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Percutaneous coronary intervention for coronary bifurcation disease: 11th consensus document from the European
Jens Flensted Lassen1, Niels Ramsing Holm, Adrian Banning
1Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Insights
Coronary bifurcation lesions are complex PCI challenges. The European Bifurcation Club recommends main vessel stenting with proximal optimisation technique and provisional side branch stenting as the preferred approach for improved patient outcomes.
Area of Science:
- Interventional Cardiology
- Cardiovascular Disease Management
- Medical Device Technology
Background:
- Coronary bifurcations represent 15-20% of percutaneous coronary interventions (PCI).
- Managing bifurcation lesions poses significant challenges to procedural success and long-term cardiac event rates.
- Optimal treatment strategies for bifurcation lesions remain a subject of ongoing debate within the cardiology community.
Purpose of the Study:
- To provide an updated consensus and recommendations on the management of coronary bifurcation lesions.
- To facilitate scientific discussion and idea exchange on bifurcation disease management.
- To summarize the European Bifurcation Club's (EBC) latest consensus on bifurcation stenting strategies.
Main Methods:
- The European Bifurcation Club (EBC) convenes annual meetings with multidisciplinary experts.
- Consensus statements are developed based on detailed discussions among interventional cardiologists and scientists.
- This document represents the 11th EBC consensus, summarizing current recommendations.
Main Results:
- Multiple stenting strategies exist for bifurcation lesions, including provisional and two-stent approaches.
- The primary EBC recommendation emphasizes main vessel (MV) stenting combined with proximal optimisation technique (POT) and provisional side branch (SB) stenting.
- This approach is favored for its procedural efficacy and potential to improve patient outcomes.
Conclusions:
- The management of coronary bifurcations requires careful consideration of various stenting strategies.
- The recommended approach of MV stenting with POT and provisional SB stenting offers a preferred pathway.
- Further research is crucial for non-left main (LM) and LM bifurcation lesions to continuously enhance patient outcomes.
Abstract:
Coronary bifurcations are involved in 15-20% of all percutaneous coronary interventions (PCI) and remain one of the most challenging lesions in interventional cardiology in terms of procedural success rate as well as long-term cardiac events. The optimal management of bifurcation lesions is, despite a fast growing body of scientific literature, the subject of considerable debate. The European Bifurcation Club (EBC) was initiated in 2004 to support a continuous overview of the field, and aims to facilitate a scientific discussion and an exchange of ideas on the management of bifurcation disease. The EBC hosts an annual, compact meeting, dedicated to bifurcations, which brings together physicians, engineers, biologists, physicists, epidemiologists and statisticians for detailed discussions. Every meeting is finalised with a consensus statement which reflects the unique opportunity of combining the opinions of interventional cardiologists with the opinions of a large variety of other scientists on bifurcation management. The present 11th EBC consensus document represents the summary of the up-to-date EBC consensus and recommendations. It points to the fact that there is a multitude of strategies and approaches to bifurcation stenting within the provisional strategy and in the different two-stent strategies. The main EBC recommendation for PCI of bifurcation lesions remains to use main vessel (MV) stenting with a proximal optimisation technique (POT) and provisional side branch (SB) stenting as a preferred approach. The consensus document covers a moving target. Much more scientific work is needed in non-left main (LM) and LM bifurcation lesions for continuous improvement of the outcome of our patients.