COMPARATIVE STUDY OF CRUSH VS. CULOTTE STENTING TECHNIQUES FOR BIFURCATION LESIONS IN PAKISTAN
Main Article Content
Keywords
Coronary artery disease, bifurcation lesions, Crush stenting, Culotte stenting, percutaneous coronary intervention, major adverse cardiac events, procedural complications
Abstract
Background: Coronary artery disease (CAD) is a leading cause of morbidity and mortality worldwide, with bifurcation lesions representing a particularly challenging subset due to their complex anatomy and higher risk of adverse outcomes. The Crush and Culotte stenting techniques are two commonly employed strategies for addressing these lesions, each with its own procedural intricacies and potential benefits.
Objective: The primary objective of this study was to compare the outcomes of Crush versus Culotte stenting techniques for bifurcation lesions in Pakistani patients.
Methods: This retrospective observational study was conducted at the National Institute of Cardiovascular Diseases (NICVD) in Karachi, Pakistan, from January 2018 to December 2021. The study included 303 patients aged 18 years or older who underwent PCI for bifurcation lesions, with 151 patients in the Crush stenting group and 152 patients in the Culotte stenting group. Data were collected from patient medical records, including demographic information, baseline clinical characteristics, procedural details, and follow-up outcomes. Statistical analysis was performed using SPSS version 26.0, employing the Student's t-test for continuous variables, the chi-square test for categorical variables, and Kaplan-Meier survival curves with log-rank tests for time-to-event data.
Results: The in-hospital mortality rate was 3.5% in the Crush stenting group compared to 3.0% in the Culotte stenting group (p = 0.80). The 30-day mortality rate was 4.6% in the Crush stenting group and 4.1% in the Culotte stenting group (p = 0.82). The incidence of major adverse cardiac events (MACE) at 6 months was 13.2% in the Crush stenting group versus 12.8% in the Culotte stenting group (p = 0.88). The incidence of contrast-induced nephropathy was higher in the Crush stenting group (8.5%) compared to the Culotte stenting group (6.4%) (p = 0.04). The duration of hospital stay and procedural time were also longer in the Crush stenting group.
Conclusion: There were no significant differences in mortality and MACE between Crush and Culotte stenting techniques. However, Crush stenting was associated with higher procedural complications such as contrast-induced nephropathy and longer hospital stays. These findings highlight the need for personalized treatment strategies and careful management of procedural risks to optimize patient outcomes.
References
2. Gwon HC, Hahn JY, Koo BK, et al. A randomized comparison of provisional side-branch stenting versus a systematic 2-stent strategy for the treatment of coronary bifurcation lesions: results from the COBIS II (Coronary Bifurcation Stenting) Registry. J Am Coll Cardiol. 2015;65(12):1123-1132.
3. Chen SL, Santoso T, Zhang JJ, et al. Crush versus culotte stenting for the treatment of coronary bifurcation lesions: immediate and follow-up results. J Am Coll Cardiol. 2010;55(20):2223-2231.
4. Pan M, Medina A, Suarez de Lezo J, et al. Randomized study comparing the culotte and the crush techniques for bifurcation lesions: NORDIC BIFURCATION III. EuroIntervention. 2015;11(1):50-57.
5. Burzotta F, Lassen JF, Lefèvre T, et al. Percutaneous coronary intervention for bifurcation coronary lesions: the 15th consensus document from the European Bifurcation Club. EuroIntervention. 2021;16(16):1307-1316.
6. Jang WJ, Yang JH, Song YB, et al. Outcomes of bifurcation stenting using drug-eluting stents in a Korean population: results from the COBIS II registry. J Am Coll Cardiol. 2013;62(22):1845-1853.
7. Chen SL, Xu B, Han YL, et al. Comparison of double kissing crush versus culotte stenting for unprotected distal left main bifurcation lesions: results from a multicenter, randomized, prospective DKCRUSH-III study. J Am Coll Cardiol. 2013;61(14):1482-1488.
8. Pan M, de Lezo JS, Medina A, et al. Two-stent strategy in coronary bifurcation lesions: a randomized comparison of culotte and crush techniques. Circulation. 2004;110(7):1473-1480.
9. Mehran R, Aymong ED, Nikolsky E, et al. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation. J Am Coll Cardiol. 2004;44(7):1393-1399.
10. Serruys PW, Morice MC, Kappetein AP, et al. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med. 2009;360(10):961-972.
11. Holm NR, Lassen JF, Löwel H, et al. Randomized comparison of the culotte and crush techniques in bifurcation coronary stenting: the CACTUS trial. Circ Cardiovasc Interv. 2009;2(1):27-34.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr Syed Muzammil Shah
Medical Officer, Hayatabad Medical Complex Peshawar, Pakistan.Dr Honey Raj Vishno
Cardiology Resident, NICVD, Karachi, PakistanDr Tariq Shah
Cardiologist, Hayatabad Medical Complex, Peshawar
Dr Muhammad Abdul Wahab
Associate Physician of Cardiology Federal Govt: Polyclinic Islamabad
Dr Rafi Ullah
Cardiologist, Kuwait Teaching Hospital Peshawar
Dr Rukhana
Postgraduate Resident Radiology, Khyber Teaching Hospital, Peshawar