Editorial
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Nov 26, 2018; 10(11): 191-195
Published online Nov 26, 2018. doi: 10.4330/wjc.v10.i11.191
Thin and crush: The new mantra in left main stenting?
Gianluca Rigatelli, Marco Zuin, Debradata Dash
Gianluca Rigatelli, Section of Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo 45100, Italy
Marco Zuin, Section of Internal and Cardiopulmonary Medicine, Department of Medical Science, University of Ferrara, Ferrara 44124, Italy
Debradata Dash, Interventional Cardiology, Thumbay Hospital, Ajman 415555, United Arab Emirates
Author contributions: Rigatelli G, Zuin M and Dash D conceived the study and drafted the manuscript; all authors approved the final version of the article.
Conflict-of-interest statement: The authors have no conflict of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author to: Gianluca Rigatelli, FACC, FACP, MD, PhD, Assistant Professor, Section of Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Viale Tre Martiri 140, Rovigo 45100, Italy. jackyheart@libero.it
Telephone: +39-42-5394509 Fax: +39-42-5394513
Received: July 11, 2018
Peer-review started: July 11, 2018
First decision: August 2, 2018
Revised: August 23, 2018
Accepted: October 9, 2018
Article in press: October 9, 2018
Published online: November 26, 2018
Processing time: 138 Days and 14.9 Hours
Abstract

Complex bifurcations have been suggested to be better approached by a planned double stent technique; however, recent randomized trials have shown better outcomes of provisional compared to planned two-stent strategy, in terms of both short-term efficacy and safety. In left main (LM) bifurcations, double kissing (DK)-Crush has demonstrated its superiority over Culotte and provisional-T in terms of restenosis and stent thrombosis, gaining respect as one of the most performant techniques for bifurcations stenting. On the other hand, the Nano-Crush technique has recently become part of the repertoire of double stenting techniques, providing evidence that the use of ultrathin strut stents and very minimal crush would be beneficial for both the physiological and rheological properties of the complex bifurcations, even in LM scenario, leading to a lower rate of thrombosis and restenosis at both side branch and true carina. Finally, the newest generation of ultrathin strut stents are gaining a reputation for its safe and effective use in LM treatment thanks to improved design with increased expansion rate capable of LM treatment up to 5-6 mm diameter. The modern crush techniques, such as DK-Crush and Nano-Crush, are providing excellent results on mid and long-term follow up, suggesting that minimal crushing obtained using ultra-thin stents is a good way to obtain surgical-like outcomes in the treatment of complex LM bifurcation disease.

Keywords: Coronary bifurcation; Interventional cardiology; Percutaneous coronary intervention; Stent; Crush

Core tip: Modern crush techniques such as DK-Crush and Nano-Crush are providing excellent results on mid and long-term follow-up, suggesting that minimal crushing obtained using ultra-thin stents is a good way to obtain surgical-like outcomes in the treatment of complex left main bifurcation disease.