Fundamentals of percutaneous coronary bifurcation interventions

Figure 3 Proposed algorithm for selecting an optimum percutaneous coronary intervention strategy in both left main coronary artery and non-left main coronary artery bifurcation lesions. ¹Plaque on the same side of SB, SB stenosis > 50%, POC stenosis > 50%, bifurcation angle > 70%, MV/SB diameter ratio (diameter of PMV+DMV/2×diameter of SB) >1 and low MV TIMI flow grade are predictors of a high likelihood of SB occlusion. The larger the size of the numbers and/or the lower the TIMI flow grade and/or the more predictors, the higher the risk of SB occlusion. A recently created SB occlusion risk score may be used[44]. ²The DK-crush technique seems to be preferable to the other EDS techniques in view of the recent data; however, the operator’s experience is decisive in the choice between the EDS technique and is important in obtaining the best result. ³The TAP technique cannot be considered the upfront technique in cases with difficult SB access and a high risk of SB occlusion because of SB stenting after MV stenting. CBL: Coronary bifurcation lesion; EDS: Elective double stenting; LCx: Left circumflex artery; LMCA: Left main coronary artery; MV: Main vessel; POC: Polygon of confluence; PST: Provisional stenting technique; SB: Side branch.