ArticleCatheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions2026
Mechanistic Insights Into How Rewiring and Bifurcation Angle Affect DK-Crush Stent Deployment.
Article in Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundDouble kissing crush (DKC) is a preferred two-stent technique for complex coronary bifurcation lesions. Proximal cell rewiring is routinely recommended to reduce technical failure, and DKC is considered effective across various bifurcation angles. However, it remains unclear whether this standard approach is optimal for all patients.
aimsThis study investigates the interaction between bifurcation angle and rewiring configuration to identify anatomy-specific strategies.
methodsComputational modeling of the DKC procedure was used to simulate 12 DKC procedures across three left main bifurcation angles (45°, 70°, and 100°) and four rewiring configurations: proximal-proximal (P-P), proximal-distal (P-D), distal-proximal (D-P), and distal-distal (D-D). Evaluation metrics included stent malapposition, side branch ostium clearance, arterial wall stress, low time-averaged endothelial shear stress, and high shear rates.
resultsDKC performed in wide bifurcations (100°) resulted in worse outcomes, with malapposition reaching 18%, side branch clearance down to 23%, and up to twice the exposure to adverse high shear rates compared to narrower angles. In contrast, intermediate (70°) and narrow (45°) angles generally resulted in more favorable outcomes, though optimal rewiring varied by angle. Proximal strategies, that is, P-P and P-D, were most effective at 70°, while D-D performed best at 45°. No single strategy was consistently superior across all bifurcation angles.
conclusionsDKC outcomes depend on bifurcation angle and can be optimized by tailoring rewiring strategies, challenging the current clinical understanding. These findings support anatomy-specific procedural planning and intravascular imaging to guide rewiring. This study provides a mechanistic rationale to improve clinical decision-making and tailor bifurcation interventions.
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