J Transcat Intervent.2020;28:eA202008.

REVIEW

Double kissing crush: technical aspects and current considerations

Alexandre do Canto Zago , Gabriel Zago , Rafael Coimbra Ferreira Beltrame , Alcides José Zago

DOI: 10.31160/JOTCI202028A202008

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ABSTRACT

Percutaneous treatment of coronary bifurcation lesions remains a challenge, even with all advances in technique and materials available, such as hydrophilic guidewires, lower profile balloons and drug-eluting stents with new materials, thinner struts and less thrombogenic polymers. Despite these advances, little progress has been made in dedicated bifurcation stenting. The degree of technical difficulty and the lack of dedicated material result in higher rates of restenosis and stent thrombosis, especially in true bifurcation lesions, in which the therapeutic strategy requires the implantation of, at least, two stents. Several double stent bifurcation techniques have been developed, such as kissing-stent, stent-crush, culotte, T-stenting, Y-stenting, and double kissing crush. The latter includes technical aspects whose primary objective is to facilitate crossing of the stent meshes, enabling a routinely execution of the final kissing balloon inflation, to reduce major adverse cardiovascular events (MACE). The double kissing crush technique has been improved since its conception, and has been extensively evaluated over several multicenter randomized studies comparing it with other techniques, which showed the superiority of the double kissing crush technique in true bifurcation lesions, including in the left main coronary artery, when analyzing the most commonly used techniques today.