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Treatment of Coronary Artery Bifurcation Lesions

  • Yves Louvard
  • Thierry Lefèvre
Chapter

Abstract

Optimal treatment of coronary bifurcation lesions is still the subject of debate.

Balloon angioplasty for this type of lesion used to be associated with a significant risk of acute complications compounded by a high risk of recurrent stenosis. With the advent of bare 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 SB.

Drug-eluting stents allowed a 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 confirmed the absence of benefits and even, in some instances, the inferiority of complex strategies compared with provisional SB stenting.

Recent comparative studies focusing on the most proximal coronary bifurcation, namely, the distal left main, have shown that PCI seems to be as efficient and safe as bypass surgery in this setting.

Over the past few years, a large number of stents dedicated to the treatment of bifurcation lesions have been developed with the main objective of allowing treatment of these complex lesions by all operators. The first randomized study comparing a dedicated device to a provisional side branch stenting approach using workhorse stents is currently underway.

Keywords

Stent Thrombosis Side Branch Fractional Flow Reserve Bifurcation Lesion Coronary Bifurcation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques CartierMassyFrance

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