Bifurcation coronary lesions treated with the "crush" technique: an intravascular ultrasound analysis.
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.
Costa
Ricardo A
RA
Cardiovascular Research Foundation and Columbia University Medical Center, New York, New York 10022, USA.
Mintz
Gary S
GS
Carlier
Stephane G
SG
Lansky
Alexandra J
AJ
Moussa
Issam
I
Fujii
Kenichi
K
Takebayashi
Hideo
H
Yasuda
Takenori
T
Costa
Jose R
JR
Tsuchiya
Yoshihiro
Y
Jensen
Lisette O
LO
Cristea
Ecaterina
E
Mehran
Roxana
R
Dangas
George D
GD
Iyer
Sriram
S
Collins
Michael
M
Kreps
Edward M
EM
Colombo
Antonio
A
Stone
Gregg W
GW
Leon
Martin B
MB
Moses
Jeffrey W
JW
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
D020123:Sirolimus