Percutaneous coronary intervention for coronary bifurcation disease: consensus from the first 10 years of the European Bifurcation Club meetings

Abstract

The European Bifurcation Club (EBC) is an independent, non-political and informal "think tank" of scientists with a particular interest in clinical, technical and fundamental aspects of the management of coronary artery bifurcation disease. Bifurcations account for 15-20% of all percutaneous coronary interventions (PCI) and remain one of the most challenging lesions in interventional cardiology in terms of procedural success rate as well as long-term cardiac events. The optimal management is, despite a fast growing scientific literature, still the subject of considerable debate, one of the main concerns being the potential increased risk of late stent thrombosis associated with treatment complexity. The EBC was initiated in 2004 and aims to facilitate an exchange of ideas on management of bifurcation disease. The EBC hosts an annual, compact meeting dedicated to bifurcations which brings together physicians, engineers, biologists, physicists, epidemiologists and statisticians for detailed discussions. Every meeting is finalised with a consensus statement which reflects the unique opportunity of combining the opinion of interventional cardiologists with the opinion of a large variety of other scientists on bifurcation management. This year the EBC celebrates its 10-year anniversary. This consensus document represents the summary of the consensus from the last ten years of the annual EBC meetings.

Is it possible to further improve clinical results with coronary bifurcation stenting, or what is more important — the technique or the stent?

“…These results reflect the earlier results with SB flow-guided strategy, performed with a first-generation DES (with a difference of more than doubled restenosis rates at shorter follow-up time) [46]. Some authors are against SB predilatation considering the potential for major dissection of the SB ostium, requiring additional stenting (which is also the official position of the European Bifurcation Club) [2]. However, the randomised study comparing predilatation with no-predilatation before main vessel stenting demonstrated improved TIMI flow after MB stenting and less indication to subsequently treat the SB [47].…”

“…These results are comparable with results from other studies shown in the Table 1. The most important asset of this analysis is the large number of patients constituting a homogenous group treated systematically with provisional T-stenting, currently the most recommended strategy [2]. These results from Germany are in accordance with the pooled analysis of coronary bifurcation patients treated with a first-and second-generation DES [25].…”

“…The point is to define what is significant side branch -a branch, which occlusion will cause significant ischaemia and/or ventricular dysfunction in short-term or long-term follow-up [1][2][3], but most importantly -how much and what type of ostial compromise (stenosis) or flow in the branch would not result in myonecrosis or significant (symptom causing and electrocardiogram changes causing) ischaemia? We and others [28,40,42] have demonstrated that the most important mechanism of SB stenosis occurrence is displacement of the bifurcation carina tip from stent struts in the direction of the SB ostium.…”

“…Coronary bifurcation are involved in 20-25% of all percutaneous coronary interventions (PCI) [1,2]. Bifurcation interventions, when compared with non-bifurcation interventions, have a lower rate of procedural success and a higher rate of restenosis, which is definitely true for the era of bare metal stents (BMS) and early experience with drug-eluting stents (DES) [2].…”

“…Bifurcation interventions, when compared with non-bifurcation interventions, have a lower rate of procedural success and a higher rate of restenosis, which is definitely true for the era of bare metal stents (BMS) and early experience with drug-eluting stents (DES) [2]. Different techniques with the use of one or two stents have been developed to optimise the treatment of this subset of lesions.…”