The Patient, Lesion, Operator, Technique, and Outcomes (PLOTO) framework provides a systematic approach to optimize percutaneous coronary intervention for complex bifurcation lesions.
The proposed PLOTO framework provides a structured, algorithmic approach to simplify decision-making and optimize outcomes in the technically challenging percutaneous treatment of coronary bifurcation lesions.
Percutaneous coronary intervention (PCI) of coronary bifurcation lesions remains one of the most technically challenging procedures in interventional cardiology due to the complex anatomy and diverse lesion characteristics. These lesions account for approximately 15–25% of all PCI cases and are associated with higher rates of restenosis and adverse clinical outcomes compared to non-bifurcation lesions. Despite advancements in stent technology and procedural techniques, managing bifurcation lesions requires a tailored strategy that considers patient factors, lesion morphology, operator expertise, and outcome goals. This review introduces the Patient, Lesion, Operator, Technique, and Outcomes (PLOTO) framework, an innovative, algorithmic, and systemic approach to bifurcation PCI. Emphasis is placed on lesion assessment, including Medina classification, bifurcation angle, calcification, and imaging guidance, and the choice between provisional and two-stent strategies. Practical recommendations and evidence from contemporary studies are integrated to guide optimal procedural planning and execution, aiming to simplify complexity while enhancing clinical results.
Kassier et al. (Fri,) conducted a review in Coronary bifurcation lesions. Percutaneous coronary intervention (PCI) was evaluated. The Patient, Lesion, Operator, Technique, and Outcomes (PLOTO) framework provides a systematic approach to optimize percutaneous coronary intervention for complex bifurcation lesions.
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