Long-Term Outcomes of Crush versus Culotte Stenting in Coronary Bifurcation Lesions: A Systematic Review and Network Meta-Analysis

<ns3:p>Introduction Coronary bifurcation lesions (CBL) represent a challenging subset in percutaneous coronary intervention, often necessitating complex stenting strategies. Among these, Crush and Culotte techniques are widely employed; however, their long-term comparative effectiveness remains debated. Methods This systematic review and network meta-analysis aimed to evaluate one-, three-, and five-year clinical outcomes of Crush versus Culotte stenting techniques in patients with CBL. Results This meta-analysis included 13 articles involving 3,777 patients with coronary bifurcation lesions, with a mean age of 65.93 ± 4.67 years. At the one-year follow-up, Culotte stenting showed better outcomes in reducing target lesion revascularization and target vessel revascularization, with significant differences observed in TVR (RR 2.22; 95% CI: 0.40–12.38, p=0.0014) and TLR (RR 1.14; 95% CI: 0.30–4.37, p=0.0225), favoring Culotte. However, by the three-year follow-up, Crush stenting demonstrated superior effectiveness, showing lower risks of TVR (RR 0.62; 95% CI: 0.36–1.10, p=0.0105) and TLR (RR 0.68; 95% CI: 0.38–1.21, p=0.0284). No significant differences were observed between Crush and Culotte in myocardial infarction, stent thrombosis, cardiac death, or coronary artery bypass grafting (CABG). SUCRA analysis revealed that DK Crush ranked highest for reducing TVR (RR 0.39; 95% CI: 0.27–0.57; SUCRA 0.99), Nano Crush for TLR (RR 0.11; 95% CI: 0.01–2.04; SUCRA 0.89), DK Crush for ST (RR 0.23; 95% CI: 0.05–1.08; SUCRA 0.86), Mini Crush for MI (RR 0.23; 95% CI: 0.03–1.73; SUCRA 0.78), Nano Crush for CD (RR 0.26; 95% CI: 0.03–2.18; SUCRA 0.84), and Typical Crush for CABG (RR 0.74; 95% CI: 0.29–1.88; SUCRA 0.82). Conclusion DK Crush stenting demonstrated superior long-term efficacy over Culotte, particularly in reducing TLR and TVR at three years. While differences in other outcomes were not statistically significant, SUCRA analysis supports DK Crush as the preferred strategy for complex bifurcation PCI.</ns3:p>