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CLINICAL RESEARCH: FOCUS ISSUE: TREATMENT OF BIFURCATION LESIONS

Bifurcation Coronary Lesions Treated With the "Crush" Technique

An Intravascular Ultrasound Analysis

Ricardo A. Costa, MD^_*, Gary S. Mintz, MD, FACC^_*, Stephane G. Carlier, MD, PhD^_*,_*, Alexandra J. Lansky, MD, FACC^_*, Issam Moussa, MD, FACC^_*, Kenichi Fujii, MD^_*, Hideo Takebayashi, MD^_*, Takenori Yasuda, MD^_*, Jose R. Costa, Jr, MD^_*, Yoshihiro Tsuchiya, MD^_*, Lisette O. Jensen, MD, PhD, Ecaterina Cristea, MD^_*, Roxana Mehran, MD, FACC^_*, George D. Dangas, MD, PhD, FACC^_*, Sriram Iyer, MD, FACC, Michael Collins, MD, FACC^_*, Edward M. Kreps, MD, FACC^_*, Antonio Colombo, MD, FACC, Gregg W. Stone, MD, FACC^_*, Martin B. Leon, MD, FACC^_* and Jeffrey W. Moses, MD, FACC^_*

^_* Cardiovascular Research Foundation and Columbia University Medical Center, New York, New York
Odense University Hospital, Odense, Denmark
Lenox Hill Hospital, New York, New York
San Raffaele Hospital, Milan, Italy

Manuscript received December 16, 2004; revised manuscript received February 28, 2005, accepted March 10, 2005.

^_* Reprint requests and correspondence: Dr. Stephane Carlier, Intravascular Imaging and Physiology, The Cardiovascular Research Foundation, 55 East 59th Street, 5th floor, New York, New York 10022 (Email: scarlier{at}crf.org).

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

BACKGROUND: 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.

METHODS: 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.

RESULTS: Overall, the MV minimum stent area was larger than the SB (6.7 ± 1.7 mm² vs. 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 mm² in 8% of lesions and <5 mm² in 20%. For the SB, a minimum stent area <4 mm² was found in 44%, and a minimum stent area <5 mm² in 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.

CONCLUSIONS: 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.

Abbreviations and Acronyms   CSA = cross-sectional area   DS = diameter stenosis   IVUS = intravascular ultrasound   LM = left main artery   MLD = minimum lumen diameter   MSA = minimum stent area   MV = main vessel   PCI = percutaneous coronary intervention   QCA = quantitative coronary angiography   SB = side branch

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