Defining Key Features of Complex Coronary Lesions: An Evidence Based Review of Clinical Practice. Part I: Bifurcations, Left Main Disease, and Calcifications

Fig. 1.. SCAI expert consensus domains of ‘Complex PCI’, consisting of a mixture of coronary anatomy, patient co-morbidities, and interventional equipment used. Anatomical features listed include particular lesion location and lesion morphology that add to the complexity of PCI. Comorbidities listed include underlying cardiovascular risk factors, non-cardiovascular risk factors and clinical scenarios that add to the complexity of PCI. Equipment listed include devices used to treat particular lesion morphologies, tools used to determine lesion severity and aid in lesion imaging as well as support devices used to stabilize patients, all of which add to the complexity of PCI. Reproduced with permission from Riley et al. [3] Copyright © 2029, John Wiley and Sons.

Fig. 2.. The final two stent conformation in bifurcation lesions based on approach. Crush: The first stent is placed in the side branch with protrusion into the main vessel. The protruding portion is ‘crushed’ against the wall by dilatation with a balloon with subsequent stent placement in the main vessel. The procedure is completed with a final kissing balloon. TAP: The first stent is placed in the main vessel followed by rewiring of the side branch and kissing balloon to open the ostium. Subsequently, the side branch stent is deployed with minimal protrusion and a final kissing balloon is performed. Culotte: The first stent is placed in the side branch with protrusion into the main vessel. The main vessel is rewired through the strut of the first stent. A second stent is then placed in the main vessel and finished with a final kissing balloon.