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. 2021 Mar 19;16(16):1307-1317.
doi: 10.4244/EIJ-D-20-00169.

Percutaneous coronary intervention for bifurcation coronary lesions: the 15th consensus document from the European Bifurcation Club

Francesco Burzotta  1 , Jens Flensted Lassen, Thierry Lefèvre, Adrian P Banning, Yiannis S Chatzizisis, Thomas William Johnson, Miroslaw Ferenc, Sudhir Rathore, Remo Albiero, Manuel Pan, Olivier Darremont, David Hildick-Smith, Alaide Chieffo, Marco Zimarino, Yves Louvard, Goran Stankovic
Affiliations

Percutaneous coronary intervention for bifurcation coronary lesions: the 15th consensus document from the European Bifurcation Club

Francesco Burzotta et al. EuroIntervention. .

Abstract

The 15th European Bifurcation Club (EBC) meeting was held in Barcelona in October 2019. It facilitated a renewed consensus on coronary bifurcation lesions (CBL) and unprotected left main (LM) percutaneous interventions. Bifurcation stenting techniques continue to be refined, developed and tested. It remains evident that a provisional approach with optional side branch treatment utilising T, T and small protrusion (TAP) or culotte continues to provide flexible options for the majority of CBL patients. Debate persists regarding the optimal treatment of side branches, including assessment of clinical significance and thresholds for bail-out treatment. In more complex CBL, especially those involving the LM, adoption of dedicated two-stent techniques should be considered. Operators using such techniques have to be fully familiar with their procedural steps and should acknowledge associated limitations and challenges. When using two-stent techniques, failure to perform a final kissing inflation is regarded as a technical failure, since it may jeopardise clinical outcome. The development of novel technical tools and drug regimens deserves attention. In particular, intracoronary imaging, bifurcation simulation, drug-eluting balloon technology and tailored antiplatelet therapy have been identified as promising tools to enhance clinical outcomes. In conclusion, the evolution of a broad spectrum of bifurcation PCI components has resulted from studies extending from bench testing to randomised controlled trials. However, further advances are still needed to achieve the ambitious goal of optimising the clinical outcomes for every patient undergoing PCI on a CBL.

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Conflict of interest statement

F. Burzotta has received speaker fees from Medtronic, Abiomed, and Abbott. J.F. Lassen has received speaker fees from Medtronic, Boston Scientific, Biotronik, Abbott and Biosensors. A.P. Banning has received institutional funding of a fellowship from Boston Scientific and speaker fees from Boston, Abbott, Medtronic, Philips/Volcano and Miracor. T.W. Johnson has received speaker fees from Abbott, Boston Scientific, Medtronic, and Terumo, and institutional funding for fellowships from Boston Scientific and Terumo. D. Hildick-Smith has received advisory board/consultancy/research funding from Terumo, Medtronic, Abbott, and Boston Scientific. R. Albiero has received speaker fees from Medtronic and Abbott. M. Pan has received speaker fees from Abbott, Terumo and Volcano. A. Chieffo has received speaker fees from Abiomed and GADA. O. Darremont has received speaker fees from Edwards. Y.S. Chatzizisis has received speaker fees, consultation fees and research grant from Boston Scientific, and research support from Medtronic. T. Lefèvre has received speaker fees from Abbott, Medtronic and Terumo. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Example of in vitro and computational stenting simulations using a patient-specific coronary bifurcation anatomy. A) In vitro stenting of a patient-specific coronary artery bifurcation (TAP with a long neocarina denoted by the white arrow in panel C)). B) Computational simulation of the same stenting technique in the same bifurcation anatomy. C) Virtual fly-through view of the neocarina. D) Computational fluid dynamics of the stented bifurcation. E) Von-Mises stress distribution.
Figure 2
Figure 2
Main determinants of bifurcation PCI complexity.
Figure 3
Figure 3
Possible consequences of incorrect balloon position during POT.
Figure 4
Figure 4
“Fenestrated” restenosis after crossover stenting. A) Pre-PCI angiography. B) Result after stent implantation into the LM-LAD followed by POT. C) 36-month follow-up with short restenosis at LCX ostium. D) Three-dimensional OCT assessment showing neointima growth over the stent struts splitting the LCX ostium in three different, small orifices. E) Fractional flow reserve assessment documenting the haemodynamic significance of the multi-hole restenosis. (Case presented at EBC 2019 by Dr Rony Mathew Kadavil).
Figure 5
Figure 5
Efficacy of provisional technique in modifying the stent platform allowing the achievement of a good result in a patient with a complex bifurcation lesion. A) Pre-PCI angiography. B) Result after LAD stent implantation followed by POT, distal rewiring, kissing balloon inflation with short balloon overlap and re-POT. C) & D) Three-dimensional OCT reconstructions of the final result achieved.
Visual summary
Visual summary
15th consensus document from the European Bifurcation Club.
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References

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