Step crush technique for coronary bifurcation stenting

Step crush technique for coronary bifurcation stenting

The difference between standard crush technique and step crush technique is that each stent is introduced into the vessel and deployed separately [1]. Initially a side branch stent is introduced, protruding a few millimeters into the main branch. Next a balloon is advanced into the main branch and the side branch is deployed, keeping the main branch balloon across the bifurcation. Then the deploying balloon is removed and a check angio taken. If the result is good, the guide wire is also removed. Further the main branch balloon is inflated to crush the protruding portion of the side branch stent and then removed. Next step is to advance the main branch stent and deploy it at a pressure of 12 atmospheres or more. The side branch stent is then recrossed and dilated, followed by a kissing balloon dilatation as in crush technique. The advantage of the step crush is that a six French guiding catheter can be used and this could be especially attractive with the transradial approach. Disadvantages of standard crush technique except this aspect are the same for step crush.

Reference

  1. Ioannis Iakovou, Lei Ge, Antonio Colombo. Contemporary stent treatment of coronary bifurcations. J Am Coll Cardiol. 2005 Oct 18;46(8):1446-55.