Percutaneous coronary intervention for coronary bifurcation lesions

Abstract

Percutaneous coronary intervention (PCI) of lesions at coronary bifurcations poses a technical challenge. Short-term complications, including periprocedural myocardial infarction, and long-term complications such as in-stent restenosis and stent thrombosis, are higher in patients with bifurcation lesions. Techniques for PCI of bifurcation lesions include stenting of the main branch alone, and the use of two or more stents to cover the main and side branches. Two- or three-stent techniques include T-stenting, crush, culotte, simultaneous kissing stents, V-stenting, and Y-stenting. The goal of these techniques is to minimize areas of vessel that are not covered by stent. Dedicated bifurcation stents exist, including stents with apertures that allow standard stents to be placed within the aperture. Simultaneous kissing balloon angioplasty in the two branches should be performed to optimize angiographic results. Many studies exist comparing the different techniques; however, no consensus exists on the preferred method.