Overview
Coronary bifurcation lesions are a complex subset of coronary artery disease that require specific percutaneous coronary intervention (PCI) techniques 12. The choice of stenting technique can influence clinical outcomes, leading to ongoing efforts to standardize classifications and best practices 12.Management
Percutaneous coronary intervention (PCI) is employed to treat bifurcation lesions 2.
Stenting techniques include provisional stenting (PS), T-stenting, double-kissing (DK)-crush, crush, and culotte stenting 1.
The European Bifurcation Club (EBC) has updated the Main-Across-Distal-Side (MADS)-2 classification for bifurcation stenting techniques to standardize reporting and practice 2.
For true bifurcation lesions, 2-stent techniques may be associated with a lower rate of major adverse cardiac events (MACE) 1.
A 2-stent strategy may offer greater benefit for side branch lesions with a mean length exceeding 11 mm 1.
The DK-crush technique is associated with the lowest rate of major adverse cardiac events (MACE) compared to other strategies, including provisional stenting 1.Key Recommendations
For patients undergoing PCI for coronary bifurcation lesions, the double-kissing (DK)-crush stenting technique is associated with the lowest rate of major adverse cardiac events (MACE) compared to other techniques, including provisional stenting 1. (Evidence: Strong)
In patients with true bifurcation lesions, consider a 2-stent technique, especially when the side branch lesion has a mean length greater than 11 mm, as this may lead to a lower rate of major adverse cardiac events (MACE) 1. (Evidence: Strong)
Utilize standardized classification systems, such as the updated Main-Across-Distal-Side (MADS)-2, for consistent reporting of bifurcation stenting techniques in both clinical practice and scientific studies 2. (Evidence: Expert opinion)References
1 Bujak K, Verardi FM, Arevalos V, Gabani R, Spione F, Rajwa P et al.. Clinical outcomes following different stenting techniques for coronary bifurcation lesions: a systematic review and network meta-analysis of randomised controlled trials. EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 2023. link
2 Burzotta F, Lassen JF, Louvard Y, Lefèvre T, Banning AP, Daremont O et al.. European Bifurcation Club white paper on stenting techniques for patients with bifurcated coronary artery lesions. Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions 2020. link