Bifurcation Coronary Lesions Treated With the “Crush” Technique: An Intravascular Ultrasound Analysis

Abstract

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