Treatment of Coronary Bifurcation Lesions

Chapter

Abstract

The optimal treatment for coronary bifurcation lesions is still the subject of debate. Balloon angioplasty for this type of lesion used to be associated with significant risk of acute complications compounded by a high risk of recurrent stenosis. With the advent of bare-metal stents, the first controversies arose as to whether one or several stents should be used to treat these lesions. The outcome of various nonrandomized studies demonstrated the benefit of implementing a single-stent strategy, whereby a stent is implanted in the main branch across the side branch. Drug-eluting stents allowed considerable reduction in the risk of restenosis and repeat interventions while encouraging the development of numerous complex techniques permitting complete bifurcation coverage. However, the results of large randomized studies, for which 5-year data is now available, confirmed the absence of benefits for complex strategies compared with provisional side-branch stenting, when both approaches are possible. Today, the provisional side branch stenting approach is considered the gold standard. This chapter explains when and how to perform this technique and how to resolve common difficulties. It also describes when and how to use a two-stent approach.

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Marco Spaziano
    • 1
    • 2
  • Yves Louvard
    • 1
  • Thierry Lefèvre
    • 1
  1. 1.Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques CartierMassyFrance
  2. 2.McGill University Health CenterMontrealCanada

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