Key result
Single-stent technique with IVUS guidance remains the recommended default strategy for coronary bifurcations.
The single-stent technique remains the default strategy for coronary bifurcation lesions, with a strong emphasis on stent optimization and intravascular ultrasound guidance.
Reinforces single-stent bifurcation strategy; leaves open need for RCTs validating IVUS optimization.
Current evidence and guidelines support the use of the single-stent technique as the default treatment strategy for the treatment of coronary bifurcations. For the single-stent technique, routine final kissing balloon inflation is not recommended, unless side branch ostial stenosis is assumed to be functionally significant. The double-stent technique is still a viable option for bifurcations with large and severely diseased side branches. Due to the unique features of bifurcation anatomy and bifurcation stenting techniques, all deployed stents should be optimized by postdilation, kissing balloon inflation and/or the proximal optimization technique, regardless of the stenting technique used. Intravascular ultrasound can guide preimplantation decision-making and postimplantation optimization by providing information on reference diameter, plaque burden and distribution, and stent underexpansion and malapposition.
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Roh et al. (2015) conducted a review in Coronary bifurcations. Percutaneous treatment using drug-eluting stents was evaluated. The single-stent technique is recommended as the default strategy for coronary bifurcations, with intravascular ultrasound guiding preimplantation decision-making and postimplantation optimization.
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