Coronary Bifurcation PCI-Part I: Fundamentals

Area of Science:

• Interventional Cardiology
• Cardiovascular Surgery

Background:

• Percutaneous coronary intervention (PCI) of bifurcation lesions presents significant technical challenges in interventional cardiology.
• Optimal strategies are crucial for maintaining main vessel and side branch patency, with ongoing evolution in provisional versus two-stent approaches.

Purpose of the Study:

• To provide a comprehensive narrative review of current knowledge on bifurcation PCI.
• To serve as a practical, technique-focused reference for interventionalists and trainees managing complex coronary bifurcations.

Main Methods:

• Synthesis of current scientific literature on bifurcation PCI.
• Detailed description of anatomical classifications, lesion assessment, and procedural planning.
• In-depth explanation of techniques such as T and Protrusion (TAP), double-kissing (DK) crush, mini-crush, culotte, and V-stent.

Main Results:

• The review outlines various techniques for bifurcation PCI, including established and emerging modifications.
• It emphasizes the importance of tailoring strategy selection based on lesion complexity, procedural objectives, and patient factors.
• The choice between provisional and two-stent strategies is contextualized within these considerations.

Conclusions:

• Effective management of bifurcation lesions requires careful planning and precise execution of chosen PCI techniques.
• This review serves as a foundational resource for interventional cardiologists seeking to enhance their skills in complex bifurcation interventions.
• The selection of the optimal PCI strategy is multifactorial, integrating anatomical, procedural, and patient-specific elements.