Bifurcation coronary lesions treated with the "crush" technique - An intravascular ultrasound analysis

OBJECTIVES We report intravascular ultrasound (IVUS) findings after crush-stenting of bifurcation lesions. BACKGROUND Preliminary results with the crush-stent technique are encouraging; however, isolated reports suggest that restenosis at the side branch (SB) ostium continues to be a problem. METHODS Forty patients with bifurcation lesions underwent crush-stenting with the sirolimus-eluting stent. Postintervention IVUS was performed in both branches in 25 lesions and only the main vessel (MV) in 15 lesions; IVUS analysis included five distinct locations: MV proximal stent, crush area, distal stent, SB ostium, and SB distal stent. RESULTS Overall, the MV minimum stent area was larger than the SB (6.7 +/- 1.7 mm(2) vs. 4.4 +/- 1.4 mm 2, p < 0.0001, respectively). When only the MV was considered, the minimum stent area was found in the crush area (rather than the proximal or MV distal stent) in 56%. When both the MV and the SB were considered, the minimum stent area was found at the SB ostium in 68%. The MV minimum stent area measured < 4 mm(2) in 8% of lesions and < 5 mm(2) in 20%. For the SB, a minimum stent area < 4 mm(2) was found in 44%, and a minimum stent area < 5 mm(2) in 76%, typically at the ostium. "Incomplete crushing"-incomplete apposition of SB or MV stent struts against the MV wall proximal to the carina-was seen in > 60% of non-left main lesions. CONCLUSIONS In the majority of bifurcation lesions treated with the crush technique, the smallest minimum stent area appeared at the SB ostium. This may contribute to a higher restenosis rate at this location. (c) 2005 by the American College of Cardiology Foundation