How to perform the reverse crush technique for bifurcation stenting

Step-by-step description of the reverse crush (also called "internal crush") technique for bifurcation stenting.
Reverse crush is performed during provisional stenting when: (a) the SB is compromised after stenting the main vessel, (b) balloon angioplasty fails to achieve an acceptable SB result, and (c) the SB angulation is less than 70 degrees.
The 10 steps of reverse crush are the following:
1. Rewire SB + remove jailed wire
2. Dilate SB
3. Deliver MV balloon
4. Deliver SB stent
5. Deploy SB stent
6. Remove stent balloon
7. Crush SB stent
8. Rewire SB stent + remove jailed wire
9. Kissing balloon inflation
10. POT

[@haithambatarseh866]

This is the last alternative in saving SB after PCI of the MV, 2 Stent materials in the MV in an asymmetrical fashion, Rewiring 2 times! I do never prefere it at all, Thank you for the Illustration Dr.Brilakis

[@matheuscsmed]

Thank you, Matheus Silva

[@BarrieLouis]

superb!

[@micger]

Thanks for the great video. How do you ensure when you're wiring into the side branch you're going to the distal strut and not the proximal strut of the MV stent?

[@manosbrilakis]

Proximal strut is the goal. OCT can help determine which strut you are crossing through.

[@AhmedElborae]

Thanks Dr Manos for your great illustration. I have a question about the optimum site of re cross through the SB stent before final kissing ( Is it better to recross through proximal strut as DK crush to ensure Carina coverage?
Thanks alot

[@manosbrilakis]

Proximal strut for the same reason it is done for the first recrossing into the side branch

[@Its_ME09976]

Thanks sir, what’s the difference between this technique and TAP technique

[@obscuraterror1891]

Perfect

[@rajarajanmurugaiyan5353]

Hello dr. Manos... After main branch stenting recrossing the side branch is through the distal struts( as in provisional stenting. Once the side branch stentnis crushed, then the crossing is done through the proximal stent.. am I right sir..

[@bassamalsabatien9376]

What if the jailed wired stacked after crushing

[@amanullahsaleh2280]

Hi,
I am highly thankful to Mr. BRIKALIS for uploading these videos. Its really for helpful for student like me.
Consultant Interventional Cardiologist
Dr Aman Ullah Saleh

[@mehmetdemir2369]

In the end , it seems that there is some impingement in the main stent at the carina, so final POT should be done when the distal end of the balloon should be at the carina .

[@manosbrilakis]

Agree

[@Strongcardiology]

Two questions
Why didn't you remove the SB wire before kissing its Stent by MV balloon ?
Why didn't you put the MV balloon opposite the ostium of SB before deploying its stent ?
Thanks sir

[@manosbrilakis]

1. You could remove the wire before crushing the SB stent - I prefer to leave it in place to facilitate recognition of the course of the SB.
2. You could place the MV opposite the ostium of the SB or you would place it distally - both options are fine.