximal segment and fully expands the orifice of the side stent. One potential caution, which relates to all Crush techniques, is the possibility of the guidewire crossing in an inappropriate position toward the Crushed SB stent. When this occurs, the SB stent may be further Crushed, leaving the ostium uncovered, which potentially negates the benefit of the Crush technique. In our experience, proximal side optimization (PSO) during DK-Crush stenting ensures stent size ‘accommodation’ to the larger vessel diameter in the proximal segment and better strut apposition to the wall, which is particularly important in the ostial segment. The benefits of this additional modification of the established DK-Crush technique are reduction or elimination of the risk of SB stent distortion, increase of the space of optimal wiring, and avoidance of guidewire advancement under the stent struts, even in unfavorable anatomies with extreme angulation. The author describes a step-by-step approach of a proposed PSO technique, which is easy to perform without any additional procedural time or costs.Francesco LavarraRadcliffe Medical MediaarticleDiseases of the circulatory (Cardiovascular) systemRC666-701ENUS Cardiology Review , Vol 14, Iss , Pp - (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	Diseases of the circulatory (Cardiovascular) system RC666-701 Francesco Lavarra Proximal Side Optimization: A Modification of the Double Kissing Crush Technique
description	Coronary bifurcations with significant lesions >10 mm in the side branch (SB) are likely to require two-stent treatment techniques. To date, double kissing Crush (DK-Crush) stenting has demonstrated higher rates of final kissing balloon inflation and better clinical outcomes. The technical iterations that lead to optimal clinical outcomes have been attributed to the first kissing balloon that repairs the distorted proximal segment and fully expands the orifice of the side stent. One potential caution, which relates to all Crush techniques, is the possibility of the guidewire crossing in an inappropriate position toward the Crushed SB stent. When this occurs, the SB stent may be further Crushed, leaving the ostium uncovered, which potentially negates the benefit of the Crush technique. In our experience, proximal side optimization (PSO) during DK-Crush stenting ensures stent size ‘accommodation’ to the larger vessel diameter in the proximal segment and better strut apposition to the wall, which is particularly important in the ostial segment. The benefits of this additional modification of the established DK-Crush technique are reduction or elimination of the risk of SB stent distortion, increase of the space of optimal wiring, and avoidance of guidewire advancement under the stent struts, even in unfavorable anatomies with extreme angulation. The author describes a step-by-step approach of a proposed PSO technique, which is easy to perform without any additional procedural time or costs.
format	article
author	Francesco Lavarra
author_facet	Francesco Lavarra
author_sort	Francesco Lavarra
title	Proximal Side Optimization: A Modification of the Double Kissing Crush Technique
title_short	Proximal Side Optimization: A Modification of the Double Kissing Crush Technique
title_full	Proximal Side Optimization: A Modification of the Double Kissing Crush Technique
title_fullStr	Proximal Side Optimization: A Modification of the Double Kissing Crush Technique
title_full_unstemmed	Proximal Side Optimization: A Modification of the Double Kissing Crush Technique
title_sort	proximal side optimization: a modification of the double kissing crush technique
publisher	Radcliffe Medical Media
publishDate	2020
url	https://doaj.org/article/c8228e51fb904ff8a14c75f4bb5da628
work_keys_str_mv	AT francescolavarra proximalsideoptimizationamodificationofthedoublekissingcrushtechnique
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Proximal Side Optimization: A Modification of the Double Kissing Crush Technique

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