The Treatment of Bifurcation Disease is a challenging area in interventional cardiology. It presents a challenge as interventional cardiology takes on increasingly complex coronary cases.Load more
Studies report that when compared to non-bifurcation stenting, intervention to bifurcation disease is associated with lower rates of success, higher costs, longer hospitalisation and a higher rate of clinical and angiographic restenosis. Whilst the use of drug-eluting stents (DESs) has improved some outcomes, side branch ostial residual stenosis and long-term restenosis remain a problem.
Bifurcation stenting requires a diverse armamentarium of stenting strategies. Provisional stenting to the main vessel, tackling the side branch only if there is a poor angiographic result remains the prevailing approach. Other more complex two stent approaches include those that stent the main branch first, such as elective T-Stenting, the Culotte and TAP approaches. Other approaches include those that stent the side-branch first such as the various Crush approaches. Innovations such as dedicated bifurcation stents and improved stent and balloon technologies will mean bifurcation approaches will expand and evolve rapidly.
With so many different approaches, it can be seen that the most important question in bifurcation disease PCI is selecting the best possible strategy for an individual bifurcation and optimising the performance of this technique. Educating Interventional Cardiologists will be essential to keep up-to-date on the current data and help physicians choose the most relevant procedure for their patient.Load Less
Key Bifurcation Guidelines from around the web
2015 ACC/AHA/SCAI Focused Update on Primary Percutaneous Coronary Intervention for Patients With ST-Elevation Myocardial InfarctionLevine GN, Bates ER, Blankenship JC, et al. Circulation 2016;133:1135–47.
Percutaneous coronary intervention for coronary bifurcation disease: 11th consensus document from the European Bifurcation ClubLassen JF, Holm NR, Banning AP, et al. EuroIntervention 2016;12:38– 46.
Key Bifurcation Presentations From Around The Web
Round Table Discussions
Simple Education Videos
Key Bifurcation Articles from around the web
Hoo AS, Ryan L, Neville R, Mukherjee M. J Vasc Surg Cases Innov Tech 2018;4:278–82.
Dual Antiplatelet Therapy Duration Determines Outcome After 2- But Not 1-Stent Strategy in Left Main Bifurcation Percutaneous Coronary InterventionRhee TM, Park KW, Kim CH, et al. JACC Cardiovasc Interv 2018;11:2453–63.
Procedural Characteristics for the Optimization of Dual Antiplatelet Therapy Duration: Another Piece of the Puzzle?De Luca L. JACC Cardiovasc Interv 2018;11:2464–6
Kandzari DE, Gershlick AH, Serruys PW, et al. Circ Cardiovasc Interv 2018;11:e007007.
Upul Wickramarachchi, Simon EccleshallInterventional Cardiology Review 2016;11(2):110–5DOI: https://doi.org/10.15420/icr.2016:17:3
Choice of Intracoronary Imaging: When to Use Intravascular Ultrasound or Optical Coherence TomographySudheer Koganti, Tushar Kotecha, Roby D Rakhit, et alInterventional Cardiology Review, 2016;11(1):11–6DOI: http://dx.doi.org/10.15420/icr.2016:6:1
John Rawlins, Jehangir Din, Suneel Talwar, et alInterventional Cardiology Review 2015;10(2):85–9DOI: https://doi.org/10.15420/icr.2015.10.2.85
Sidakpal Panaich, Theodore Schreiber, Cindy Grines, et alInterventional Cardiology Review 2014;9(3):175–9DOI: https://doi.org/10.15420/icr.2014.9.3.175