Left Main Bifurcation: When & How to Approach?
from the recent @crtmeeting #CRT2019 #CRT2020 #LM #SBKCathLab
![](https://pbs.twimg.com/media/D1Rg8lUWoAAROeb.jpg)
The #LM is oval shaped w/ mean RVD ~ 5mm and mean length ~ 10 mm. The atherosclerotic distribution extends beyond the main shaft to occupy the major side-branches (SB)
![](https://pbs.twimg.com/media/D1RhkY7X0AAgwhu.jpg)
#DKCrush V trial was the most recent RCT that was presented as LBCT @TCTConference @TCTMD in 2017
![](https://pbs.twimg.com/media/D1RmU84XcAAZmv3.jpg)
Compared with PS, #DKCrush also resulted in lower rates of definite or probable stent thrombosis: 3.3% vs. 0.4%; p=0.02
![](https://pbs.twimg.com/media/D1RnH1BX0AAV1WU.jpg)
The distribution of ISR was more prevalent in the ostium of the SB. Nevertheless, #DKCrush showed lower restenotic rate compared to PS in this location.
![](https://pbs.twimg.com/media/D1RnZU1XcAArVEQ.jpg)
The DKCrush III trial compared the culotte stenting technique with the #DKCrush in Distal UPLM CBLs. 419 patients were enrolled and randomly assigned to DK (n=210) or Culotte (n-209). The primary endpoint was MACE @ 1Y
![](https://pbs.twimg.com/media/D1Rno6xWoAAP4Th.jpg)
The cumulative MACE-free survival in the #DKCrush group was significantly greater compared to the Culotte group: 93.8% vs. 83.7%, p=0.001
![](https://pbs.twimg.com/media/D1Rn0LxXQAATMKh.jpg)
Similarly, the components of TLR- & TVR-free survival @ 1Y were significantly greater in the #DKCrush group vs. the Culotte group.
![](https://pbs.twimg.com/media/D1Rn-tSXcAIopb0.jpg)