Coronary bifurcation lesions represent a frequent technical challenge, making between 15% and 20% of cases. Though provisional stenting is mostly used, complex bifurcations are preferably treated with two-stent strategies, such as Double-Kissing Crush (DKCR) and Double-Kissing Culotte (DKCU). Even though both strategies are supported by the current guidelines, further direct comparative studies are needed in this specific context.
The ROUTE (Revascularization of Nonleft Main Bifurcation Through Double Kissing Crush or Double Kissing Culotte) observational, prospective study compared DKCR and DKCU clinical outcomes of in non-left main coronary bifurcation lesions. In total, it included 202 patients: 101 treated with DKCR and 101 with DKCU.
Primary end point was target lesion failure (TLF), defined as the composite of target lesion revascularization (TLR), acute target vessel MI (TVMI) and cardiac death assessed at 12-month follow-up.
Patient and Procedure Characteristics
Both groups presented similar baseline characteristics: mean age 64, mostly men, 72% hypertensive, 39% diabetic, 69% had dyslipidemia, 20% had a history of PCI, and 18% a history of acute MI. The cause of PCI was more frequent in stable coronary syndromes (54%), with 55% mean ejection fraction.
As regards bifurcations, there were no significant differences in classification: the most frequent was 1.1.1 (60%), followed by 0.1.1 and, in lower proportion, 1.0.1. Neither were there differences in diameter or main and secondary vessels, or obstruction degree.
99% of procedures were femoral. There were no differences in the use of pre and post dilation, POT technique, or stent diameter and length in main and secondary vessels. After procedure, all patients received dual antiaggregation therapy with no differences in the drugs components.
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Primary end point resulted in favor of DKCU, with a minor difference in TLF (3% vs. 10.8%, P = 0.028). Better outcomes were also observed in TLR (3% vs. 9.9%, P = 0.045). However, there were no significant differences in TVMI (2% vs. 3%, P = 0.651), cardiac death (0% vs. 1%, P = 0.315) or stent thrombosis.
Conclusion
In this analysis, DK Culotte was associated with a lower incidence of TLF at one-year vs DK Crush in non-left main coronary bifurcations.
Original Title: Clinical Outcomes of Double-Kissing Crush or Double-Kissing Culotte in Nonleft Main Bifurcation Lesions: The ROUTE Trial.
Reference: Serkan Kahraman et al. CirculationCirc Cardiovasc Interv. 2024;17:e014616. DOI: 10.1161/CIRCINTERVENTIONS.124.014616.
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