Clinical outcomes of double kissing crush or double kissing culotte technique in left main bifurcation lesions: the MAIN-ROUTE registry.

Introduction: Percutaneous coronary intervention (PCI) of a left main coronary artery (LMCA) bifurcation lesion is a challenging topic among interventional cardiologists. The optimal stenting modality for patients requiring a 2-stent strategy is still debated. Aim: To compare the clinical outcomes of double kissing (DK) crush and DK culotte techniques in distal LMCA bifurcation lesions. Material and methods: Patients with unprotected distal LMCA bifurcation lesions undergoing PCI with DK crush or DK culotte technique were enrolled in 9 heart centers. The primary endpoint of the study was target lesion failure (TLF) as a composite endpoint of target lesion revascularization (TLR), target vessel myocardial infarction (TVMI), and cardiac death. Results: A total of 245 patients with unprotected distal LMCA bifurcation lesions treated with DK culotte (121 patients) or DK crush (124 patients) technique were followed up for 3 years. The incidence of 3-year TLF was lower in the DK culotte group than the DK crush group (5.0% vs. 11.3%, HR = 0.557, 95% CI: 0.211-1.471; p = 0.06). There was also no difference in 3-year TLR (5.0% vs. 7.3%, HR = 0.907, 95% CI: 0.310-2.651; p = 0.42), TVMI (2.5% vs. 3.2%, HR = 0.762, 95% CI: 0.160-3.627; p = 0.71), or cardiac death (0.8% vs. 2.4%, HR = 0.733, 95% CI: 0.063-8.550; p = 0.32) between groups. Conclusions: In the present multicenter study, the DK culotte group had a lower TLF ratio than the DK crush group, without a statistically significant difference in distal true left main bifurcation lesions.