Bifurcations

Various stenting techniques can be used to perform percutaneous coronary intervention (PCI) of coronary bifurcations. Choice of technique depends on the size of the side branch (SB; usually branches <2 mm in diameter do not need to be preserved) and the supplied myocardial territory. If a decision is made to preserve the SB, it must be decided whether to simply wire the SB to help preserve patency during provisional stenting of the main vessel (MV), or whether to perform an upfront dedicated two-stent bifurcation PCI strategy if the risk of SB occlusion is high. Several bifurcation stenting techniques (provisional stenting, T-stenting, T and protrusion, reverse crush, double kissing crush, culotte, V-stenting, and simultaneous kissing stents) are presented in a stepwise fashion, outlining how to overcome potential challenges and how to minimize the risk of complications as well as identify and treat them early. Intravascular imaging is strongly recommended to help plan bifurcation PCI and assess the final result.