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Contemporary Treatment of Coronary Bifurcation Lesions

  • James Cockburn
  • Osama Alsanjari
  • David Hildick-Smith
Chapter

Abstract

A bifurcation lesion is a lesion occurring at or adjacent to a significant division of a major epicardial coronary artery [ Hildick-Smith D, Lassen JF, Albiero R, Lefevre T, Darremont O, Pan M, Ferenc M, Stankovic G, Louvard Y; European Bifurcation Club, EuroIntervention 6:34–38, 2010]. Bifurcations represent 10–15% of all lesions treated by percutaneous coronary intervention (PCI). To date the evidence from randomized control trials of single- vs. two-stent strategies suggest that using a single-stent strategy where possible offers the best outcome to patients. Two-stent techniques are associated with higher rates of major adverse cardiovascular events (MACE), largely driven by higher rates of periprocedural myocardial infarction (PMI). Most recently, the 5-year survival from a patient-level pooled analysis of the Nordic Bifurcation Study and the British Bifurcation Coronary Study was published confirming a provisional single-stent approach was associated with lower long-term mortality than a systematic two-stent technique [Behan MW, Holm NR, de Belder AJ, Cockburn J, Erglis A, Curzen NP, Niemelä M, Oldroyd KG, Kervinen K, Kumsars I, Gunnes P, Stables RH, Maeng M, Ravkilde J, Jensen JS, Christiansen EH, Cooter N, Steigen TK, Vikman S, Thuesen L, Lassen JF, Hildick-Smith D, Eur Heart J 37:1923–1928, 2016].

Keywords

Bifurcation Murray’s law Medina classification Provisional strategy Complex strategy Proximal optimization technique (POT) Kissing technique Dedicated bifurcation stents Intravascular ultrasound (IVUS) Optical frequency domain imaging (OFDI) Optical coherence tomography (OCT) 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • James Cockburn
    • 1
  • Osama Alsanjari
    • 1
  • David Hildick-Smith
    • 1
  1. 1.Sussex Cardiac CentreBrighton and Sussex University Hospitals NHS TrustBrightonUK

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