A provisional stenting approach remains the preferred strategy for most coronary bifurcation lesions, while dedicated two-stent techniques should be considered for more complex anatomy.
The 15th European Bifurcation Club consensus document reaffirms the provisional stenting approach for most coronary bifurcation lesions and provides updated guidance on complex and left main bifurcations.
The 15th European Bifurcation Club (EBC) meeting was held in Barcelona in October 2019. It facilitated a renewed consensus on coronary bifurcation lesions (CBL) and unprotected left main (LM) percutaneous interventions. Bifurcation stenting techniques continue to be refined, developed and tested. It remains evident that a provisional approach with optional side branch treatment utilising T, T and small protrusion (TAP) or culotte continues to provide flexible options for the majority of CBL patients. Debate persists regarding the optimal treatment of side branches, including assessment of clinical significance and thresholds for bail-out treatment. In more complex CBL, especially those involving the LM, adoption of dedicated two-stent techniques should be considered. Operators using such techniques have to be fully familiar with their procedural steps and should acknowledge associated limitations and challenges. When using two-stent techniques, failure to perform a final kissing inflation is regarded as a technical failure, since it may jeopardise clinical outcome. The development of novel technical tools and drug regimens deserves attention. In particular, intracoronary imaging, bifurcation simulation, drug-eluting balloon technology and tailored antiplatelet therapy have been identified as promising tools to enhance clinical outcomes. In conclusion, the evolution of a broad spectrum of bifurcation PCI components has resulted from studies extending from bench testing to randomised controlled trials. However, further advances are still needed to achieve the ambitious goal of optimising the clinical outcomes for every patient undergoing PCI on a CBL.
Burzotta et al. (Mon,) conducted a review in Coronary bifurcation lesions and unprotected left main disease. Percutaneous coronary intervention (provisional vs. two-stent techniques) was evaluated. A provisional stenting approach remains the preferred strategy for most coronary bifurcation lesions, while dedicated two-stent techniques should be considered for more complex anatomy.
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