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.

Successful management of Ellis III coronary perforation and complex bifurcation lesion of the right coronary artery in a patient with high- risk coronary anatomy. A case report

“…On the other hand, coronary bifurcation lesions (CBL) represent one of the most challenging treatments in interventional cardiology. They account for approximately 15-20% of all PCIs 6 . For more than 15 years, the technique of choice for the management of CBL has been the provisional stenting technique (PST); however, over time, the concepts of complex CBL have been developed and, likewise, various double stenting techniques (DST) have been perfected.…”

Analyzing coronary bifurcation structures: Towards personalized balloon angioplasty and stent deployment

“…To restore the native geometry in the bifurcation region, some approximation of the pre-diseased shape is required. True bifurcation lesions tend to have stenoses in the outer walls of the bifurcation core, opposite to the carina [23][24][25][26]. The presence of these lesions makes direct measurement of the widest intended region in the bifurcation core difficult.…”