ABSTRACT

BACKGROUND - Double kissing (DK) crush approach for patients with coronary bifurcation lesions, particularly localized at distal left main or lesions with increased complexity, is associated with significant reduction in clinical events when compared with provisional stenting (PS). Recently, randomized clinical trial has demonstrated the net clinical benefits by intravascular ultrasound (IVUS)-guided implantation of drug-eluting stent (DES) in all-comers. However, the improvement in clinical outcome after DK crush treatment guided by IVUS over angiography-guidance for patients with complex bifurcation lesions have never been studied in a randomized fashion.

TRIAL DESIGN - DKCRUSH VIII study is a prospective, multicenter, randomized controlled trial designed to assess superiority of IVUS-guided versus angiography-guided DK crush stenting in patients with complex bifurcation lesions according to DEFINITION criteria. A total of 556 patients with complex bifurcation lesions will be randomly (1:1 of ratio) assigned to IVUS-guided or angiography-guided DK crush stenting group. The primary endpoint is the rate of 12-month target vessel failure (TVF), including cardiac death, target vessel myocardial infarction (TV-MI) or clinically driven target vessel revascularization (CD-TVR). The secondary endpoints consist of the individual component of primary endpoint, all-cause death, MI, and in-stent restenosis. The safety endpoint is the incidence of definite or probable stent thrombosis. An angiographic follow-up will be performed for all patients at 13 months and clinical follow-up will be continued annually until 3 years after the index procedure.

CONCLUSION - DKCRUSH VIII trial is the first study designed to evaluate the differences in efficacy and safety between IVUS-guided and angiography-guided DK crush stenting in patients with complex true bifurcation lesions. This study will also provide IVUS-derived criteria to define optimal DK crush stenting for bifurcation lesions at higher complexity.