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Year : 2018  |  Volume : 1  |  Issue : 2  |  Page : 124-135

Current concepts in bifurcation stenting

1 Department of Cardiology, Heart Institute, Nanavati Hospital, Mumbai, Maharashtra
2 Department of Cardiology, Bankers Heart Institute, Vadodara, Gujarat, India

Correspondence Address:
Dr. Rajiv G Bhagwat
Department of Cardiology, Heart Institute (1st Floor), Nanavati Hospital, S. V. Road, Mumbai, Maharastra 400056

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/IHJI.IHJI_23_18

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A bifurcation lesion is traditionally defined as a coronary artery narrowing occurring adjacent to and/or involving the origin of a significant side branch. Long before the nomenclature of lesion complexity matured, side-branch involvement was recognized as an unfavorable determinant of angioplasty success. Miere and associates were among the first to define the risk of side-branch occlusion associated with parent vessel angioplasty, emphasizing the importance of plaque extension into the side branch as the predictor of percutaneous coronary intervention (PCI) outcome. PCI of coronary bifurcation lesion poses a challenge to the operator in terms of difficulty in wiring, passage of hardware, recrossing, and immediate/long-term outcomes. Several important factors such as anatomic variation, angulation between branches, downstream territory, and the extent of plaque burden should be taken into consideration when addressing a bifurcation lesion to choose the most appropriate approach and achieve an optimal result. Factors to be considered before strategizing a bifurcation angioplasty include the extent of disease (whether it is limited to ostium or extending beyond), size (>2.5mm reference diameter), and area of distribution of side branch. Implantation of a single stent in the main branch is the most widely used approach and should be considered the default strategy. Two-stent strategy as “intention to treat” should be considered for large side branches or when the disease extends beyond the ostium or a branch supplying a significant territory.

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