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Minerva Cardioangiologica 2013 October;61(5):575-90

Copyright © 2013 EDIZIONI MINERVA MEDICA

language: English

How to optimize the percutaneous treatment of bifurcated lesions: dedicated stents vs. provisional stenting

Alegria-Barrero E. 1, Foin N. 2, Lindsay A. C. 1, Paulo M. 1, Hei Chan P. 1, Syrseloudis D. 1, Viceconte N. 3, Martos R. 4, Beatt K. 4, Di Mario C. 1

1 Cardiovascular Biomedical Research Unit Royal Brompton Hospital, London, UK; 2 Imperial College, London, United Kingdom; 3 Heart and Great Vessels Department Sapienza University of Rome, Rome, Italy; 4 Cardiology Department, Mayday University Hospital, Croydon, UK


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Although provisional T-stenting with stenting of the main branch and optional side branch stenting is nowadays the default strategy generally preferred for simple bifurcation lesions, percutaneous coronary intervention (PCI) of complex true bifurcation lesions remains a difficult task to achieve also with modern second generation drug eluting stents. Treatment of complex bifurcational lesions is not only more time consuming but can lead to significantly higher rate of periprocedural myocardial infarction and late estenosis, stent trombosis and target lesion revascularizationn. These clinical complications may be at least in part be due to the fact that current bifurcation techniques often fail to ensure continuous stent coverage of the SB ostium and the bifurcation branches and often leave a significant number of malapposed struts. Struts left unapposed in the lumen are not efficient for drug delivery to the vessel wall, disturb blood flow and may increase the risk of restenosis and stent thrombosis. This article summarises the various techniques of bifurcation stenting, highlighting their relative merits and disadvantages. In addition, the role of newer dedicated bifurcation stent devices, as well as the role of imaging in guiding optimal stent deployment will be discussed.

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