Though provisional stenting (PS) is the most popular PCI technique used to treat distal left main (LM) bifurcation lesions, a double kissing (DK) crush two-stent technique yielded more positive results in a large-scale randomized trial comparing the two, according to research presented at the 29th annual Transcatheter Cardiovascular Therapeutics (TCT) conference.

DK crush techniques have proven beneficial to LM patients before, first author Shao-Liang Chen, MD, PhD, and colleagues explained in their study, seeing statistically better results than culotte stenting and better outcomes in non-LM bifurcation patients than PS. Before Chen et al.’s DKCRUSH-V trial, the DK crush technique hadn’t ever been compared to PS for LM bifurcation lesions in a random setting.

“In prior randomized trials, most planned two-stent techniques have been found to be inferior to PS in non-LM bifurcation lesions, primarily because of greater periprocedural myonecrosis with multiple stents,” the authors wrote in the paper, published today in the Journal of the American College of Cardiology. “By contrast, in the present randomized trial ... DK crush resulted in greater freedom from stent thrombosis, target vessel myocardial infarction and target lesion failure through one-year follow-up.”

Chen and co-authors randomized 482 true distal LM bifurcation lesion patients from 26 medical centers in five countries, including the U.S., to either PS treatment or DK crush stenting. Once a primary endpoint was met—either target lesion failure (TLF), cardiac death, target-vessel myocardial infarction (TVMI) or clinically-driven target lesion revascularization (TLR)—the researchers completed a routine 13-month angiographic follow-up with each patient.

According to the research, DK crush was successful in 100 percent of its randomized group members, while 97.1 percent of the PS cohort saw success. Five percent of DK crush patients and 10.7 percent of PS patients suffered from TLF within one year of the procedure, according to the study, and DK crush also resulted in lower rates of TVMI and definite or probable stent thrombosis, at 0.4 percent and 0.4 percent compared to PS’s 2.9 percent and 3.3 percent, respectively. Clinically driven TLR and angiographic restenosis were more frequent in the PS cohort, though there was no significant difference in cardiac death rates between the groups.

“In this trial, PCI of true distal LM bifurcation lesions using a planned double kissing crush two-stent strategy resulted in a lower rate of TLF at one year compared to provisional stenting,” Chen said in a release from TCT. “These results indicate that double kissing crush may be a better option for these patients.”