Evolution of the Crush Technique for Bifurcation Stenting

JACC Cardiovasc Interv. 2021 Nov 8;14(21):2315-2326. doi: 10.1016/j.jcin.2021.08.048.


Bifurcation lesions are frequently encountered, associated with greater procedural complexity and consequently are at higher risk for restenosis and stent thrombosis. Early trials in bifurcation percutaneous coronary intervention favored a provisional stenting approach, but contemporary randomized trials have highlighted potentially superior outcomes using a double-kiss crush technique in unprotected distal left main stem bifurcation lesions. Although the evidence is greatest for double-kiss crush, many operators favor a mini-crush or nano-crush single-kiss approach. In this review, the authors describe the iterations of the crush technique and the evidence for each and review general principles for bifurcation percutaneous coronary intervention.

Keywords: DK-crush; bifurcation; crush; mini-crush; nano-crush.

Publication types

  • Review

MeSH terms

  • Coronary Angiography / methods
  • Coronary Artery Disease* / diagnostic imaging
  • Coronary Artery Disease* / therapy
  • Humans
  • Percutaneous Coronary Intervention* / adverse effects
  • Percutaneous Coronary Intervention* / methods
  • Stents
  • Thrombosis*
  • Time Factors
  • Treatment Outcome