Stenting of Coronary Bifurcation Lesions: a Literature and Technical Review

Abstract

Newer generation drug-eluting stents have improved outcomes in various subsets of coronary lesions including bifurcation lesions. This article reviews the current literature on various issues in bifurcation percutaneous coronary intervention (PCI). Generally, the provisional approach of placing one stent in the main vessel is the preferred first-line treatment for most bifurcation lesions. However, some lesions require 2-stenting. It is unknown whether 2nd-generation DES have improved outcomes with 2-stenting. The use of fractional flow reserve (FFR) for the assessment of functional significance of the jailed side branch can help avoid unnecessary stenting in complex lesions. Skilled techniques in every step of the 2-stenting process and meticulous use of imaging techniques including IVUS or OCT are warranted to obtain optimal angiographic and clinical results. Dedicated bifurcation stents are feasible treatment options and may change future concepts in bifurcation PCI, although larger trials with control groups are required in order to widely apply these techniques into daily routine practice.

Innovation in 3D Braiding Technology and Its Applications

“…In this case, only the main branch is stented and the opening to the side branch is realized by means of balloon dilatation. When using the two-stent technique, different procedures are used depending on the case at hand, e.g., the Coulotte technique, T-stenting, crush stenting, Y-stenting, or the kissing stent technique [35,36].…”

Long-term treatment effect and adverse events of a modified jailed-balloon technique for side branch protection in patients with coronary bifurcation lesions

“…Approximately 15 to 20% of percutaneous coronary interventions (PCI) are performed to treat coronary bifurcation lesions [10, 11]. PCI of bifurcation lesions is technically challenging and associated with lower success rates and higher frequency of immediate and long-term adverse outcomes [12, 13]. Despite randomized studies and observational series, the selection of the optimal interventional strategy for true coronary bifurcation lesions remains controversial because of the variability in side branch (SB) disease and the desire to preserve the patency of the SB [14, 15].…”

Cardiovascular outcomes associated with crush versus provisional stenting techniques for bifurcation lesions: a systematic review and meta-analysis

“…Percutaneous coronary intervention (PCI) for bifurcation lesions which accounts for approximately 15 to 20% of patients undergoing this invasive procedure [1] has often been challenging for interventional cardiologists [2]. Even if the estimated annual cost of PCI for bifurcation lesions in the United States is approximately $ 4.4 billion [3], what matters at a later stage is the technique applied in order to prevent future complications [4]. With recent technological progress in interventional cardiology, application of the correct intra-procedural technique is vital to generate beneficial outcomes after coronary angioplasty.…”