Cases of Early, Aggressive In-Stent Restenosis in Left Main Double Kissing (DK) Crush Technique and Treatment Options.
Brachytherapy
Double-kissing crush technique
In-stent restenosis
Left main artery bifurcation
Journal
Cardiovascular revascularization medicine : including molecular interventions
ISSN: 1878-0938
Titre abrégé: Cardiovasc Revasc Med
Pays: United States
ID NLM: 101238551
Informations de publication
Date de publication:
06 2021
06 2021
Historique:
received:
29
09
2020
accepted:
30
09
2020
pubmed:
9
1
2021
medline:
25
2
2023
entrez:
8
1
2021
Statut:
ppublish
Résumé
We present three recent cases at our institution that demonstrate early, aggressive in-stent restenosis (ISR) of double-kissing (DK) crush technique despite careful adherence to the technique and compliance of the patient. There are multiple percutaneous coronary intervention strategies for left main (LM) coronary artery bifurcation disease. The DK crush technique has gained popularity for the treatment of complex bifurcation lesions, including distal LM bifurcations. We reviewed clinical and procedural characteristics of three recent patients who presented at our tertiary center with non-ST-elevation myocardial infarction (NSTEMI) in the setting of early, aggressive ISR of DK crush. All patients underwent imaging-guided DK crush stenting with full adherence to all steps of the technique. The median age was 65 years, median follow-up was 8 months from initial DK crush, and all three patients presented with NSTEMI. Patients had significant ISR in both limbs of the bifurcation involving aggressive tissue proliferation. These patients were treated differently: intracoronary brachytherapy, direct stenting, and coronary artery bypass grafting. DK crush for unprotected LM distal bifurcation can result in aggressive ISR with tissue proliferation and target vessel failure despite adhering to all steps of the technique. More research is warranted before DK crush is adopted as the default technique for bifurcation lesions.
Sections du résumé
BACKGROUND/PURPOSE
We present three recent cases at our institution that demonstrate early, aggressive in-stent restenosis (ISR) of double-kissing (DK) crush technique despite careful adherence to the technique and compliance of the patient. There are multiple percutaneous coronary intervention strategies for left main (LM) coronary artery bifurcation disease. The DK crush technique has gained popularity for the treatment of complex bifurcation lesions, including distal LM bifurcations.
METHODS/MATERIALS
We reviewed clinical and procedural characteristics of three recent patients who presented at our tertiary center with non-ST-elevation myocardial infarction (NSTEMI) in the setting of early, aggressive ISR of DK crush. All patients underwent imaging-guided DK crush stenting with full adherence to all steps of the technique.
RESULTS
The median age was 65 years, median follow-up was 8 months from initial DK crush, and all three patients presented with NSTEMI. Patients had significant ISR in both limbs of the bifurcation involving aggressive tissue proliferation. These patients were treated differently: intracoronary brachytherapy, direct stenting, and coronary artery bypass grafting.
CONCLUSIONS
DK crush for unprotected LM distal bifurcation can result in aggressive ISR with tissue proliferation and target vessel failure despite adhering to all steps of the technique. More research is warranted before DK crush is adopted as the default technique for bifurcation lesions.
Identifiants
pubmed: 33414080
pii: S1553-8389(20)30619-9
doi: 10.1016/j.carrev.2020.09.044
pii:
doi:
Types de publication
Letter
Langues
eng
Sous-ensembles de citation
IM
Pagination
90-94Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of competing interest RW – Advisory Board/Board Member/Consulting: Amgen, Pi-Cardia Ltd., Cardioset, Medtronic, Philips, Boston Scientific; Consulting: Biosensors, Biotronik; Grant Support: AstraZeneca, Biosensors, Biotronik, Chiesi, Boston Scientific; Speaker Bureau: AstraZeneca, Chiesi; Investor: MedAlliance. TR – Proctor: Edwards, Medtronic. Inventor on patents, assigned to NIH, for transcatheter leaflet laceration devices. All other authors have no conflicts of interest to disclose.