Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
Science Centers, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA.
Catheter Cardiovasc Interv. 2022 Mar;99(4):1038-1044. doi: 10.1002/ccd.30135. Epub 2022 Feb 23.
Although the double kissing (DK) crush stenting technique can provide excellent outcomes in percutaneous coronary intervention (PCI) of bifurcation lesions, it can be challenging to perform.
We examined the clinical and angiographic characteristics, challenges encountered, and procedural outcomes of bifurcation PCI with DK crush in Prospective Global Registry of Percutaneous Coronary Intervention in Bifurcation Lesions (PROGRESS-BIFURCATION, NCT05100992).
DK crush was used in 48 of 435 bifurcation lesions (11%). Technical success was 100%, procedural success was 96%, and the incidence of in-hospital major adverse cardiovascular events was 4%. Challenges while performing DK crush were encountered in 26 lesions (54%): (1) difficulty in side branch (SB) first rewiring (38%) that was overcome with the use of a new guidewire (30%) or a microcatheter (15%); (2) inability to deliver balloon to an SB for the first kiss (54%) that was overcome with the use of a smaller balloon (86%), rewiring (29%), microcatheter (14%), and increased support 7%; (3) difficulty in SB second rewiring (19%) that was overcome with the use of a new guidewire (80%) and/or microcatheter (60%). DK crush was more often performed in left main and proximal left anterior descending artery lesions (70% vs. 50%, p = 0.014). DK crush cases required more contrast (198 ± 84 ml vs. 163 ± 70 ml, p = 0.003), fluoroscopy time (35 ± 20 min vs. 25 ± 21 min, p = 0.004), and lasted longer (137 ± 69 min vs. 99 ± 66 min, p = 0.001) compared with non-DK crush techniques.
While challenges are common when performing DK crush bifurcation stenting, success rates are high and complication rates are low.
尽管双吻（DK）挤压支架技术在经皮冠状动脉介入治疗（PCI）分叉病变中能提供出色的结果，但操作具有一定挑战性。
我们检查了前瞻性全球经皮冠状动脉介入治疗分叉病变注册研究（PROGRESS-BIFURCATION，NCT05100992）中分叉 PCI 采用 DK 挤压技术的临床和血管造影特征、遇到的挑战以及手术结果。
在 435 个分叉病变中，48 个（11%）采用了 DK 挤压技术。技术成功率为 100%，手术成功率为 96%，住院期间主要不良心血管事件发生率为 4%。在 26 个病变（54%）中遇到了 DK 挤压操作的挑战：（1）SB 首次重布线困难（38%），使用新导丝（30%）或微导管（15%）克服；（2）第一次亲吻时无法将球囊输送到 SB（54%），使用较小的球囊（86%）、重布线（29%）、微导管（14%）和增加 7%的支持克服；（3）SB 第二次重布线困难（19%），使用新导丝（80%）和/或微导管（60%）克服。DK 挤压更常用于左主干和近端左前降支病变（70%比 50%，p=0.014）。DK 挤压病例需要更多的造影剂（198±84ml 比 163±70ml，p=0.003）、透视时间（35±20min 比 25±21min，p=0.004）和持续时间更长（137±69min 比 99±66min，p=0.001）。
虽然在进行 DK 挤压分叉支架术时会遇到常见的挑战，但成功率高，并发症发生率低。
