title: Serial intravascular ultrasound analysis comparing double kissing and classical crush stenting for coronary bifurcation lesions.
abstract: BACKGROUND
  Compared with the classical crush, double kissing (DK) crush improved outcomes in patients with coronary bifurcation lesions. However, there is no serial intravascular ultrasound (IVUS) comparisons between these two techniques.
  
  
  OBJECTIVE
  This study aimed to analyze the mechanisms of the two crush stenting techniques using serial IVUS imaging.
  
  
  METHODS
  A total of 54 patients with IVUS images at baseline, post-stenting and eight-month follow-up were classified into classical (n = 16) and DK (n = 38) groups. All patients underwent final kissing balloon inflation (FKBI). Unsatisfactory kissing (KUS) was defined as the presence of wrist or >20% stenosis during FKBI at the side branch (SB) ostium. The vessels at bifurcation lesions were divided into the proximal main vessel (MV) stent, the crushed segment, the distal MV stent, the SB ostium and the SB stent body.
  
  
  RESULTS
  KUS and incomplete crushing were commonly observed in the classical group (62.5%, 81.3%), compared with DK group (18.0%, 39.5%, P < 0.001 and P = 0.004). The post-stenting stent symmetry in the classical group was 71.85 ± 7.69% relative to 85.93 ± 6.09% in DK group (P = 0.022), resulting in significant differences in neointimal hyperplasia (NIH, 1.60 ± 0.21 mm(2) vs. 0.85 ± 0.23 mm(2) , P = 0.005), late lumen loss (1.31 ± 0.81 mm(2) vs. 0.55 ± 0.70 mm(2) , P = 0.013), and minimal lumen area (MLA, 3.57 ± 1.52 mm(2) vs. 4.52 ± 1.40 mm(2,) P = 0.042) at the SB ostium between two groups. KUS was positively correlated with the incomplete crush and was the only predictor of in-stent-restenosis (ISR) at the SB ostium.
  
  
  CONCLUSIONS
  DK crush was associated with improved quality of the FKBI and larger MLA. KUS predicted the occurrence of ISR.
authors.affiliation: Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, 210006 Nanjing, China. chmengx@126.com
authors.forename: Shao-Liang
authors.initials: SL
authors.lastname: Chen
authors.forename: Gary
authors.initials: G
authors.lastname: Mintz
authors.forename: Jing
authors.initials: J
authors.lastname: Kan
authors.forename: Jun-Jie
authors.initials: JJ
authors.lastname: Zhang
authors.forename: Zuo-Ying
authors.initials: ZY
authors.lastname: Hu
authors.forename: Fei
authors.initials: F
authors.lastname: Ye
authors.forename: Nai-Liang
authors.initials: NL
authors.lastname: Tian
authors.forename: Jun-Xia
authors.initials: JX
authors.lastname: Zhang
authors.forename: Tian
authors.initials: T
authors.lastname: Xu
authors.forename: Zhi-Zhong
authors.initials: ZZ
authors.lastname: Liu
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional