Coronary Bifurcation Lesions

Area of Science:

• Cardiovascular Interventions
• Interventional Cardiology
• Medical Device Technology

Background:

• Percutaneous coronary intervention (PCI) using drug-eluting stents (DES) for coronary bifurcation lesions (CBLs) presents significant technical challenges.
• CBLs are associated with higher acute and chronic complication rates compared to non-bifurcation lesions.
• Optimizing PCI strategies for CBLs remains a critical area of research in interventional cardiology.

Purpose of the Study:

• To compare the efficacy and safety of different PCI strategies for CBLs.
• To evaluate the role of the double kissing (DK) crush technique versus provisional stenting (PS) in complex CBLs.
• To highlight the importance of intracoronary imaging and physiologic evaluation in guiding CBL intervention.

Main Methods:

• Review and analysis of current literature on PCI techniques for CBLs.
• Comparison of outcomes between provisional stenting (PS) and double kissing (DK) crush techniques.
• Assessment of the utility of intracoronary imaging and physiologic assessment in optimizing PCI for CBLs.

Main Results:

• Provisional stenting (PS) is the default strategy for most CBLs.
• The double kissing (DK) crush technique demonstrates superior clinical outcomes compared to PS in complex left main (LM)-CBLs and non-LM-CBLs stratified by the DEFINITION criteria.
• Intracoronary imaging and/or physiologic evaluation are valuable tools for optimizing PCI in CBLs.

Conclusions:

• While PS is standard for most CBLs, DK crush should be considered for complex cases based on DEFINITION criteria.
• Intracoronary imaging and physiologic guidance are essential for successful CBL intervention.
• Further research is needed to establish the role of drug-coated balloons in treating CBLs.