The story of side branch predilatation before provisional stenting

Bifurcation lesions remain a therapeutic challenge and present an increased risk of complications. It also seems clear that the provisional stenting strategy, using only one drug-eluting stent in the main vessel (MV), is the first choice of treatment for most patients. However, provisional stenting is not a unitary approach, and diverse technical possibilities such as the use of final kissing balloon inflation, or the type of drug-eluting stent implanted at the MV may influence the outcome of the procedure. In the context of provisional stenting, predilation of the side branch (SB) before MV stent implantation is another manoeuvre which could facilitate the performance of this technique. However, SB predilation has generated many controversies and it has been discussed at length during several sessions of the European Bifurcation Club meetings. In this paper we analyse the advantages and disadvantages of side branch predilation as well as the most relevant articles dealing with this topic. We conclude that predilation of the SB is in many cases probably not needed, but may be considered in order to simplify the procedure. Predilation of the SB is recommended when SB compromise after MV stenting is highly anticipated, such as in long ostial SB lesions or heavily calcified lesions.