Review
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Mar 26, 2022; 14(3): 108-138
Published online Mar 26, 2022. doi: 10.4330/wjc.v14.i3.108
Fundamentals of percutaneous coronary bifurcation interventions
Tamer Kırat
Tamer Kırat, Department of Cardiology, Yücelen Hospital, Muğla 48000, Turkey
Author contributions: The author reviewed the literature and related books, and wrote the article.
Conflict-of-interest statement: Author declares no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tamer Kırat, MD, Doctor, Staff Physician, Department of Cardiology, Yücelen Hospital, Kötekli Mevkii, Muğla 48000, Turkey. tamekir@hotmail.com
Received: March 17, 2021
Peer-review started: March 17, 2021
First decision: July 8, 2021
Revised: July 22, 2021
Accepted: February 22, 2022
Article in press: February 22, 2022
Published online: March 26, 2022
Processing time: 369 Days and 13 Hours
Abstract

Coronary bifurcation lesions (CBLs) account for 15%-20% of all percutaneous coronary interventions. The complex nature of these lesions is responsible for poorer procedural, early and late outcomes. This complex lesion subset has received great attention in the interventional cardiac community, and multiple stenting techniques have been developed. Of these, the provisional stenting technique is most often the default strategy; however, the elective double stenting (EDS) technique is preferred in certain subsets of complex CBLs. The double kissing crush technique may be the preferred EDS technique because of its efficacy and safety in comparative trials; however, this technique consists of many steps and requires training. Many new methods have recently been added to the EDS techniques to provide better stent scaffolding and to reduce early and late adverse outcomes. Intravascular imaging is necessary to determine the interventional strategy and postinterventional results. This review discusses the basic concepts, contemporary percutaneous interventional technical approaches, new methods, and controversial treatment issues of CBLs.

Keywords: Percutaneous coronary intervention; Coronary artery disease; Drug-eluting stents; Bifurcation lesion; Stenting technique; Left main intervention

Core Tip: Coronary bifurcation lesions are one of the most challenging subsets in percutaneous interventions. Many different interventional techniques have been used to overcome the relatively poor procedural and long term outcomes of these lesions of great interest. In this review, basic aspects of coronary bifurcation lesions and step-by-step classical stenting techniques, as well as recently introduced techniques, modifications, trials and important issues in the latest guidelines are discussed.