Fundamentals of percutaneous coronary bifurcation interventions

Abstract

Coronary bifurcation lesions (CBLs) account for 15%-20% of all percutaneous coronary interventions. The complex nature of these lesions is responsible for poorer procedural, early and late outcomes. This complex lesion subset has received great attention in the interventional cardiac community, and multiple stenting techniques have been developed. Of these, the provisional stenting technique is most often the default strategy; however, the elective double stenting (EDS) technique is preferred in certain subsets of complex CBLs. The double kissing crush technique may be the preferred EDS technique because of its efficacy and safety in comparative trials; however, this technique consists of many steps and requires training. Many new methods have recently been added to the EDS techniques to provide better stent scaffolding and to reduce early and late adverse outcomes. Intravascular imaging is necessary to determine the interventional strategy and postinterventional results. This review discusses the basic concepts, contemporary percutaneous interventional technical approaches, new methods, and controversial treatment issues of CBLs.

Keywords: Percutaneous coronary intervention, Coronary artery disease, Drug-eluting stents, Bifurcation lesion, Stenting technique, Left main intervention

Core Tip: Coronary bifurcation lesions are one of the most challenging subsets in percutaneous interventions. Many different interventional techniques have been used to overcome the relatively poor procedural and long term outcomes of these lesions of great interest. In this review, basic aspects of coronary bifurcation lesions and step-by-step classical stenting techniques, as well as recently introduced techniques, modifications, trials and important issues in the latest guidelines are discussed.