[Hot issues in bifurcation lesions PCI in 2019]

Area of Science:

• Interventional Cardiology
• Cardiovascular Medicine
• Medical Devices

Background:

• Coronary bifurcations represent 15-20% of percutaneous coronary interventions (PCI).
• These lesions pose significant challenges in interventional cardiology, impacting procedural success and long-term cardiac events.
• Optimal management strategies for bifurcation lesions are actively debated.

Purpose of the Study:

• To outline the current best practices for managing coronary bifurcation lesions during PCI.
• To emphasize the importance of a structured approach, including assessment, planning, and specific stenting techniques.
• To highlight the role of advanced imaging and physiological assessment tools.

Main Methods:

• The study reviews current literature and expert consensus on coronary bifurcation lesion management.
• It describes the preferential strategy of main vessel (MV) stenting with proximal optimisation technique (POT).
• It discusses the role of provisional side branch (SB) stenting and situations requiring two stents, emphasizing optimal deployment and expansion.
• It notes the utility of intracoronary imaging (IVUS, OCT) and fractional flow reserve (FFR).

Main Results:

• The preferential strategy for PCI of bifurcation lesions is MV stenting with POT and provisional SB stenting.
• Final kissing balloon inflation is not universally recommended.
• In cases requiring two stents, careful deployment and optimal expansion are crucial for long-term success.
• Intracoronary imaging and FFR are valuable tools for optimizing results.

Conclusions:

• The sequential provisional approach, starting with MV stenting and POT, is the preferred strategy for most coronary bifurcation lesions.
• Careful technique and use of advanced imaging/FFR are essential for achieving optimal outcomes, especially when two stents are needed.
• Further research may refine optimal management, but current evidence supports a structured, technique-dependent approach.