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What is the Mini Crush Technique?

Published in Coronary Intervention Technique 2 mins read

The mini crush technique is a specialized percutaneous coronary intervention (PCI) method used to treat blockages at arterial bifurcations, where a main vessel divides into a side branch. This technique is a variation of the "crush" stenting strategy, designed to minimize the amount of stent material protruding into the main vessel while ensuring optimal treatment of both vessels.

Understanding the Procedure

The mini crush technique is a multi-step process carefully executed by interventional cardiologists. It is particularly designed for complex coronary artery disease involving the point where a Main Branch (MB) vessel splits into a Side Branch (SB).

Here's a breakdown of the key steps involved in the mini crush technique:

  1. Side Branch Stent Positioning: A stent is carefully advanced into the Side Branch (SB) and positioned so that it extends only a very small distance, typically just 1-2 millimeters, into the Main Branch (MB). This precise positioning is crucial for the success of the technique.

  2. Initial Crushing of the SB Stent: Prior to the full deployment of the side branch stent, a balloon is positioned within the Main Branch (MB). This balloon is then inflated to crush the small, protruding segment (1-2 mm) of the side branch stent against the vessel wall. This pre-deployment crushing step is a distinctive feature of the mini crush technique, aiming to minimize metallic obstruction in the MB.

  3. Main Branch Stent Deployment: After the initial crushing of the protruding SB stent segment, a stent specifically for the Main Branch (MB) is delivered and deployed. This MB stent covers the ostium (opening) of the side branch and the crushed portion of the SB stent.

  4. Jailing the Side Branch Wire: A consequence of the MB stent deployment is the "jailing" of the Side Branch (SB) guide wire. This means the wire that was used to access the SB becomes trapped behind the struts of the newly deployed MB stent. Subsequent steps, such as re-wiring the side branch and performing final kissing balloon inflation, are typically required to ensure optimal flow and stent apposition in both vessels.

This technique is valued in interventional cardiology for its approach to managing complex bifurcation lesions, offering a structured method to achieve successful revascularization.