Crush technique for coronary bifurcation lesion stenting

Crush technique for coronary bifurcation lesion stenting

Crush technique for coronary bifurcation lesion stenting: Crush technique is useful when the proximal segment of the coronary bifurcation is also involved. This technique uses two stents, one in the main branch and another in the side branch, the the main branch stent a little proximal than the the side branch stent. Initially both branches are wired and dilated sequentially. Then the stents are placed as mentioned above. The side branch stent is dilated first. The balloon and wire are removed from the side branch and then the main branch stent is dilated. The side branch is then re wired and balloon dilated, followed by a kissing balloon dilatation. During the initial dilatation of the main branch without a wire across the side branch, a portion of the side branch stent protruding into the main main vessel gets crushed on to the proximal segment of the main vessel. Final kissing balloon inflation allows better strut contact against the side branch ostium and hence better delivery of the eluting drug. The maximum opening of the stent cell which can be achieved is different for different manufacturers. This should be kept in mind while choosing the stents for side branches of higher luminal diameter as there could be a miss match at the final side branch ostium. The up side of crush technique is immediate patency of both branches and good coverage of the side branch ostium. Down side is the need to cross multiple stent struts with a wire and balloon to dilate re dilate the side branch.