How to do dk crush

Stratification of a given bifurcation lesion
The double kissing (DK) crush technique is better for complex coronary bifurcation
Stenting the side branch (SB)
Balloon crush
First kissing
Stenting the main vessel (MV)
2nd kissing balloon inflation
Careful rewiring from the proximal cell of the MV stent to make sure the wire is in the true lumen of the SB stent is key to acquiring optimal angiographic results
Balloon anchoring from the MV
Alternative inflation and each kissing inflation using large enough non-compliant balloons at high pressure
Proximal optimisation technique are mandatory to improve both angiographic and clinical

1. How to do DK-Crush THE SUCCESSFUL STENTING STRATEGY FOR DISTAL LEFT MAIN

2. Abstract Stratification of a given bifurcation lesion The double kissing (DK) crush technique is better for complex coronary bifurcation Stenting the side branch (SB) Balloon crush First kissing Stenting the main vessel (MV) 2 nd kissing balloon inflation Careful rewiring from the proximal cell of the MV stent to make sure the wire is in the true lumen of the SB stent is key to acquiring optimal angiographic results Balloon anchoring from the MV Alternative inflation and each kissing inflation using large enough non-compliant balloons at high pressure Proximal optimisation technique are mandatory to improve both angiographic and clinical

3. Medina 1.1.1

4. Wiring SB

5. WIRING MAIN VESSEL

6. DILATING SIDE BRANCH

7. DILATING MAIN VESSEL

8. STENTING SIDE BRANCH

9. TAKING A BALLOON IN THE MAIN VESSEL FOR CRUSING SIDE BRANCH STENT

10. REMOVED SIDE BRANCH STENT BALLOON

11. CRUSING SIDE BRANCH STENT

12. PROPER CRUSING OF SIDE BRANCH STENT

13. FIRST KISSING

14. MV STENTING

15. POT

16. RECROSSING SIDE BRANCH

17. PREPARING FOR 2 ND KISS

18. 2 ND KISS

19. POT AFTER KISSING

20. FINAL RESULT

21. Final result without wire

22. Through the lumen (OCT)

23. Summery A) One balloon was introduced into the MV and the SB stent. B) & C) The balloon in the MV was then inflated to crush the SB stent after its deployment. D) After rewiring the SB proximally, a first kissing was performed. E) Stenting the MV. F) & G) Final kissing balloon inflation was conducted after rewiring the SB from the proximal MV stent cell. H) & I) After stenting both the MV and the SB, the proximal optimisation technique (POT) should be performed to improve MV stent strut apposition

24. Damage by distal strut wiring of MV before 2 nd KISS A) Position of MV and SB stents. B) SB stent deployment. C) MV stent deployment to crush the SB stent. D) Gap formation near the carina. E) Distal SB re-crossing, wire going between the SB stent and vessel wall. F) Final kissing balloon inflation. G) & H) Leaving a significant gap near the carina