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

Mehmet Erturk; Serkan Kahraman; Can Y. Karabay; Mehmet A. Erdol; Hasan Ari; Eser Durmaz; Ertugrul Okuyan; Regayip Zehir; Ali R. Akyuz; Cagri Yayla; Irfan Sahin; Cansu Ebren; Gokhan Demirci; Ahmet Guner; Erhan Melikoglu; Mehmet Cicek; Sezgin Atmaca; Irem Turkmen; Ahmet Goktug Ertem; Mustafa A. Sungur; Bilal M. Ulker; Ahmet C. Cebeci; Ali Nural; Busra G. Sengor; Ahmet O. Aslan; Ishak Yilmaz; Ali Kemal Kalkan; Muzaffer Degertekin

doi:10.5114/aic.2025.154307

eISSN: 1897-4295
ISSN: 1734-9338

Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej

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abstract:

Original paper

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

Mehmet Erturk

¹

,

Serkan Kahraman

¹

,

Can Y. Karabay

²

,

Mehmet A. Erdol

³

,

Hasan Ari

⁴

,

Eser Durmaz

⁵

,

Ertugrul Okuyan

⁶

,

Regayip Zehir

⁷

,

Ali R. Akyuz

⁸

,

Cagri Yayla

³

,

Irfan Sahin

⁶

,

Cansu Ebren

⁹

,

Gokhan Demirci

¹

,

Ahmet Guner

¹

,

Erhan Melikoglu

¹

,

Mehmet Cicek

¹

,

Sezgin Atmaca

¹

,

Irem Turkmen

¹

,

Ahmet Goktug Ertem

³

,

Mustafa A. Sungur

²

,

Bilal M. Ulker

⁴

,

Ahmet C. Cebeci

²

,

Ali Nural

²

,

Busra G. Sengor

⁷

,

Ahmet O. Aslan

⁸

,

Ishak Yilmaz

⁶

,

Ali Kemal Kalkan

¹

,

Muzaffer Degertekin

⁹

University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Department of Cardiology, Istanbul, Turkiye
University of Health Sciences, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkiye
University of Health Sciences, Ankara City Hospital, Department of Cardiology, Ankara, Turkiye
University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, Bursa, Turkiye
Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Department of Cardiology, Istanbul, Turkiye
University of Health Sciences, Bagcılar Training and Research Hospital, Department of Cardiology, Istanbul, Turkiye
University of Health Sciences, Kosuyolu Kartal Heart Training and Research Hospital, Department of Cardiology, Istanbul, Turkiye
University of Health Sciences, Trabzon Ahi Evren Cardiovascular and Thoracic Surgery Research and Application Center, Department of Cardiology, Trabzon, Turkiye
Yeditepe University Medical Faculty Hospital, Department of Cardiology, Istanbul, Turkiye

Adv Interv Cardiol 2025; 21, 3 (81): 305–313

DOI: https://doi.org/10.5114/aic.2025.154307

Online publish date: 2025/09/17

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AMA

Erturk M, Kahraman S, Karabay C, et al. Clinical outcomes of double kissing crush or double kissing culotte technique in left main bifurcation lesions: the MAIN-ROUTE registry. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej. 2025;21(3):305-313. doi:10.5114/aic.2025.154307.

APA

Erturk, M., Kahraman, S., Karabay, C., Erdol, M., Ari, H.,  & Durmaz, E. et al. (2025). Clinical outcomes of double kissing crush or double kissing culotte technique in left main bifurcation lesions: the MAIN-ROUTE registry. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej, 21(3), 305-313. https://doi.org/10.5114/aic.2025.154307

Chicago

Erturk, Mehmet, Serkan Kahraman, Can Y. Karabay, Mehmet A. Erdol, Hasan Ari, Eser Durmaz,  and Ertugrul Okuyan et al. 2025. "Clinical outcomes of double kissing crush or double kissing culotte technique in left main bifurcation lesions: the MAIN-ROUTE registry". Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej 21 (3): 305-313. doi:10.5114/aic.2025.154307.

Harvard

Erturk, M., Kahraman, S., Karabay, C., Erdol, M., Ari, H., Durmaz, E., Okuyan, E., Zehir, R., Akyuz, A., Yayla, C., Sahin, I., Ebren, C., Demirci, G., Guner, A., Melikoglu, E., Cicek, M., Atmaca, S., Turkmen, I., Ertem, A., Sungur, M., Ulker, B., Cebeci, A., Nural, A., Sengor, B., Aslan, A., Yilmaz, I., Kalkan, A.,  and Degertekin, M. (2025). Clinical outcomes of double kissing crush or double kissing culotte technique in left main bifurcation lesions: the MAIN-ROUTE registry. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej, 21(3), pp.305-313. https://doi.org/10.5114/aic.2025.154307

MLA

Erturk, Mehmet et al. "Clinical outcomes of double kissing crush or double kissing culotte technique in left main bifurcation lesions: the MAIN-ROUTE registry." Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej, vol. 21, no. 3, 2025, pp. 305-313. doi:10.5114/aic.2025.154307.

Vancouver

Erturk M, Kahraman S, Karabay C, Erdol M, Ari H, Durmaz E et al. Clinical outcomes of double kissing crush or double kissing culotte technique in left main bifurcation lesions: the MAIN-ROUTE registry. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej. 2025;21(3):305-313. doi:10.5114/aic.2025.154307.

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.

keywords:

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

left main coronary artery, bifurcation lesion, double kissing culotte, double kissing crush