title: Bifurcation coronary lesions treated with the "crush" technique: an intravascular ultrasound analysis.
abstract: OBJECTIVE
  We report intravascular ultrasound (IVUS) findings after crush-stenting of bifurcation lesions.
  
  
  BACKGROUND
  Preliminary results with the crush-stent technique are encouraging; however, isolated reports suggest that restenosis at the side branch (SB) ostium continues to be a problem.
  
  
  METHODS
  Forty patients with bifurcation lesions underwent crush-stenting with the sirolimus-eluting stent. Postintervention IVUS was performed in both branches in 25 lesions and only the main vessel (MV) in 15 lesions; IVUS analysis included five distinct locations: MV proximal stent, crush area, distal stent, SB ostium, and SB distal stent.
  
  
  RESULTS
  Overall, the MV minimum stent area was larger than the SB (6.7 +/- 1.7 mm2 vs. 4.4 +/- 1.4 mm2, p < 0.0001, respectively). When only the MV was considered, the minimum stent area was found in the crush area (rather than the proximal or MV distal stent) in 56%. When both the MV and the SB were considered, the minimum stent area was found at the SB ostium in 68%. The MV minimum stent area measured <4 mm2 in 8% of lesions and <5 mm2 in 20%. For the SB, a minimum stent area <4 mm2 was found in 44%, and a minimum stent area <5 mm2 in 76%, typically at the ostium. "Incomplete crushing"--incomplete apposition of SB or MV stent struts against the MV wall proximal to the carina--was seen in >60% of non-left main lesions.
  
  
  CONCLUSIONS
  In the majority of bifurcation lesions treated with the crush technique, the smallest minimum stent area appeared at the SB ostium. This may contribute to a higher restenosis rate at this location.
authors.affiliation: Cardiovascular Research Foundation and Columbia University Medical Center, New York, New York 10022, USA.
authors.forename: Ricardo A
authors.initials: RA
authors.lastname: Costa
authors.forename: Gary S
authors.initials: GS
authors.lastname: Mintz
authors.forename: Stephane G
authors.initials: SG
authors.lastname: Carlier
authors.forename: Alexandra J
authors.initials: AJ
authors.lastname: Lansky
authors.forename: Issam
authors.initials: I
authors.lastname: Moussa
authors.forename: Kenichi
authors.initials: K
authors.lastname: Fujii
authors.forename: Hideo
authors.initials: H
authors.lastname: Takebayashi
authors.forename: Takenori
authors.initials: T
authors.lastname: Yasuda
authors.forename: Jose R
authors.initials: JR
authors.lastname: Costa
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Tsuchiya
authors.forename: Lisette O
authors.initials: LO
authors.lastname: Jensen
authors.forename: Ecaterina
authors.initials: E
authors.lastname: Cristea
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.forename: George D
authors.initials: GD
authors.lastname: Dangas
authors.forename: Sriram
authors.initials: S
authors.lastname: Iyer
authors.forename: Michael
authors.initials: M
authors.lastname: Collins
authors.forename: Edward M
authors.initials: EM
authors.lastname: Kreps
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Moses
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation / Q000379:methods*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D016503:Drug Delivery Systems; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D020123:Sirolimus / Q000008:administration & dosage / Q000627:therapeutic use; D015607:Stents; D018084:Ultrasonography, Interventional
chemical_list: D020123:Sirolimus