Clinical outcomes of double kissing crush or double kissing culotte technique in left main bifurcation lesions: the MAIN-ROUTE registry
Year: 2025
Type: article
Study design: Observational Study
Abstract: Introduction: Percutaneous coronary intervention (PCI) of a left main coronary artery (LMCA) bifurcation lesion is a challenging topic among interventional cardiologists.The optimal stenting modality for patients requiring a 2-stent strategy is still debated.Aim: To compare the clinical outcomes of double kissing (DK) crush and DK culotte techniques in distal LMCA bifurcation lesions.Material and methods: Patients with unprotected distal LMCA bifurcation lesions undergoing PCI with DK crush or DK culotte technique were enrolled in 9 heart centers.The primary endpoint of the study was target lesion failure (TLF) as a composite endpoint of target lesion revascularization (TLR), target vessel myocardial infarction (TVMI), and cardiac death.Results: A total of 245 patients with unprotected distal LMCA bifurcation lesions treated with DK culotte (121 patients) or DK crush (124 patients) technique were followed up for 3 years.The incidence of 3-year TLF was lower in the DK culotte group than the DK crush group (5.0% vs. 11.3%,HR = 0.557, 95% CI: 0.211-1.471;p = 0.06).There was also no difference in 3-year TLR (5.0% vs. 7.3%, HR = 0.907, 95% CI: 0.310-2.651;p = 0.42), TVMI (2.5% vs. 3.2%, HR = 0.762, 95% CI: 0.160-3.627;p = 0.71), or cardiac death (0.8% vs. 2.4%, HR = 0.733, 95% CI: 0.063-8.550;p = 0.32) between groups.Conclusions: In the present multicenter study, the DK culotte group had a lower TLF ratio than the DK crush group, without a statistically significant difference in distal true left main bifurcation lesions. Key words: left main coronary artery, bifurcation lesion, double kissing culotte, double kissing crush. S u m m a r yWhile provisional side branch stenting is the prominent strategy for distal left main bifurcations, double kissing (DK) crush has favorable outcomes over provisional stenting in selected patients.DK culotte stenting seems to have better outcomes than other bifurcation stenting techniques in bench tests.For the first time, it was demonstrated that the DK culotte technique had lower incidence of target lesion failure compared to the DK crush technique in left main bifurcation lesions.
Authors: Mehmet Erturk, Serkan Kahraman, Can Y. Karabay, Mehmet A. Erdol, Hasan Ari, Eser Durmaz, Ertugrul Okuyan, Regayip Zehir, Ali R. Akyuz, Cagri Yayla, Irfan Sahin, Cansu Ebren, Gokhan Demirci, Ahmet Guner, Erhan Melikoglu, Mehmet Cicek, Sezgin Atmaca, Irem Turkmen, Ahmet Goktug Ertem, Mustafa A. Sungur, Bilal M. Ulker, Ahmet C. Cebeci, Ali Nural, Busra G. Sengor, Ahmet O. Aslan, Ishak Yilmaz, Ali Kemal Kalkan, Muzaffer Degertekin
Institutions: Sağlık Bilimleri Üniversitesi, Mehmet Akif Ersoy Göğüs Kalp ve Damar Cerrahisi Eğitim ve Araştırma Hastanesi, S.B.Ü. Bursa Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Istanbul University-Cerrahpaşa, Istanbul University, Bağcılar Eğitim ve Araştırma Hastanesi, Kartal Koşuyolu High Specialization Training and Research Hospital, Yeditepe University, Yeditepe University Hospital
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $215
OpenAlex ID: W4414482758
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