Azmat Ullah, Ali Nawaz Khan, Mohsin Saif, Noor Shah, Javeria Kamran, Kumail Abbas Khan, Abdul Hameed Siddiqui, Sajjad Ali.
Outcome of double kissing (DK) crush versus provisional stenting for left main distal bifurcation lesions.
Pak Armed Forces Med J Jan ;71(Sup-2):S357-62.

Objective: To determine whether a planned 2-stent double kissing crush technique is superior to provisional stenting patients presenting with true distal LM bifurcation lesions. Study Design: Cross-sectional comparative study. Place and Duration of Study: Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi, Pakistan, from Dec 2020 to May 2021. Methodology: A total of 70 patients enrolled in the study presented with true distal LM bifurcation lesions (Medina 1, 1, 1 or 0, 1, 1). Patients were randomized to PS or DK crush technique. The primary end-point was peri hospital and 1 month composite rate target lesion failure (TLF): target vessel myocardial infarction (TVMI), cardiac death, stent thrombosis (ST), target vessel revascularization (TVR). Routine clinical follow up done at 2 weeks and 4 weeks followed by 3 and 6 months thereafter. Results: A total of 70 patients fulfilling the inclusion criteria were enrolled in the study. The patient population was divided into two groups. Group A participants underwent DK crush technique while group B participants underwent provisional stenting. In group A [DK crush technique] 16 (45.7%) patients presented with Non-ST elevation MI followed by 14 (40%) who presented with chronic coronary syndrome (CCS) while in group B [Provisional stenting] 13 (37.1%) presented with chronic coronary syndrome followed by 9 (25.7%) who presented with non-ST elevation MI. Conclusion: LM-PCI is an acceptable procedure in patients with true distal LM bifurcation lesions who are candidates for PCI. This study also showed that DK-Crush has good periprocedural and angiographic outcomes and superior to PS in complex LMCAD lesions. PS is an acceptable option in simple distal LMCAD.

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