Managing coronary bifurcation lesions remains a complex challenge for interventional cardiologists. Choosing optimal bifurcation PCI techniques is critical when a side branch becomes compromised during a provisional stenting strategy. Recently, data from the PROGRESS-BIFURCATION registry evaluated the differences between the reverse crush and culotte methods in these scenarios.

The study analyzed 43 patients who required a two-stent bailout after initial main vessel stenting. Researchers found that operators preferred the reverse crush technique for lesions in the left anterior descending artery. Furthermore, this method was more frequently chosen for smaller bifurcation angles, averaging 45 degrees. Conversely, the culotte technique was the preferred option for lesions involving the left main coronary artery.

Comparing Success in Bifurcation PCI Techniques

Regarding procedural outcomes, both methods demonstrated high levels of technical and procedural success. Interestingly, the study reported no significant differences in major adverse cardiovascular events (MACE) between the groups. Both techniques recorded a MACE rate of approximately 3% during the in-hospital period. Consequently, clinical selection often depends on the specific anatomical characteristics of the bifurcation rather than a single superior strategy.

Which anatomical factors influence the choice of technique?

Interventionalists often choose the reverse crush technique for smaller bifurcation angles and lesions located in the left anterior descending artery. In contrast, the culotte technique is more common for left main coronary artery bifurcations.

Are there differences in safety between reverse crush and culotte?

Current registry data indicates that both techniques offer similar safety profiles. Both methods show comparable rates of technical success and low in-hospital MACE rates of approximately 3%.

Disclaimer: This content is for informational and educational purposes only. It does not constitute medical advice or establish a doctor-patient relationship. Always consult with a qualified healthcare professional regarding any medical condition or treatment. Refer to the latest local and national guidelines for clinical practice.

References

1. Kladou E et al. Reverse Crush Versus Culotte in Bifurcation Lesions After Provisional Stenting: Insights From the PROGRESS-BIFURCATION Registry. Catheter Cardiovasc Interv. 2026 May 27. doi: 10.1002/ccd.70674. PMID: 42204386.
2. Sawaya FJ et al. Comparison of the Crush and Culotte Techniques for Coronary Artery Bifurcation Lesions. EuroIntervention. 2016;12(11):e1351-e1358.
3. Lassen JF et al. Percutaneous coronary intervention for bifurcation disease: 11th consensus document from the European Bifurcation Club. EuroIntervention. 2016;12(1):38-46.