Abstract and Introduction
Abstract
The use of drug-eluting stents in clinical practice has altered the treatment perspective for bifurcation lesions; however, relatively high rates of stent thrombosis and restenosis are still observed. All bifurcations are unique; therefore, a crucial issue in bifurcation angioplasty regards the selection of the most appropriate strategy for an individual bifurcation. When stenting is used, a major question to address is whether both the main vessel and the side branch should be stented. Moreover, plaque debulking in conjuction with directional coronary atherectomy or modification with a scoring device before stent deployment could minimize arterial injury and subsequent neointimal proliferation and prevent restenosis formation. Dedicated bifurcation stents represent an alternative treatment option for restenosis. We believe that biodegradable stents will replace metal stents leaving behind only the healed natural vessel.
Introduction
Coronary bifurcation lesions account for 15–20% of all coronary lesions that require percutaneous coronary intervention (PCI). Bifurcation stenosis is one of the most complex coronary lesions requiring endovascular treatment because the lumen of both the main vessel and the side branch needs to be restored. The best approach for the management of a bifurcation to achieve optimal procedural outcomes and, more importantly, long-term success with low restenosis rates and low major adverse clinical event (MACE) rates is still debated. Balloon angioplasty alone to treat bifurcation lesions has resulted in relatively low angiographic success and high restenosis rates. Although the introduction of bare-metal stents (BMSs) resulted in more predictable results and higher success rates, angiographic restenosis rates still remained high. The introduction of drug-eluting stents (DESs) in clinical practice has altered the treatment perspective when dealing with this type of lesion; however, abrupt side-branch closure with the single-stent strategies, together with the risk of thrombosis and restenosis associated with the complex two-stent techniques, remains a predictor of adverse clinical outcomes.