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Bifurcation Lesion

Complex Coronary Angioplasty is an advanced minimally invasive procedure used to restore blood flow in severely narrowed or blocked coronary arteries, particularly in patients with complex coronary artery disease and previous bypass surgery.

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Bifurcation Lesion

is a coronary artery narrowing occurring adjacent to, and/or involving, the origin of a significant side branch that you do not want to lose. In simple terms, it is a lesion in parent vessel very close or involving a significant side branch.
Drug-eluting stents (DES) should be used for the treatment of bifurcation lesions, as treatment with bare metal stents (BMS) ha yield sub-optimal results.

What is a bifurcation blockage?

Stenoses, or narrowing, located in a main coronary artery and an adjoining side-branch vessel.

What is a bifurcated stent?

It is a novel platform designed to permit stenting in bifurcation lesions regardless of branch angulation or plaque location, in a short simple procedure.

Types of Left Main Bifurcation

The left main is the largest bifurcation of the coronary tree and is therefore easier to access.

One-Stent Approach with Provisional Side Branch Stenting

Wire both the Main Branch (MB) and Side Branch (SB) with coronary guidewires, then predilate the Main Branch.
Perform Main Branch stenting sized to the distal Main Branch reference diameter while jailing the Side Branch wire.
Assess the angiographic result in both the Main Branch and Side Branch.
Rewire the Side Branch through the distal Main Branch stent strut to improve Side Branch scaffolding. If successful, remove the jailed Side Branch wire.
After successful rewiring, dilate the Side Branch.
Reassess the angiographic result in both the Main Branch and Side Branch.
If the Side Branch result is suboptimal, perform Final Kissing Inflation (FKI) or preferably Sequential Side-Main-Side (SMS) balloon dilatation using a noncompliant balloon, or assess the hemodynamic significance with Fractional Flow Reserve (FFR).
Perform Side Branch stenting if the Side Branch is ≥2.5 mm with ≥75% stenosis, FFR ≤0.80, TIMI flow grade <3, or there is plaque shift into the Side Branch.
After Side Branch stenting, repeat Final Kissing Inflation (FKI) or Sequential Side-Main-Side (SMS) balloon dilatation.

Two-Stent Approach

Classic T-stent and Modified T-stent Technique: Used for bifurcation lesions where the Side Branch originates at nearly a right angle, providing precise Side Branch stent placement.
TAP (T and Protrusion) Technique: Commonly used with the provisional one-stent approach but can also be applied in an elective two-stent strategy to ensure complete Side Branch coverage.
Culotte Technique: Provides complete lesion coverage and is preferably performed using stent platforms with an open-cell design for better vessel access.
Mini-crush and Step-crush Techniques: The mini-crush technique minimizes stent overlap in the proximal Main Branch, while the step-crush technique crushes the protruding Side Branch stent using a noncompliant Main Branch balloon.
V-stent and Simultaneous Kissing Stent (SKS) Techniques: Both involve simultaneous implantation of Main Branch and Side Branch stents. The V-stent technique uses minimal stent protrusion into the proximal Main Branch, whereas the SKS technique involves greater stent protrusion.