Treatment Algorithm for Bifurcation Lesions According to Current Guidelines

Dr. Alperen Taş

Kırşehir Training and Research Hospital, Department of Cardiology, Kırşehir, Türkiye

ABSTRACT

Coronary bifurcation lesions are considered one of the most challenging lesion types to treat in interventional cardiology, accounting for 15-20% of all percutaneous coronary interventions. These lesions are associated with lower procedural success rates and long-term complications. The optimal treatment strategy for bifurcation lesions remains a topic of debate, and the approach used can vary depending on the anatomical features of the lesion, the clinical condition of the patient, and the experience of the physician.Many studies have compared singlestent and dualstent strategies, with most showing no significant difference between the two. However, recent research has suggested that dual-stent strategies may offer greater advantages, especially in complex bifurcation lesions. The prognostic significance of the side branch, the complexity of the lesion, and the operator’s experience are key factors to consider when determining the treatment strategy. Simplifying the procedure and minimizing the number of stents used can improve long-term clinical outcomes and reduce the risk of complications.In cases where the side branch is important and access to the side branch is easy, starting with a provisional stenting strategy and switching to a dual-stent approach if necessary tends to yield better results. On the other hand, in cases where side branch access is difficult and the stenosis is severe and involves long segments, starting with a dual-stent strategy and placing the first stent in the side branch is a more effective approach. In such cases, techniques like proximal optimization technique (POT) can help reduce the risk of side branch occlusion and improve overall procedural success.The European Bifurcation Club (EBC) guidelines emphasize the need to simplify the procedure and use as few stents as possible. These guidelines suggest that dual-stent strategies can improve long-term success, particularly in complex bifurcation lesions. EBC’s recommendations also stress the importance of using proper imaging techniques during the procedure and thoroughly evaluating the lesion’s anatomy. This ensures that the most appropriate treatment plan is chosen, ultimately improving the patient’s clinical outcomes.In conclusion, an individualized approach is crucial in the treatment of bifurcation lesions. The clinical significance of the side branch, the complexity of the lesion, and theoperator’s experience are key in determining the most suitable strategy. It is important to remember that the techniques used during the procedure will have a direct impact on the patient’s long-term quality of life.

Keywords: Coronary stenosis; Percutaneous coronary intervention; Dual stent strategy; Proximal optimization technique (POT); Provisional stenting; Complex lesions; Side branch occlusion

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