Percutaneous coronary intervention for coronary bifurcation disease: 11th consensus document from the European Bifurcation Club

Abstract

Coronary bifurcations are involved in 15-20% of all percutaneous coronary interventions (PCI) and remain one of the most challenging lesions in interventional cardiology in terms of procedural success rate as well as long-term cardiac events. The optimal management of bifurcation lesions is, despite a fast growing body of scientific literature, the subject of considerable debate. The European Bifurcation Club (EBC) was initiated in 2004 to support a continuous overview of the field, and aims to facilitate a scientific discussion and an exchange of ideas on the management of bifurcation disease. The EBC hosts an annual, compact meeting, dedicated to bifurcations, which brings together physicians, engineers, biologists, physicists, epidemiologists and statisticians for detailed discussions. Every meeting is finalised with a consensus statement which reflects the unique opportunity of combining the opinions of interventional cardiologists with the opinions of a large variety of other scientists on bifurcation management. The present 11th EBC consensus document represents the summary of the up-to-date EBC consensus and recommendations. It points to the fact that there is a multitude of strategies and approaches to bifurcation stenting within the provisional strategy and in the different two-stent strategies. The main EBC recommendation for PCI of bifurcation lesions remains to use main vessel (MV) stenting with a proximal optimisation technique (POT) and provisional side branch (SB) stenting as a preferred approach. The consensus document covers a moving target. Much more scientific work is needed in non-left main (LM) and LM bifurcation lesions for continuous improvement of the outcome of our patients.

Anatomic assessment of the left main bifurcation and dynamic bifurcation angles using computed tomography angiography

“…On the other hand, culottes or mini-crush techniques are preferred for Y-shaped or V-shaped (< 70%) distal LMCA BA [19,20,26,29]. Substantive role of distal LMCA BA on procedural side branch (SB) occlusion and patients' outcome is controversial [19,20,26]. Previous studies have found that LMCA distal BA > 70° carries higher risk of SB occlusion than distal BA < 70° [1].…”

“…The European Bifurcation Club has advised routine measurement of LMCA-LAD BA (or distal LMCA BA) for planning bifurcation treatment strategy and for the prediction of procedural outcomes [19,20,26,29]. A T-stent or modified T-stent, or TAP (T-and-protrusion) techniques are considered for T-shaped (≥ 70%) LMCA distal BA lesions because of its contribution to complete coverage of the bifurcation [19,20,26,29].…”

“…A T-stent or modified T-stent, or TAP (T-and-protrusion) techniques are considered for T-shaped (≥ 70%) LMCA distal BA lesions because of its contribution to complete coverage of the bifurcation [19,20,26,29]. On the other hand, culottes or mini-crush techniques are preferred for Y-shaped or V-shaped (< 70%) distal LMCA BA [19,20,26,29]. Substantive role of distal LMCA BA on procedural side branch (SB) occlusion and patients' outcome is controversial [19,20,26].…”

Impact of plaque type and side branch geometry on side branch compromise after provisional stent implantation: a simulation study

“…Coronary bifurcation lesions, which account for approximately 15-20% of total coronary lesions, represent a challenge in percutaneous coronary intervention in terms of both procedural success rate and long-term cardiac events 1 . Currently, the standard of care to treat a bifurcation lesion is the provisional side branch (PSB) approach 1 .…”

“…Currently, the standard of care to treat a bifurcation lesion is the provisional side branch (PSB) approach 1 . A potential complication of this procedure is the aggravation of side branch (SB) ostial stenosis after stent implantation in the main branch (MB) 1,2 and the associated increased risk of periprocedural myocardial infarction [3][4][5] .…”