title: Drug-eluting stents for coronary bifurcations: insights into the crush technique.
abstract: Sirolimus-eluting stents appear to reduce substantially restenosis following percutaneous coronary bifurcation intervention. The crush technique was devised to reduce restenosis further by improving stent and drug application to the side-branch ostium. We aimed to investigate the performance of drug-eluting stent (DES) platforms with the crush technique, to identify deployment pitfalls, and to clarify the best deployment strategies. Each stage of the crush technique was photographed in a bifurcation phantom. Simultaneous side- and main-branch dilatation (kissing balloons) fully expanded the stent in the side-branch ostium, widened the gaps between stent struts covering the side branch, and eliminated main-branch distortion. With side branches angled at > 70 degrees , sequential (side- then main-branch) inflations may be needed to achieve best results. Postdilatation of the main branch with a balloon of narrower diameter than the deploying balloon caused main-branch stent distortion. These principles applied to all the bifurcation strategies and stent designs tested.
authors.affiliation: Mercy Hospital, Auckland, New Zealand. johno@mercyangiography.co.nz
authors.forename: John A
authors.initials: JA
authors.lastname: Ormiston
authors.forename: Erin
authors.initials: E
authors.lastname: Currie
authors.forename: Mark W I
authors.initials: MW
authors.lastname: Webster
authors.forename: Patrick
authors.initials: P
authors.lastname: Kay
authors.forename: Peter N
authors.initials: PN
authors.lastname: Ruygrok
authors.forename: James T
authors.initials: JT
authors.lastname: Stewart
authors.forename: Richard C
authors.initials: RC
authors.lastname: Padgett
authors.forename: Monique J
authors.initials: MJ
authors.lastname: Panther
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D023903:Coronary Restenosis / Q000517:prevention & control*; D006801:Humans; D011474:Prosthesis Design; D015607:Stents