Percutaneous treatment of left main and non-left main bifurcation coronary lesions using drug-eluting stents

Area of Science:

• Interventional Cardiology
• Cardiovascular Surgery

Background:

• Coronary artery bifurcation lesions present unique challenges in percutaneous coronary intervention.
• Current guidelines favor the single-stent technique for most bifurcation treatments.

Purpose of the Study:

• To review current evidence and guidelines for coronary bifurcation stenting.
• To discuss optimal stent deployment and optimization techniques for bifurcations.

Main Methods:

• Review of current evidence and guidelines.
• Discussion of single-stent and double-stent techniques.
• Emphasis on post-stenting optimization strategies.

Main Results:

• Single-stent technique is the default; routine final kissing balloon inflation is not recommended unless side branch compromise is significant.
• Double-stent technique remains an option for complex bifurcations with large side branches.
• All stenting techniques require optimization via post-dilation, kissing balloon, or proximal optimization technique (POT).
• Intravascular ultrasound (IVUS) is valuable for pre- and post-stenting assessment.

Conclusions:

• The single-stent technique is preferred for coronary bifurcations, but stent optimization is paramount.
• Kissing balloon inflation and POT are key optimization steps.
• Intravascular ultrasound enhances procedural success by providing detailed anatomical and stent deployment information.