Ten tips and tricks of bifurcation percutaneous coronary intervention

Bifurcation lesions represent one of the most technically challenging subsets in PCI and accounts for approximately 15-20% of all interventions. The complex anatomy of bifurcation segments due to varying vessel diameters, plaque distributions, carinal geometry makes side branch patency and stent optimization difficult. Procedural complications such as side branch occlusion, stent malposition, and restenosis are more frequent in bifurcation interventions compared with non-bifurcation lesions. Over the past decade, several dedicated techniques and strategies have been developed to improve outcomes in these lesions. While provisional stenting of the main vessel remains the default approach in most bifurcations, complex anatomy may necessitate planned two-stent strategies. This article focuses on a practical and stepwise approach to bifurcation PCI, highlighting procedural planning, commonly used techniques, optimization strategies, and practical tips to improve procedural success and long-term outcomes.