Key result
The provisional one-stent approach for left main bifurcation stenosis is associated with more favorable outcomes than the two-stent technique and is the preferred strategy for most patients.
Why the study?
What is the optimal stenting strategy and role of intravascular imaging and physiology in percutaneous left main bifurcation intervention?
What is the optimal stenting strategy and role of intravascular imaging and physiology in percutaneous left main bifurcation intervention?
This review highlights that the provisional one-stent approach is preferred for most left main bifurcation lesions, emphasizing the importance of IVUS and FFR guidance to optimize procedural success and long-term outcomes.
Should not yet change practice; leaves open need for randomized confirmation of provisional stenting benefit.
Despite the recent developments that have been made in the field of percutaneous left main (LM) intervention, the treatment of distal LM bifurcation remains challenging. The provisional one-stent approach for LM bifurcation has shown more favorable outcomes than the two-stent technique, making the former the preferred strategy in most types of LM bifurcation stenosis. However, elective two-stent techniques, none of which has been proven superior to the others, are still used in patients with severely diseased large side branches to avoid acute hemodynamic compromise. Selecting the proper bifurcation treatment strategy using meticulous intravascular ultrasound evaluation for side branch ostium is crucial for reducing the risk of side branch occlusion and for improving patient outcomes. In addition, unnecessary complex intervention can be avoided by measuring fractional flow reserve in angiographically isolated side branches. Most importantly, good long-term clinical outcomes are more related to the successful procedure itself than to the type of stenting technique, emphasizing the greater importance of optimizing the chosen technique than the choice of method.
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Ahn et al. (2016) conducted a review in Left main bifurcation stenosis. Provisional one-stent approach vs. Two-stent technique was evaluated. The provisional one-stent approach for left main bifurcation stenosis is associated with more favorable outcomes than the two-stent technique and is the preferred strategy for most patients.
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