A Rare “Double DK Crush” PCI: Precision Redefined in Complex Coronary Disease

“Double DK Crush” PCI: Precision Redefined in Complex Coronary Disease

A 71-year-old female patient presented to the emergency department with symptoms suggestive of acute coronary syndrome. Coronary angiography revealed severe, complex left coronary artery disease involving the left system, traditionally best managed with Coronary Artery Bypass Grafting (CABG).

After a detailed Heart Team discussion, CABG was strongly advised considering the complexity of the lesions. However, after understanding the risks and benefits, the patient declined surgical intervention and opted for a percutaneous solution.

The Challenge

The patient had complex bifurcation disease of the left coronary system, requiring advanced interventional expertise. Standard PCI techniques would not ensure optimal long-term outcomes in such anatomy.

The Solution

Dr. Ashish Agarwal performed a highly complex, precision-driven PCI, achieving complete restoration of the left coronary system using the DK Crush technique—a globally recognized gold-standard approach for complex bifurcation lesions.

What makes this case exceptional is that DK Crush itself involves “Double Kissing” balloon inflations, and in this procedure, a “Double–Double DK Crush” strategy was meticulously executed—an approach rarely performed and seldom reported, demanding extraordinary technical skill, timing, and anatomical understanding.

The Outcome

• Complete revascularization of the left coronary system
• Excellent angiographic result
• Optimal stent expansion and side-branch preservation
• Hemodynamically stable post-procedure

Why This Case Is Unique

This procedure stands out as one of its kind, demonstrating that with expert hands, advanced techniques, and precise execution, even the most complex coronary anatomies can be treated successfully without surgery when patients are unwilling or unfit for CABG.

A Testament to Advanced Interventional Cardiology

This case reflects Dr. Ashish Agarwal’s expertise in complex coronary interventions, showcasing how innovation, experience, and precision can redefine treatment possibilities—offering patients world-class outcomes with minimally invasive solutions.