Predictors of failure of final kissing-balloon inflation after mini-crush stenting in non-left main bifurcation lesions: importance of the main-vessel angle.

BACKGROUND The majority of bifurcation lesions are treated with crush stenting. However, the success of crush stenting depends on final kissing-balloon inflation (FKBI), which is potentially difficult. Although mini-crush stenting has a higher rate of successful FKBI, it still cannot be achieved in some patients. The aim of this study was to investigate the factors that contribute to failure of FKBI in mini-crush stenting. METHODS AND RESULTS We included 173 consecutive patients who were treated with mini-crush stenting. The patients were divided into FKBI and non-FKBI groups. The bifurcation angles were measured: (1) proximal bifurcation angle (angle A, between proximal main vessel and side branch); (2) distal bifurcation angle (angle B, between distal main branch and side branch); and (3) the main-vessel angle (angle C, between proximal main vessel and distal main branch). FKBI could be performed in 153 patients. Angle C and calcification were significantly lower and angle A and mean stent diameter in the main vessel were significantly higher in the FKBI group. Multivariate logistic regression analysis showed that only Angle C was an independent predictor of FKBI failure. CONCLUSIONS Main-vessel angle was the only independent predictor of FKBI failure in mini-crush stenting.