Fundamentals of percutaneous coronary bifurcation interventions

Figure 12  Step-by-step double kissing-crush technique. A: After the preparation of the vessels, the side branch (SB) stent protruding 2-3 mm into the proximal main vessel (MV) is deployed while an uninflated proximal optimization technique (POT) balloon is positioned in the MV; B, C: “Proximal side optimization”. A slightly withdrawn stent balloon is inflated at a higher pressure. Then, a new larger NC balloon is inflated in the protruding stent part to further open the struts; D: Crushing the stent by POT after the SB balloon and wire are removed; E: Wiring the SB through a non-distal cell; F: First kissing balloon inflation (KBI) after sequential inflation of the two balloons; G: MV stenting after the SB balloon and wire are removed; H: Second POT; I: Wiring the SB through a non-distal cell for the second time; J: Second KBI; K: Final POT; L: Final result.