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Bifurcation Disease

What Do We Know, What Should We Do?

Azeem Latib, MB BCh^_*,, Antonio Colombo, MD^_*,,_*

^_* Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
Interventional Cardiology Unit, EMO Centro Cuore Columbus, Milan, Italy
Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa.

^_* Reprint requests and correspondence: Dr. Antonio Colombo, EMO Centro Cuore Columbus, Via Buonarroti 48, 20145 Milan, Italy. (Email: info{at}emocolumbus.it).

The percutaneous treatment of coronary bifurcations has moved past an important milestone in that the 1- versus 2-stent debate appears to have been resolved. The provisional approach of implanting one stent on the main branch should be the default approach in most bifurcations lesions. Selection of the most appropriate strategy for an individual bifurcation is important. Some bifurcations require 1 stent, whereas others require the stenting of both branches. Irrespective of whether a 1- or 2-stent strategy is chosen, the results after bifurcation percutaneous coronary intervention (PCI) have dramatically improved. Dedicated bifurcation stents are an exciting new technology that may further simplify the management of bifurcation PCI and change some of these concepts.

Abbreviations and Acronyms   BMS = bare-metal stent   DES = drug-eluting stent   FFR = fractional flow reserve   FKI = final kissing inflation   IVUS = intravascular ultrasound   MACE = major adverse cardiac event   MB = main branch   PCI = percutaneous coronary intervention   SB = side branch   SES = sirolimus-eluting stent   ST = stent thrombosis   TIMI = Thrombolysis In Myocardial Infarction   TLR = target lesion revascularization

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