Double kissing crush and nano crush stenting in left main coronary bifurcation lesions: Besting the rival techniques!

Abstract

Percutaneous coronary intervention of left main (LM) bifurcation can be technically demanding and is often associated with significant in-stent restenosis in contemporary practice. The heterogeneity of these lesions makes it difficult to establish a consensus as to the best interventional strategy. The provisional one-stent approach has shown a more favorable outcome than two-stent technique in terms of both efficacy and safety. In complex LM bifurcation lesions, double kissing has demonstrated its superiority over culotte and provisional-T in terms of restenosis making it one of the most performed techniques. On the other hand, the nano-crush technique has recently become part of the repertoire of two-stent techniques, providing evidence that the use of ultrathin-strut stents and very minimal crush would be beneficial for both the physiological and rheological properties of the complex LM bifurcations, leading to a lower rate of thrombosis and restenosis at both side branch and true carina. Finally, the newest generation of ultrathin-strut stents is gaining a reputation for its safe and effective use in this scenario thanks to an improved design with increased expansion rate capable of LM treatment up to 5–6 mm diameter. The modern crush techniques, such as double-kiss-crush and nano-crush, are providing excellent results on mid- and long-term follow-up, suggesting that minimal crushing obtained using ultra-thin stents is an excellent way to obtain surgical-like outcomes in the treatment of complex LM bifurcation disease.