Challenging the “Provisional” Technique for Coronary Bifurcation Lesions


Despite considerable progress in the field of interventional cardiology, percutaneous treatment of coronary bifurcations continues to be associated with a lower procedural success rate and a higher incidence of complications, target lesion revascularization, and stent thrombosis (1). Excluding the 15% to 30% of lesions where stenting on both branches is clearly required from the beginning of the procedure (relatively large side branch [SB] with severe disease extending well beyond the ostium or with an unfavorable anatomy for SB rewiring), the provisional approach has become widely accepted as the default technique in the majority of bifurcations. Provisional consists in stenting the main branch (MB) with the option to rewire the SB, to perform kissing balloon inflation and if necessary to place a stent in the SB (1).

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JACC Cardiovasc Interv. 2016 Jul 11;9(13):1347-8.