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Provisional Strategy for Left Main Stem Bifurcation Disease: A State-of-the-Art Review of Technique and Outcomes

Valeria Paradies1, Adrian Banning2, Davide Cao3

  • 1Department of Cardiology, Maasstad Hospital, Rotterdam, the Netherlands; Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, Rotterdam, the Netherlands.

JACC. Cardiovascular Interventions
|April 12, 2023
PubMed

Insights

Percutaneous coronary intervention is a viable treatment for unprotected left main coronary artery disease. This review examines optimal stenting strategies for left main bifurcation lesions, focusing on provisional stenting and two-stent techniques.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Biology

Background:

  • Left main coronary artery (LMCA) disease affects a significant myocardial area, increasing adverse cardiovascular event risk.
  • LMCA disease is diagnosed in 5-7% of coronary angiographies, with most complex cases involving distal bifurcation/trifurcation.
  • Percutaneous coronary intervention (PCI) is emerging as a treatment for unprotected LMCA disease, yet optimal stenting strategies remain undefined.

Purpose of the Study:

  • To review current evidence on PCI strategies for LMCA bifurcation lesions.
  • To compare provisional stenting with two-stent techniques for LMCA bifurcation disease.
  • To summarize optimal techniques and factors influencing strategy selection in LMCA stenting.

Main Methods:

  • Review of data from randomized controlled trials and prospective registries.
  • Analysis of technical aspects of provisional stenting for LMCA bifurcation.
  • Summary of angiographic and intravascular imaging determinants for escalating to two-stent strategies.

Main Results:

  • PCI is a feasible treatment option for selected patients with unprotected LMCA disease.
  • Evidence supports provisional stenting as a primary strategy, with defined criteria for escalation.
  • Optimal techniques and imaging guidance are crucial for successful LMCA bifurcation stenting.

Conclusions:

  • Provisional stenting is a key strategy for LMCA bifurcation lesions, with specific technical considerations.
  • Escalation to two-stent techniques is guided by lesion complexity and imaging findings.
  • Further research is needed to standardize optimal stenting approaches for LMCA bifurcation disease.

Keywords:
bifurcation treatmentleft main coronary artery diseasepercutaneous coronary interventionprovisional stentingstepwise layered stenting

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