Approach to Treatment of Bifurcation Lesions

Bifurcation lesions are frequently encountered in the cath lab [1] and remain a challenge for conventional percutaneous coronary intervention (PCI) techniques. Although provisional stenting remains the default approach for most bifurcation lesions [2-6], the two-stent technique is more appropriate in certain situations. If a two-stent strategy is selected, then final kissing balloon inflation (KBI) should be performed. Adjunctive assessment with intravascular imaging (intravascular ultrasound (IVUS)/optical coherence tomography (OCT)) and physiologic testing (fractional flow reserve, FFR) should be performed liberally. Drug-eluting stents (DES) are typically utilized to reduce the risk of restenosis in bifurcation disease.