True left main stem bifurcation patients have shown fewer adverse events with stepwise provisional stenting vs systematic dual stenting as first strategy, even though the difference was not significant. Usually, for any other vessel, the preferred technique is provisional stenting. However, when it comes to the left main, there is a randomized, dedicated, well designed…
Bifurcations: A Long Return Journey
When it looked like the simplest techniques reach the best outcomes, along came the DK Crush studies. Indeed, after the COVIS III results in bifurcations, it appeared we had started to retrace our steps back to the foundation. The purpose of this study was to compare long term outcomes of the remarkably simple 1-stent strategy…
EuroPCR 2021 | EBC MAIN: Provisional Stenting vs. Systematic Dual Stenting in Left Main Coronary Artery
Treating the left main coronary artery with provisional stenting was non-inferior to systematic dual stenting in the EBC MAIN trial, presented at EuroPCR 2021 and simultaneously published in the European Heart Journal. The composite primary endpoint of death, infarction, and target-lesion revascularization was 14.7% for provisional stenting vs. 17.7% for systematic dual stenting (hazard ratio:…
EuroPCR 2020 | A Trick to Find the Perfect Projection to Treat Ostia or Bifurcation Lesions
The trick is to avoid testing empirically more to the right or to the left, a more caudal or cranial angular, and check what a multislice computed tomography suggests. The increase in coronary computed tomography imaging studies—due to guideline recommendations, practicality, and patient comfort—means that we frequently have these data in the cath lab even…
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…