Skip to main content
. Author manuscript; available in PMC: 2022 Mar 14.
Published in final edited form as: EuroIntervention. 2021 Jul 20;17(4):e317–e325. doi: 10.4244/EIJ-D-19-00721

Figure 1.

Figure 1.

Angiographic case example of a bifurcation lesion treated successfully with the double kissing crush technique. A) Medina 1,1,1 bifurcation lesion (yellow circle) with significant disease involving the mid left anterior descending (LAD) artery and the bifurcating second diagonal branch. The bifurcation angle is <70°. The side branch supplies a large myocardial segment. B) Wires (yellow arrows) are placed in both the LAD (main vessel) and the diagonal branch (side branch). A balloon (white bracket) is placed in the diagonal branch for predilation. C) A balloon (white bracket) is placed in the LAD for predilation. D) A stent (yellow arrow) is positioned in the diagonal branch. A balloon (white bracket) is pre-positioned in the LAD prior to deploying the diagonal stent to allow subsequent crushing of the diagonal branch stent. E) The diagonal branch stent is deployed (yellow arrow). The angiographic result in the diagonal is optimised (for example to correct stent underexpansion indicated by arrowhead) prior to crushing the side branch stent. F) The LAD balloon (white bracket) is inflated, crushing the diagonal stent. G) A new wire (yellow arrow) is used to re-wire the crushed diagonal branch stent and the original diagonal wire is removed. H) The first simultaneous kissing balloon inflation (white bracket) is performed in the LAD and diagonal branch. I) The LAD stent is positioned (white bracket); the diagonal wire (yellow arrow) is not removed. J) The LAD stent (white bracket) is deployed, followed by proximal optimisation technique (POT) of the main vessel stent (not imaged). K) Due to difficulty re-wiring the diagonal branch, a Twin-Pass® Torque (Teleflex) dual-lumen microcatheter (white bracket) is used, with successful advancement of a new wire (yellow arrow) through the over-the-wire port of the device. L) The jailed diagonal wire (yellow arrow) is removed. M) The second simultaneous kissing balloon inflation (white bracket) is performed. A wire (yellow arrow) was placed in a more proximal first diagonal to maintain access to the vessel. N) Repeat POT is performed, with balloon inflation (yellow arrow) within the proximal main branch (LAD) stent up to the carina. O) Excellent final angiographic result.