Cases of Early, Aggressive In-Stent Restenosis in Left Main Double Kissing (DK) Crush Technique and Treatment Options.

MedStar author(s):
Citation: Cardiovascular Revascularization Medicine. 27:90-94, 2021 06.PMID: 33414080Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): LetterSubject headings: *Coronary Artery Disease | *Coronary Restenosis | *Drug-Eluting Stents | Aged | Coronary Angiography | Coronary Artery Disease/dg [Diagnostic Imaging] | Coronary Artery Disease/su [Surgery] | Coronary Restenosis/dg [Diagnostic Imaging] | Coronary Restenosis/et [Etiology] | Coronary Restenosis/th [Therapy] | Humans | Prospective Studies | Stents | Treatment OutcomeYear: 2021Local holdings: Available in print through MWHC library: 2002 - presentISSN:
  • 1878-0938
Name of journal: Cardiovascular revascularization medicine : including molecular interventionsAbstract: BACKGROUND/PURPOSE: We present three recent cases at our institution that demonstrate early, aggressive in-stent restenosis (ISR) of double-kissing (DK) crush technique despite careful adherence to the technique and compliance of the patient. There are multiple percutaneous coronary intervention strategies for left main (LM) coronary artery bifurcation disease. The DK crush technique has gained popularity for the treatment of complex bifurcation lesions, including distal LM bifurcations.CONCLUSIONS: DK crush for unprotected LM distal bifurcation can result in aggressive ISR with tissue proliferation and target vessel failure despite adhering to all steps of the technique. More research is warranted before DK crush is adopted as the default technique for bifurcation lesions. Copyright (c) 2020 Elsevier Inc. All rights reserved.METHODS/MATERIALS: We reviewed clinical and procedural characteristics of three recent patients who presented at our tertiary center with non-ST-elevation myocardial infarction (NSTEMI) in the setting of early, aggressive ISR of DK crush. All patients underwent imaging-guided DK crush stenting with full adherence to all steps of the technique.RESULTS: The median age was 65 years, median follow-up was 8 months from initial DK crush, and all three patients presented with NSTEMI. Patients had significant ISR in both limbs of the bifurcation involving aggressive tissue proliferation. These patients were treated differently: intracoronary brachytherapy, direct stenting, and coronary artery bypass grafting.All authors: Ben-Dor I, Bernardo N, Case BC, Chezar-Azerrad C, Forrestal BJ, Hashim H, Medranda GA, Rogers T, Satler L, Waksman R, Yerasi COriginally published: Cardiovascular Revascularization Medicine. 2020 Oct 03Fiscal year: FY2021Fiscal year of original publication: FY2021Digital Object Identifier: Date added to catalog: 2021-02-17
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Journal Article MedStar Authors Catalog Article 33414080 Available 33414080

Available in print through MWHC library: 2002 - present

BACKGROUND/PURPOSE: We present three recent cases at our institution that demonstrate early, aggressive in-stent restenosis (ISR) of double-kissing (DK) crush technique despite careful adherence to the technique and compliance of the patient. There are multiple percutaneous coronary intervention strategies for left main (LM) coronary artery bifurcation disease. The DK crush technique has gained popularity for the treatment of complex bifurcation lesions, including distal LM bifurcations.

CONCLUSIONS: DK crush for unprotected LM distal bifurcation can result in aggressive ISR with tissue proliferation and target vessel failure despite adhering to all steps of the technique. More research is warranted before DK crush is adopted as the default technique for bifurcation lesions. Copyright (c) 2020 Elsevier Inc. All rights reserved.

METHODS/MATERIALS: We reviewed clinical and procedural characteristics of three recent patients who presented at our tertiary center with non-ST-elevation myocardial infarction (NSTEMI) in the setting of early, aggressive ISR of DK crush. All patients underwent imaging-guided DK crush stenting with full adherence to all steps of the technique.

RESULTS: The median age was 65 years, median follow-up was 8 months from initial DK crush, and all three patients presented with NSTEMI. Patients had significant ISR in both limbs of the bifurcation involving aggressive tissue proliferation. These patients were treated differently: intracoronary brachytherapy, direct stenting, and coronary artery bypass grafting.

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