Percutaneous coronary intervention for the left main stem and other bifurcation lesions: 12th consensus document from the European Bifurcation Club

Abstract

The European Bifurcation Club (EBC) was initiated in 2004 to support a continuous overview of the field of coronary artery bifurcation interventions and aims to facilitate a scientific discussion and an exchange of ideas on the management of bifurcation disease. The EBC hosts an annual, two-day compact meeting, dedicated to bifurcations, which brings together physicians, pathologists, engineers, biologists, physicists, mathematicians, epidemiologists and statisticians for detailed discussions. Every meeting is finalised with a consensus statement that reflects the unique opportunity of combining the opinion of interventional cardiologists with the opinion of a large variety of other scientists on bifurcation management. A series of consensus sessions dedicated to specific topics, to strengthen the consensus debates and focus the discussions, was introduced at this year's meeting. The sessions comprise an intensive overview of the present literature, a pro and con debate and a voting system, to guide the consensus-building process. The present document represents the summary of the up-to-date EBC consensus and recommendations from the 12th annual EBC meeting in 2016 in Rotterdam.

Concept and practice of transradial 5 French percutaneous treatment of coronary bifurcation lesions

“…Coronary bifurcation lesions are lesions occurring sufficiently close to a significant division of a major coronary artery that thus requires to be taken into account during percutaneous treatment . To this aim, numerous techniques have been developed and over the years, a strategy of crossover MV stenting has emerged as the most appropriate approach to the complex anatomic diversity of coronary bifurcations . When implementing the so‐called provisional SB stenting technique, balloon dilation through the side of the MV stent to open a cell toward the SB may however be required .…”

“…To this aim, numerous techniques have been developed and over the years, a strategy of crossover MV stenting has emerged as the most appropriate approach to the complex anatomic diversity of coronary bifurcations . When implementing the so‐called provisional SB stenting technique, balloon dilation through the side of the MV stent to open a cell toward the SB may however be required . When a unique balloon is used for this purpose, marked stent distortion occurs .…”

“…16 In bifurcation PCI, the simple one-stent strategy, also known as provisional side branch (SB) stenting technique, is supported by numerous trials that systematically failed to show better results with a two-stent approach [17][18][19][20][21][22][23] and is accordingly recommended as the standard approach for treatment of bifurcation lesions. 14,24,25 Furthermore, the proximal optimization technique (POT) associated with single balloon SB inflation is gaining support as a valid kissing balloon alternative to allow SB dilation without compromising the main vessel (MV) stent geometry. 26,27 On this background, the need for using two devices may become infrequent thus paving the way for slender transradial bifurcation PCI.…”

Letter by Dérimay et al regarding the article: “Coronary bifurcation bench test using multimodality imaging: Impact of stent strut link location on stent deformity and jailed side‐branch orifices during reproximal optimizing technique” by Kume et al

“…Moreover, in this study, the authors used exclusively noncompliant (NC) balloons for the POTs. Compliant or NC balloons are recommended for the POT by the European Bifurcation Club . However, during the POT, the objective is just to post dilate the stent greater than the mother vessel target diameter (stent artery ratio > 1).…”

PCI or CABG for unprotected left main coronary artery disease?—new evidence justifies a change in perspective R. Andrew Archbold

“…Rates of clinically driven TLR, angiographic restenosis, and cardiac death were not significantly different between groups (24). Irrespective of stent strategy, use of the proximal optimisation technique (POT), in which a short balloon is used to post-dilate the proximal main branch to the carina, is encouraged at the end of the procedure in order to optimise stent expansion in the main branch and preserve the bifurcation anatomy (25).…”