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 carinawas 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.
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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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