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Long Term Outcome of DK Crush Studies on LMB


Long Term Outcome of DK Crush Studies on LMB

European Bifurcation Club 2019, EBC 2019 – Barcelona, Spain


Long Term Outcome of DK Crush Studies on LMB

Author: Zhaoqing Sun, MD, Shengjing Hospital Affiliated to China Medical University, China


LMB has different characteristics compared with non-LMB

  • •  1. Lumen is relatively large and with severe plaque burden
  • •  2. Wide bifurcation angles, occasionally the angle between the LAD and LCX is >90°
  • •  3. The occurrence of trifurcation or even quadrifurcation indicates topographic anatomic complexity
  • •  4. The incompatible phenomenon between size of LM and side branch (SB) is obvious
  • •  5. Side branches of LM are of critically hemodynamic significance, and will cause catastrophic outcomes once the flow is compromised.


LMB-Treatment Strategies: EBC Consensus

  1. Stent implantation involves the bifurcation in 80-90% of LM stenting cases.
  2. Provisional stenting is the recommended strategy in most distal LM bifurcation lesions.
  3. Planned two-stent techniques may be indicated in cases with long LCX lesions, high risk of LCX compromise or difficult access.
  4. It is strongly recommended to have access to intravascular imaging.

DK-CRUSH III: Conclusions

This randomized, multicenter study suggests that, compared with the DK crush technique, culotte stenting is associated with significantly increased MACE in patients with LMDBLs, especially in patients with complex lesions.

DK-CRUSH V: Conclusions

In the present multicenter randomized trial, a planned DK crush 2-stent strategy reduced TLF and ST through 3-year follow-up compared with a PS strategy in patients with true distal LM bifurcation lesions.


  • A simple LMB lesion can be treated with a single-stent provisional approach ; while a 2-stent strategy is preferred for complex lesions
  • DK-Crush is an optimal choice in 2-stent strategy
  • The ongoing EBC MAIN study will provide additional information on the optimal treatment of LMCA bifurcation lesions


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