The Era of Provisional Stenting for Bifurcations Comes to an End

After the large studies which set provisional stenting as the preferred strategy to treat bifurcations comes the double kissing crush technique (DK crush) to break the mold once again. This time, the DK crush technique is tested against provisional stenting in the left main, with a 3-year follow-up.

The DKCRUSH-V, soon to be published in J Am Coll Cardiol Intv, randomized 482 patients with unprotected left main stenosis to DK crush vs provisional stenting and followed them up to 3 years. Primary end point was target vessel failure (death, target vessel MI and target vessel revascularization). Safety end point was stent thrombosis. Patients were classified according to lesion complexity using the Syntax score, among others.

After 3 years, target vessel failure rate occurred in 16.9% of the provisional stent group vs. 8.3% in the DK crush group (p=0.005). This difference was mainly driven by a higher rate of target vessel MI (5.8% vs 1.7%; p=0.017) and higher target vessel revascularization rate (10.3% vs 5%; p=0.029) in the provisional stenting arm. 

Read also: TAVR Offers Better Quality of Life to Low Risk Patients.

Definite or probable thrombosis at 3 years resulted 4.1% for the provisional stenting arm and 0.4% for the DK crush arm (0.006). 

It is worth mentioning that DK crush was associated with a significant reduction both in the efficacy and safety end points in unprotected left main complex lesions.

Conclusion

The provisional stenting technique to treat left main lesions resulted in more target vessel MI, more target vessel revascularization and more stent thrombosis compared against the double kissing crush technique. This is the first of several randomized studies needed to gather definite evidence. 

Original Title: Three-Year Outcomes of the DKCRUSH-V Trial Comparing DK Crush With Provisional Stenting for Left Main Bifurcation Lesions.

Reference: Xiang Chen et al. J Am Coll Cardiol Intv 2019. Online before print.

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