Coronary Bifurcation Disease and Bifurcation Stenting: A Practical Approach

Approximately 20% of percutaneous coronary interventions (PCIs) are performed to treat coronary bifurcations. PCIs in bifurcation lesions have been associated with lower procedural success rates and worse clinical outcomes than non-bifurcation lesions. In addition, PCIs in bifurcation are renowned for being technically demanding. Indeed, there are several challenges in percutaneous treatment of bifurcation lesions to take into account, including: 1) localisation, size, and angle of bifurcation branches in coronary tree (e.g. left main versus others); 2) disease extension at bifurcation (true versus pseudo-bifurcation lesions); 3) stenting technique; and finally 4) choice of the most appropriate device. Several studies have been published in each of these settings, but therapeutic strategies are still linked mostly to clinical setting and operator experience. In this review, we have summarised the most important aspects and clinical studies on bifurcation lesion treatment with the aim to give the readers a practical approach to bifurcation PCI.