March 3, 2026Open Access

Double-kissing crush of the complex left main bifurcation lesions in a patient with acute coronary syndrome and cardiogenic shock

Key Points

Double kissing crush stenting shows improved efficacy for complex left main bifurcation lesions, enhancing procedural success.
In this case, procedural success was critical for treating a 69-year-old female in cardiogenic shock after acute coronary syndrome.
Challenges exist in performing percutaneous coronary intervention on bifurcation lesions, particularly without prior protection or techniques.
The potential benefit of lower adverse events with expert-led interventions highlights its importance for high-risk patients.

Abstract

Percutaneous coronary intervention of distal unprotected left main bifurcation lesions is technically very challenging, and associated with lower procedural success rate and an increased rate of major adverse cardiac and cerebrovascular events at short- and long-term follow-up, in comparison to coronary artery bypass graft surgery. Herein, we present in detailed a double kissing crush stentingof distal unprotected left main true and complex bifurcation lesion in 69-years old female patient with acute coronary syndrome and cardiogenic shock. Therefore, our patient needed urgent coronary angiography and „ad hoc“ percutaneous coronary intervention of the „culprit“ lesion due to life-threating condition. This article is focused on advantages of this 2-stent technique over other techniques in the treatment of the distal unprotected left main bifurcation lesions, and point out its limitations as well. Performing double kissing crush stenting in the distal unprotected left main true and complex bifurcation lesions is much more challenging than other stenting technique, but if it is performed by an experienced interventional cardiologist, the efficacy and safety of the procedure exceeds its potential disadvantages, which is of utmost importance for patient benefit.

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