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Mitchel L. Zoler/IMNG Medical Media
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The interventionalists who participated in the DKCRUSH-III trial are to be congratulated for their excellent patient outcomes. Patients treated in this study had a 1% cardiac death rate after 1 year despite having unprotected left main disease, with 70% having triple-vessel disease. These outcomes prompt us to ask whether interventionalists should be doing more of these types of cases.
Despite this success, I am not a big fan of the crush technique. I sometimes find it difficult to assess the side branch after stenting due to x-ray artifact caused by having so much metal in place when we crush a stent placed in a side branch. My practice is to do more single-vessel stenting and leave the side branch alone.
The "one stent" technique involves stenting the main branch and just rescuing the side branch, going through the struts of the main stent to enter the circumflex and push the struts out of the way. Results from several studies have shown that this approach is just as good as using two stents and causes fewer complications, although it has not been examined specifically at the distal left main coronary bifurcation. The one-stent approach is what U.S. interventionalists most commonly use today to treat lesions at coronary bifurcations.
Dr. Cindy L. Grines, an interventional cardiologist at Detroit Medical Center, made these comments as a designated discussant for the report. She had no relevant disclosures.
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