Key Points<\/p>\n\n\n\n
Intravascular imaging has been increasingly recognized as a cornerstone of contemporary percutaneous coronary intervention, particularly for complex coronary anatomy. Complex bifurcation lesions represent one of the highest\u2011risk subsets, where the technical demands of two\u2011stent strategies, such as double kissing (DK) crush, raise the stakes for optimal procedural execution. The DKCRUSH VIII trial (NCT03770650<\/a>), presented as a late\u2011breaking clinical trial at ACC.26 and simultaneously published in the Journal of the American College of Cardiology<\/em>,<\/a> evaluated whether systematic IVUS guidance could improve clinical outcomes over angiography\u2011guided PCI in patients with true complex bifurcation disease.<\/p>\n\n\n\n This multicenter, randomized, open\u2011label superiority trial enrolled 555 patients meeting DEFINITION criteria for complex bifurcation lesions across 24 centers in China. Patients were randomized 1:1 to IVUS-guided DK crush (n=277) or angiography-guided DK crush (n=278). Nearly half of all lesions involved the distal left main (44.8% vs. 43.9%), and DK crush was used in 96.8% of procedures. The prespecified primary endpoint was target vessel failure (TVF); a composite of cardiac death, target vessel MI, or clinically driven target vessel revascularization-at 12 months.<\/p>\n\n\n\n At one year, TVF occurred in 17 patients (6.1%) in the IVUS group compared with 41 patients (14.7%) in the angiography group (HR 0.40; 95% CI, 0.23\u20130.71; p=0.002). Excluding periprocedural MI, TVF remained significantly lower with IVUS (3.6% vs. 12.2%; HR 0.28; 95% CI, 0.14\u20130.57). Target vessel MI was reduced by more than half (4.3% vs. 9.4%), driven largely by a lower rate of spontaneous MI (1.8% vs. 6.1%). Clinically driven TVR also favored the IVUS-guided strategy (2.9% vs. 7.6%). All\u2011cause and cardiac mortality were infrequent and similar between groups.<\/p>\n\n\n\n IVUS revealed frequent procedural pitfalls that were unrecognized angiographically. Incomplete crushing was seen in 28.2% of cases following balloon crush and 12.7% after stent crush; distal rather than proximal rewiring occurred in 41.5% of patients during the first rewiring step. Despite these challenges, operators achieved IVUS-defined optimal PCI in 75.4% of cases. Patients meeting these criteria had a strikingly low 1\u2011year TVF rate of 2.6%, compared with 15.9% in those with suboptimal IVUS results-nearly identical to the angiography-guided cohort. Safety outcomes were similar across groups. Definite or probable stent thrombosis was rare (0.4% vs. 1.1%), and intraprocedural complications were infrequent, though TIMI flow <3 occurred more often with angiography guidance (4.7% vs. 0.7%). Contrast use and procedural time were modestly higher with IVUS, reflecting the multistep imaging protocol.<\/p>\n\n\n\n According to the trial\u2019s lead investigator, Shaoliang Chen, MD, \u201cthe one-year TVF rate was 6.1% in the IVUS-guided group compared to 14.1% in the angiography-guided group, and this benefit was achieved largely through meeting IVUS-defined optimization targets rather than IVUS use alone.\u201d<\/p>\n\n\n\n Together, these findings demonstrate that in real complex bifurcation lesions, nearly all treated with the DK crush technique, IVUS guidance meaningfully improves clinical outcomes, primarily by preventing spontaneous MI and reducing repeat revascularization. The magnitude of benefit, however, depends on achieving rigorous imaging\u2011based optimization, underlining the importance of meticulous technique in this challenging lesion subset.<\/p>\n","protected":false},"excerpt":{"rendered":" Key Points Intravascular imaging has been increasingly recognized as a cornerstone of contemporary percutaneous coronary intervention, particularly for complex coronary anatomy. Complex bifurcation lesions represent one of the highest\u2011risk subsets, where the technical demands of two\u2011stent strategies, such as double kissing (DK) crush, raise the stakes for optimal procedural execution. The DKCRUSH VIII trial (NCT03770650), […]<\/p>\n","protected":false},"author":40604,"featured_media":139799,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"aside","meta":{"footnotes":""},"categories":[1074,8],"tags":[1075,45,47,185],"ppma_author":[1031],"class_list":{"0":"post-139798","1":"post","2":"type-post","3":"status-publish","4":"format-aside","5":"has-post-thumbnail","7":"category-acc-2026","8":"category-news","9":"tag-acc-2026","10":"tag-conference","11":"tag-featured","12":"tag-news","13":"post_format-post-format-aside","14":"author-basir-gill"},"authors":[{"term_id":1031,"user_id":40604,"is_guest":0,"slug":"basir-gill","display_name":"Basir Gill MD","avatar_url":"https:\/\/secure.gravatar.com\/avatar\/05064ea2c277f8906826ab0662151459a584dc4b50046758e59dbf39135256c6?s=96&r=g","0":null,"1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":""}],"_links":{"self":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/139798","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/users\/40604"}],"replies":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=139798"}],"version-history":[{"count":1,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/139798\/revisions"}],"predecessor-version":[{"id":139800,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/139798\/revisions\/139800"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/media\/139799"}],"wp:attachment":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=139798"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=139798"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=139798"},{"taxonomy":"author","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fppma_author&post=139798"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}