Abstract
BACKGROUND: The DK-mini-Crush (DKMC) technique, an established strategy to treat coronary bifurcation stenoses, is known to be complex, with possible strain on time and resources. AIMS: To analyze predictors of technical failure as well as time and resourced required for each procedural step of th DKMC technique. METHODS AND RESULTS: We prospectively enrolled 105 patients scheduled for coronary revascularization using the DKMC technique. Technical failure-defined as the inability to complete all mandatory procedural steps or any switch to other bifurcation stent deployment techniques-occurred in 10% (11/105) of the patients, most commonly due to inability to correctly place the side branch (SB) stent (3/11) or the inability to perform the 1st kissing balloon dilatation (KBD; 4/11). Even procedures with technical success required material that exceeded the base requirement in 83% of cases and the average procedure time was 47:24 min (IQR 39:00-57:09). The most time and resource-intense steps were the placement of the SB balloon for the 1st (additional material 48%; 01:38 min [00:35-03:23]) and the 2nd KBD (additional material 58%; 02:10 min [IQR 01:00-04:18]). Performance of a 1st proximal optimization technique (POT)-following crush of the SB stent-was associated with reduced overall need for additional material (OR 0.164 [95% CI 0.046-0.588], p = 0.006). CONCLUSION: Technical failure occurs in approximately 10% of DKMC procedures and is mainly due to challenges in SB stent placement or inability to perform the 1st KBD. Importantly, a 1st POT is associated with reduced resource utilization and might help to simplify this technique.