Bifurcation lesions

Summary

Coronary bifurcations are by nature prone to the development of atherosclerosis. They pose technical difficulties for percutaneous interventional treatment and they are associated with higher stent thrombosis and restenosis rates. The optimal approach for true coronary bifurcations is still a subject of debate, especially when the side branch (SB) is large, not easily accessible and narrowed by a long lesion. The overall philosophy is to keep it simple and safe, to understand and respect the original anatomy of the bifurcation, to optimize the flow and function of a bifurcation following percutaneous coronary angioplasty and to limit the number of stents which should be well apposed and expanded with limited overlap. The role of dedicated devices in this setting remains unclear. Complex techniques (using two or three stents) should only be used, when necessary, as they are associated with a worse outcome. FKB is strongly recommended when using a complex bifurcation technique.

The consensus of the European Bifurcation Club (EBC) in 2022 is that main branch (MB) stenting with provisional SB stenting should be the default approach in the majority of cases. This approach is associated with a low risk of failure and complications provided that the following guidelines are...