Reverse crush technique of coronary bifurcation stenting

Reverse crush is performed mainly with provisional side branch stenting and sub optimal side branch result. A stent is deployed in the main branch followed by final kissing inflation towards side branch. This is achieved by wiring the side branch through the struts of the main branch stent and passing a balloon for dilating the struts and the side branch ostium. A second stent is passed into the side branch. A balloon is positioned in the main branch at the level of the bifurcation. Then the side branch stent is retracted two to three millimeters into the main branch and deployed. After removing the deploying balloon, check angio is taken to ensure a good result in the side branch and exclude the need for any additional stent in the side branch. After confirming this, the side branch wire is removed and the main branch balloon is inflated at high pressure to crush the proximal edge of the side branch balloon. Re-crossing of the side branch followed by side branch dilatation and final kissing dilatation is necessary. The procedure ensure immediate patency of both branches and can be done using a six French guide catheter. But this is more laborious than the standard crush technique.