[Treatment of coronary bifurcation lesions]

Percutaneous treatment of coronary bifurcation lesions remains a challenge for interventional cardiology, both for technical aspects and long-term clinical results. Albeit coronary bifurcation encompasses 15-20% of all lesions treated in the cardiology laboratory, and their treatment has improved due to continuous progress in techniques and materials, such lesions are still related to a higher incidence of periprocedural complications, need for reinterventions, stent thrombosis, and adverse clinical events. In this context, drug-eluting stent introduction has reduced the incidence of restenosis compared to traditional bare-metal stents but it has not modified strategic modalities of treatment. Indeed, the incidence of restenosis at the ostium of the side branch still remains high regardless of the technique used (single or double stent strategy). Therefore, provisional stenting technique still remains the preferred treatment strategy in most cases. The introduction of dedicated stents, which have been designed to reduce most technical difficulties of treating such lesions, did not translate into an improvement in the long-term clinical results. In this review, we will summarize the anatomical characteristics of coronary bifurcations and the technical difficulties related to their treatment with the aim at discussing the best strategic approach.