Provisional Stenting

Assoc. Prof. Dr. Bülent Özlek1
Dr. Ozan Güneş2

1Muğla Sıtkı Koçman University, School of Medicine, Department of Cardiology, Muğla, Türkiye
2Ankara Etlik City Hospital, Department of Cardiology, Ankara, Türkiye

ABSTRACT

Bifurcation lesions represent about 20% of percutaneous coronary interventions (PCI), posing significant technical challenges due to their complex anatomy. Provisional stenting is widely adopted as the initial strat- egy, offering lower complication rates and favorable outcomes. Advanced imaging techniques, such as 3D QCA and intravascular imaging, play a crucial role in understanding the intricate geometry and planning the procedure effectively. Side branch (SB) management remains a pivotal aspect, often requiring tailored ap- proaches based on lesion severity and bifurcation angles. Predilatation of the main branch (MB) and proximal optimization technique (POT) are essential steps to ensure optimal stent expansion and vessel restoration.

In complex cases, dual stenting techniques like T-stenting, TAP, or Culotte may be necessary, with the choice influenced by bifurcation angles and SB involvement. Careful physiological assessment of SB flow and isch- emia guides decision-making on additional stenting. Ultimately, balancing procedural simplicity with achiev- ing optimal results in the MB and SB is critical to improving procedural success and patient outcomes.

Keywords: Cardiology; Coronary angiography; Provisional stenting

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