Methods for endovascular treatment of bifurcation lesions of coronary arteries: commonly used techniques

Abstract

In everyday operating practice, the endovascular surgeon often encounters complex lesions of the coronary arteries, in particular bifurcation lesions. Percutaneous coronary interventions (PCI) is technically difficult in these cases and has always been associated with lower procedural success rates and poorer clinical outcomes than non-bifurcation lesions. The introduction of antiproliferative coated stents into clinical practice significantly improved the results and gave impetus to the development of various treatment techniques. The provisional technique for implanting one stent into the main branch remains the approach of choice for most bifurcation lesions. The choice of the most effective technique for each individual bifurcation is important. The use of a two-stent technique is an acceptable approach for some forms of bifurcation lesions. However, a large amount of metal in the artery wall, as a rule, remains uncovered in the lumen of the vessel during this tactic, which is especially true for the risk of stent thrombosis. New techniques and special bifurcation stents may possibly overcome some limitations of the using two stents and revolutionize the management of PCI of bifurcation lesions of the coronary arteries in the future.