Bifurcation coronary lesions treated with the "Crush" technique: An intravascular ultrasound analysis

Ricardo A. Costa, Gary S. Mintz, Stephane G. Carlier, Alexandra J. Lansky, Issam Moussa, Kenichi Fujii, Hideo Takebayashi, Takenori Yasuda, Jose R. Costa, Yoshihiro Tsuchiya, Lisette O. Jensen, Ecaterina Cristea, Roxana Mehran, George D. Dangas, Sriram Iyer, Michael Collins, Edward M. Kreps, Antonio Colombo, Gregg W. Stone, Martin B. LeonJeffrey W. Moses

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: We report intravascular ultrasound (IVUS) findings after crush-stenting of bifurcation lesions. BACKGROUND: Preliminary results with the crush-stent technique are encouraging; however, isolated reports suggest that restenosis at the side branch (SB) ostium continues to be a problem. METHODS: Forty patients with bifurcation lesions underwent crush-stenting with the sirolimus-eluting stent. Postintervention IVUS was performed in both branches in 25 lesions and only the main vessel (MV) in 15 lesions; IVUS analysis included five distinct locations: MV proximal stent, crush area, distal stent, SB ostium, and SB distal stent. RESULTS: Overall, the MV minimum stent area was larger than the SB (6.7 ± 1.7 mm2 vs. 4.4 ± 1.4 mm 2, p <0.0001, respectively). When only the MV was considered, the minimum stent area was found in the crush area (rather than the proximal or MV distal stent) in 56%. When both the MV and the SB were considered, the minimum stent area was found at the SB ostium in 68%. The MV minimum stent area measured 2 in 8% of lesions and 2 in 20%. For the SB, a minimum stent area 2 was found in 44%, and a minimum stent area 2 in 76%, typically at the ostium. "Incomplete crushing" - incomplete apposition of SB or MV stent struts against the MV wall proximal to the carina - was seen in >60% of non-left main lesions. CONCLUSIONS: In the majority of bifurcation lesions treated with the crush technique, the smallest minimum stent area appeared at the SB ostium. This may contribute to a higher restenosis rate at this location.

Original languageEnglish
Pages (from-to)599-605
Number of pages7
JournalJournal of the American College of Cardiology
Volume46
Issue number4
DOIs
Publication statusPublished - Aug 16 2005

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Endovascular Procedures
Stents
Sirolimus

ASJC Scopus subject areas

  • Nursing(all)

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Costa, R. A., Mintz, G. S., Carlier, S. G., Lansky, A. J., Moussa, I., Fujii, K., ... Moses, J. W. (2005). Bifurcation coronary lesions treated with the "Crush" technique: An intravascular ultrasound analysis. Journal of the American College of Cardiology, 46(4), 599-605. https://doi.org/10.1016/j.jacc.2005.05.034

Bifurcation coronary lesions treated with the "Crush" technique : An intravascular ultrasound analysis. / Costa, Ricardo A.; Mintz, Gary S.; Carlier, Stephane G.; Lansky, Alexandra J.; Moussa, Issam; Fujii, Kenichi; Takebayashi, Hideo; Yasuda, Takenori; Costa, Jose R.; Tsuchiya, Yoshihiro; Jensen, Lisette O.; Cristea, Ecaterina; Mehran, Roxana; Dangas, George D.; Iyer, Sriram; Collins, Michael; Kreps, Edward M.; Colombo, Antonio; Stone, Gregg W.; Leon, Martin B.; Moses, Jeffrey W.

In: Journal of the American College of Cardiology, Vol. 46, No. 4, 16.08.2005, p. 599-605.

Research output: Contribution to journalArticle

Costa, RA, Mintz, GS, Carlier, SG, Lansky, AJ, Moussa, I, Fujii, K, Takebayashi, H, Yasuda, T, Costa, JR, Tsuchiya, Y, Jensen, LO, Cristea, E, Mehran, R, Dangas, GD, Iyer, S, Collins, M, Kreps, EM, Colombo, A, Stone, GW, Leon, MB & Moses, JW 2005, 'Bifurcation coronary lesions treated with the "Crush" technique: An intravascular ultrasound analysis', Journal of the American College of Cardiology, vol. 46, no. 4, pp. 599-605. https://doi.org/10.1016/j.jacc.2005.05.034
Costa, Ricardo A. ; Mintz, Gary S. ; Carlier, Stephane G. ; Lansky, Alexandra J. ; Moussa, Issam ; Fujii, Kenichi ; Takebayashi, Hideo ; Yasuda, Takenori ; Costa, Jose R. ; Tsuchiya, Yoshihiro ; Jensen, Lisette O. ; Cristea, Ecaterina ; Mehran, Roxana ; Dangas, George D. ; Iyer, Sriram ; Collins, Michael ; Kreps, Edward M. ; Colombo, Antonio ; Stone, Gregg W. ; Leon, Martin B. ; Moses, Jeffrey W. / Bifurcation coronary lesions treated with the "Crush" technique : An intravascular ultrasound analysis. In: Journal of the American College of Cardiology. 2005 ; Vol. 46, No. 4. pp. 599-605.
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abstract = "OBJECTIVES: We report intravascular ultrasound (IVUS) findings after crush-stenting of bifurcation lesions. BACKGROUND: Preliminary results with the crush-stent technique are encouraging; however, isolated reports suggest that restenosis at the side branch (SB) ostium continues to be a problem. METHODS: Forty patients with bifurcation lesions underwent crush-stenting with the sirolimus-eluting stent. Postintervention IVUS was performed in both branches in 25 lesions and only the main vessel (MV) in 15 lesions; IVUS analysis included five distinct locations: MV proximal stent, crush area, distal stent, SB ostium, and SB distal stent. RESULTS: Overall, the MV minimum stent area was larger than the SB (6.7 ± 1.7 mm2 vs. 4.4 ± 1.4 mm 2, p <0.0001, respectively). When only the MV was considered, the minimum stent area was found in the crush area (rather than the proximal or MV distal stent) in 56{\%}. When both the MV and the SB were considered, the minimum stent area was found at the SB ostium in 68{\%}. The MV minimum stent area measured 2 in 8{\%} of lesions and 2 in 20{\%}. For the SB, a minimum stent area 2 was found in 44{\%}, and a minimum stent area 2 in 76{\%}, typically at the ostium. {"}Incomplete crushing{"} - incomplete apposition of SB or MV stent struts against the MV wall proximal to the carina - was seen in >60{\%} of non-left main lesions. CONCLUSIONS: In the majority of bifurcation lesions treated with the crush technique, the smallest minimum stent area appeared at the SB ostium. This may contribute to a higher restenosis rate at this location.",
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TY - JOUR

T1 - Bifurcation coronary lesions treated with the "Crush" technique

T2 - An intravascular ultrasound analysis

AU - Costa, Ricardo A.

AU - Mintz, Gary S.

AU - Carlier, Stephane G.

AU - Lansky, Alexandra J.

AU - Moussa, Issam

AU - Fujii, Kenichi

AU - Takebayashi, Hideo

AU - Yasuda, Takenori

AU - Costa, Jose R.

AU - Tsuchiya, Yoshihiro

AU - Jensen, Lisette O.

AU - Cristea, Ecaterina

AU - Mehran, Roxana

AU - Dangas, George D.

AU - Iyer, Sriram

AU - Collins, Michael

AU - Kreps, Edward M.

AU - Colombo, Antonio

AU - Stone, Gregg W.

AU - Leon, Martin B.

AU - Moses, Jeffrey W.

PY - 2005/8/16

Y1 - 2005/8/16

N2 - OBJECTIVES: We report intravascular ultrasound (IVUS) findings after crush-stenting of bifurcation lesions. BACKGROUND: Preliminary results with the crush-stent technique are encouraging; however, isolated reports suggest that restenosis at the side branch (SB) ostium continues to be a problem. METHODS: Forty patients with bifurcation lesions underwent crush-stenting with the sirolimus-eluting stent. Postintervention IVUS was performed in both branches in 25 lesions and only the main vessel (MV) in 15 lesions; IVUS analysis included five distinct locations: MV proximal stent, crush area, distal stent, SB ostium, and SB distal stent. RESULTS: Overall, the MV minimum stent area was larger than the SB (6.7 ± 1.7 mm2 vs. 4.4 ± 1.4 mm 2, p <0.0001, respectively). When only the MV was considered, the minimum stent area was found in the crush area (rather than the proximal or MV distal stent) in 56%. When both the MV and the SB were considered, the minimum stent area was found at the SB ostium in 68%. The MV minimum stent area measured 2 in 8% of lesions and 2 in 20%. For the SB, a minimum stent area 2 was found in 44%, and a minimum stent area 2 in 76%, typically at the ostium. "Incomplete crushing" - incomplete apposition of SB or MV stent struts against the MV wall proximal to the carina - was seen in >60% of non-left main lesions. CONCLUSIONS: In the majority of bifurcation lesions treated with the crush technique, the smallest minimum stent area appeared at the SB ostium. This may contribute to a higher restenosis rate at this location.

AB - OBJECTIVES: We report intravascular ultrasound (IVUS) findings after crush-stenting of bifurcation lesions. BACKGROUND: Preliminary results with the crush-stent technique are encouraging; however, isolated reports suggest that restenosis at the side branch (SB) ostium continues to be a problem. METHODS: Forty patients with bifurcation lesions underwent crush-stenting with the sirolimus-eluting stent. Postintervention IVUS was performed in both branches in 25 lesions and only the main vessel (MV) in 15 lesions; IVUS analysis included five distinct locations: MV proximal stent, crush area, distal stent, SB ostium, and SB distal stent. RESULTS: Overall, the MV minimum stent area was larger than the SB (6.7 ± 1.7 mm2 vs. 4.4 ± 1.4 mm 2, p <0.0001, respectively). When only the MV was considered, the minimum stent area was found in the crush area (rather than the proximal or MV distal stent) in 56%. When both the MV and the SB were considered, the minimum stent area was found at the SB ostium in 68%. The MV minimum stent area measured 2 in 8% of lesions and 2 in 20%. For the SB, a minimum stent area 2 was found in 44%, and a minimum stent area 2 in 76%, typically at the ostium. "Incomplete crushing" - incomplete apposition of SB or MV stent struts against the MV wall proximal to the carina - was seen in >60% of non-left main lesions. CONCLUSIONS: In the majority of bifurcation lesions treated with the crush technique, the smallest minimum stent area appeared at the SB ostium. This may contribute to a higher restenosis rate at this location.

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