Double Kissing Crush Stentleme Tekniği
Özet
Double Kissing Crush (DKC) stentleme tekniği, klasik crush tekniğinde %20-25 oranında gerçekleştirilemeyen final kissing balon dilatasyonu sorununu çözmek amacıyla 2005 yılında Chen ve arkadaşları tarafından geliştirilmiştir. Zaman içerisinde yan dal stentinin ana dala protrüzyon mesafesi 1-2 mm’ye evrilen bu yöntemin klasik crush'tan temel farkı, yan dal stenti ezildikten hemen sonra uygulanan "ilk kissing balon" işlemidir. Bu aşama, bozulmuş yan dal stent ostiumunu optimize ederek tek kat strat bırakır, malzeme geçişini kolaylaştırır ve ana dal stenti takılırken oluşabilecek distorsiyonu en aza indirir. EBC ve ESC kılavuzlarında gerçek ve kompleks korumasız sol ana koroner bifurkasyon lezyonları için Sınıf IIb endikasyonla önerilen teknik; lezyon analizi (IVUS/OCT/FFR), yan dal stentleme, yan dal proksimal optimizasyonu, crush işlemi, proksimal hücreden ilk rewiring, ilk kissing, ana dal stentlemesi, proksimal optimizasyon (POT), ikinci rewiring, final kissing, son POT ve detaylı anjiyografik değerlendirmeyi içeren 12 adımdan oluşur. Tekniğin başarısı; destekleyici kateter seçimi, optimal lezyon hazırlığı, uygun stent konumlandırma ve POT ile rewiring geçişlerinin optimize edilmesine sıkı sıkıya bağlıdır.
The Double Kissing Crush (DKC) stenting technique was introduced by Chen et al. in 2005 to overcome the 20-25% failure rate of final kissing balloon dilatation encountered in the classical crush technique. Over time, the side branch stent protrusion into the main vessel has evolved to 1-2 mm. The primary distinction from classical crush is the execution of a "first kissing balloon" inflation immediately after side branch stent crushing, which optimizes the distorted side branch ostium, leaves a single-layer strut, facilitates equipment passage, and minimizes main vessel stent distortion. Recommended with a Class IIb indication by EBC and ESC guidelines for unprotected left main true and complex bifurcation lesions, the procedure follows a 12-step protocol: lesion assessment (IVUS/OCT/FFR), side branch stenting, side branch proximal optimization, crushing, proximal-cell rewiring, first kissing balloon, main vessel stenting, proximal optimization technique (POT), second rewiring, final kissing balloon, final POT, and angiographic evaluation. Achieving technical success relies heavily on selecting appropriate backup catheters, meticulous lesion preparation, precise stent positioning, and optimizing both POT and rewiring strategies.
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