Evolution of the Crush Technique for Bifurcation Stenting

Claire E. Raphael, Peter D. O'Kane, Thomas W. Johnson, Abhiram Prasad, Rajiv Gulati, Yader Sandoval, Carlo Di Mario, David R. Holmes

Research output: Contribution to journalReview articlepeer-review


Bifurcation lesions are frequently encountered, associated with greater procedural complexity and consequently are at higher risk for restenosis and stent thrombosis. Early trials in bifurcation percutaneous coronary intervention favored a provisional stenting approach, but contemporary randomized trials have highlighted potentially superior outcomes using a double-kiss crush technique in unprotected distal left main stem bifurcation lesions. Although the evidence is greatest for double-kiss crush, many operators favor a mini-crush or nano-crush single-kiss approach. In this review, the authors describe the iterations of the crush technique and the evidence for each and review general principles for bifurcation percutaneous coronary intervention.

Original languageEnglish (US)
Pages (from-to)2315-2326
Number of pages12
JournalJACC: Cardiovascular Interventions
Issue number21
StatePublished - Nov 8 2021


  • DK-crush
  • bifurcation
  • crush
  • mini-crush
  • nano-crush

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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