Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America.
Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America; Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, United States of America.
Cardiovasc Revasc Med. 2021 Jun;27:90-94. doi: 10.1016/j.carrev.2020.09.044. Epub 2020 Oct 3.
BACKGROUND/PURPOSE: We present three recent cases at our institution that demonstrate early, aggressive in-stent restenosis (ISR) of double-kissing (DK) crush technique despite careful adherence to the technique and compliance of the patient. There are multiple percutaneous coronary intervention strategies for left main (LM) coronary artery bifurcation disease. The DK crush technique has gained popularity for the treatment of complex bifurcation lesions, including distal LM bifurcations.
METHODS/MATERIALS: We reviewed clinical and procedural characteristics of three recent patients who presented at our tertiary center with non-ST-elevation myocardial infarction (NSTEMI) in the setting of early, aggressive ISR of DK crush. All patients underwent imaging-guided DK crush stenting with full adherence to all steps of the technique.
The median age was 65 years, median follow-up was 8 months from initial DK crush, and all three patients presented with NSTEMI. Patients had significant ISR in both limbs of the bifurcation involving aggressive tissue proliferation. These patients were treated differently: intracoronary brachytherapy, direct stenting, and coronary artery bypass grafting.
DK crush for unprotected LM distal bifurcation can result in aggressive ISR with tissue proliferation and target vessel failure despite adhering to all steps of the technique. More research is warranted before DK crush is adopted as the default technique for bifurcation lesions.
背景/目的：尽管我们严格遵循技术并遵守患者的规定，但我们机构最近出现了三例双吻（DK）挤压技术的早期、严重的支架内再狭窄（ISR）病例。对于左主干（LM）冠状动脉分叉病变，有多种经皮冠状动脉介入治疗策略。DK 挤压技术因其治疗复杂分叉病变（包括远端 LM 分叉病变）而受到欢迎。
方法/材料：我们回顾了在我们的三级中心就诊的三例近期患者的临床和程序特征，这些患者在 DK 挤压后的早期出现严重的 ISR，同时伴有非 ST 段抬高型心肌梗死（NSTEMI）。所有患者均接受了影像学引导的 DK 挤压支架置入术，完全遵守技术的所有步骤。
患者的中位年龄为 65 岁，中位随访时间为 DK 挤压后 8 个月，所有患者均因 NSTEMI 就诊。患者的分叉病变两支均存在明显的 ISR，涉及到严重的组织增生。这些患者的治疗方式不同：腔内放射治疗、直接支架置入和冠状动脉旁路移植术。
尽管严格遵循 DK 挤压技术的所有步骤，但 DK 挤压治疗未保护的远端 LM 分叉仍可能导致严重的 ISR 和组织增生，导致靶血管失败。在将 DK 挤压技术作为分叉病变的默认技术之前，需要进行更多的研究。
