Coronary Bifurcation Intervention: What Role Do Bifurcation Angles Play?

Bifurcation angles play an important role in coronary bifurcation intervention. Bifurcation angles affect the coronary bifurcation intervention from many aspects: (1) impact the atherosclerosis proliferation via affecting the hemodynamic parameters at bifurcation regions; (2) impact side branch compromise after main vessel stenting via hemodynamics, atherosclerosis proliferation, geometric characteristics, and plaque/carina shift; (3) affect the long-term clinical outcome after coronary bifurcation stenting. Bifurcation angles are key factors to formulate the intervention strategy of stenting procedure and can also be modified by different bifurcation stenting strategies. In the last few years, significant improvements have occurred in understanding the role of bifurcation angles. However, there are still questions remain to be clarified: (1) How to measure the bifurcation angles accurately and comprehensively? (2) How do bifurcation angles impact the immediate and long term outcome of PCI? (3) Why the results of previous studies remain controversial? The exact influence of bifurcation angles on post-PCI effect like side branch compromise and clinical outcome has not been fully elucidated. In this review, we highlight the current knowledge of bifurcation angles, summarize the questions remained to be clarified, and discuss the implications for clinical practice and future studies.