Treatment of bifurcation coronary lesions in the era of drug-eluting stents. The ‘crush’, ‘reversed crush’ and ‘skirt’ techniques

March 2004    Volume 11, Issue 1   Br J Cardiol (Acute Interv Cardiol) 2004;11:AIC 9–AIC 13

Authors:
Ghada W Mikhail, Flavio Airoldi, Antonio Colombo

Percutaneous treatment of bifurcation coronary lesions is less successful than treatment of non-bifurcation lesions, with a higher incidence of side branch occlusion and restenosis.
The ‘crush technique’ was developed to ensure complete coverage of the ostium of the side branch, where restenosis frequently occurs. Drug-eluting stents are deployed in both side and main branches. The main branch stent crushes the side branch stent against the wall of the main vessel. The ‘reversed crush’ is used when the side branch result is unsatisfactory following stenting of the main branch, or when a 6F guiding catheter is needed.
The ‘skirt technique’ was designed to treat pseudobifurcation lesions (lesions in the main branch which are immediately proximal to a bifurcation). It involves sandwiching two balloons in one stent.
Preliminary results using the crush technique in 35 patients show angiographic success in all lesions.

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