Which technique for double stenting in unprotected left main bifurcation coronary lesions?

Unprotected left main (LM) bifurcation coronary lesions are challenging for interventionists because these lesions are associated with relatively poor outcomes after percutaneous coronary intervention (PCI). Although the single-stent technique is a default treatment strategy for LM bifurcation lesions, elective double stenting is still used in patients with severely diseased side branches. The crush technique and its variants, the culotte technique and the simultaneous kissing stent technique, are applicable for distal LM disease, but none of these has proven to be superior to the others. Good long-term clinical outcomes are closely related to procedural success and optimisation of the stenting technique. The use of kissing balloon inflation during any double-stent technique is known to be an independent predictor of good angiographic and clinical outcomes by avoiding incomplete apposition or expansion. Moreover, procedural guidance using intravascular ultrasound may improve outcomes by helping to determine the appropriate stenting technique and optimise the stent procedure. Therefore, more attention should be paid to optimising the chosen technique than to choosing among techniques.