A Rare Case of Successful Resolution of Bifurcation Stenosis Using Double Kissing Crush Stenting Technique

Authors

Greeshma Molugu, HCA HealthcareFollow
Tony Alacron, HCA HealthcareFollow
Karthik Anand
Machaiah Madhrira, HCA HealthcareFollow

Files

Division

North Texas

Hospital

Medical City Fort Worth

Specialty

Internal Medicine

Document Type

Poster

Publication Date

2026

Keywords

bifurcation lesions, stenting, in-stent restenosis

Disciplines

Cardiology | Cardiovascular Diseases | Internal Medicine | Medicine and Health Sciences | Surgical Procedures, Operative

Abstract

Introduction: Bifurcation lesions are associated with greater procedural complexity and consequently are at higher risk for stent restenosis. Bifurcation lesions are still technically challenging even in the era of modern stents. High incidence of restenosis both in the main vesseI and side branch Iimits the Iong-term prognosis. We present a rare case of successful resolution of bifurcation stenosis in a patient by using the double kissing (DK) crush stenting technique.

Case Description: A 52-year-old male patient with a past medical history of hypertension presented to the hospital for elective left heart catheterization as a part of an evaluation for a renal transplant. During the angiogram, the patient was noted to have severe in-stent restenosis(ISR) of about 80-90% in obtuse marginal 1(OM1) and 70-80% stenosis in the mid-circumflex artery. It was decided to intervene on the left circumflex and OM1 lesions. Intra-vascular-ultrasound(IVUS) was for used for the assessment of the morphology of the ISR. The OM1 lesion and left circumflex lesion were successfully stented using DK- crush bifurcation technique. Stent was well opposed and no evidence of edge dissection, perforation was noted. Final angiographic pictures were obtained and resolution was seen in the stenosis of OM1 from 90% to 0% and in the left circumflex from 70- 80% to 0% with good TIMI 3 flow.

Conclusion: In-stent restenosis(ISR) is defined as a reduction in lumen diameter after percutaneous coronary intervention (PCI), either with or without stent implantation. In the case of stent employ, the mechanism is through “neointimal proliferation” consisting of excessive tissue proliferation in the luminal surface of the stent. ISR is an independent predictor for mortality during follow-up. Bifurcation lesions are often associated with ISR. Often an invasive evaluation by intra-vascular-ultrasound (IVUS) or optical-coherence-tomography (OCT) allows a more detailed analysis of correct implantation. Reports have demonstrated that the main reason for higher incidence ISR of ostial side branch even in the case of drug eluting stent placement is due to the gaps in metal coverage and drug application. Therefore, new technique ensuring complete vessel scaffolding without gaps in drug delivery at the bifurcation is crush technique with kissing balloon angioplasty to expand the stent fully in the ostiaI side branch and to prevent stent distortion in mainvessel．Hence, kissing balloon angioplasty is a key step to improve the final result and to reduce the restenosis after stenting bifurcation Iesions. DK crush stenting has reduced the unfavourable outcome, reducing clinical and angiographic restenosis rate compared to the classic crush technique. Percutaneous intervention with the use of the DK crush stenting technique seems to be the preferred upcoming strategy.

Original Publisher

HCA Healthcare Graduate Medical Education

Recommended Citation

Molugu, Greeshma; Alacron, Tony; Anand, Karthik; and Madhrira, Machaiah, "A Rare Case of Successful Resolution of Bifurcation Stenosis Using Double Kissing Crush Stenting Technique" (2026). North Texas Research Forum 2026. 73.
https://scholarlycommons.hcahealthcare.com/northtexas2026/73