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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

View larger version (70K): [in a new window]   Figure 1 A schematic diagram of the in-stent segmental approach to intravascular ultrasound analysis after crush stenting. MV = main vessel; SB = side branch.

View larger version (15K): [in a new window]   Figure 2 Intravascular ultrasound (IVUS) minimum lumen diameter (MLD) versus quantitative coronary angiography (QCA) MLD in the main vessel (left) and side branch (SB) ostium (right).

View larger version (134K): [in a new window]   Figure 3 (A, B) Preprocedure angiograms showing a "true bifurcation" lesion (type D) in the proximal left anterior descending coronary artery/first diagonal branch in the cranial and left anterior oblique (LAO) views, respectively. (C, D) Final angiograms showing optimal angiographic result after crush-stenting at the bifurcation lesion (cranial and LAO views, respectively). (E) Intravascular ultrasound image showing the distal portion of the side branch (SB) (first diagonal) stent. (F) Intravascular ultrasound of the SB ostium showing stent underexpansion. MV = main vessel.

View larger version (63K): [in a new window]   Figure 4 (A) Intravascular ultrasound image showing complete crush (apposition) of the side branch (SB) stent; arrows indicate the three layers of stent struts. (B, C) Intravascular ultrasound images showing incomplete crush (apposition) of the SB stent struts (arrows).