Francesco Burzotta; Yves Louvard; Jens  Flensted Lassen; Thierry Lefèvre; Gérard Finet; Carlos Collet; Jacek Legutko; Maciej Lesiak; Yutaka Hikichi; Remo Albiero; Manuel Pan; Yiannis  S. Chatzizisis; David Hildick-Smith; Miroslaw Ferenc; Thomas  W. Johnson; Alaide Chieffo; Olivier Darremont; Adrian Banning; Patrick W. Serruys; Goran Stankovic

doi:10.4244/EIJ-D-24-00160

The Official Journal of EuroPCR and the European Association of Percutaneous Cardiovascular Interventions (EAPCI)

The reference multimedia journal in interventional cardiology

Consensus

DOI: 10.4244/EIJ-D-24-00160

Percutaneous coronary intervention for bifurcation coronary lesions using optimised angiographic guidance: the 18th consensus document from the European Bifurcation Club

Francesco Burzotta¹^,², MD, PhD; Yves Louvard³, MD; Jens Flensted Lassen⁴, MD, PhD; Thierry Lefèvre³, MD; Gérard Finet⁵, MD; Carlos Collet⁶, MD, PhD; Jacek Legutko⁷, MD, PhD; Maciej Lesiak⁸, MD, PhD; Yutaka Hikichi⁹, MD, PhD; Remo Albiero¹⁰, MD; Manuel Pan¹¹, MD, PhD; Yiannis S. Chatzizisis¹², MD, PhD; David Hildick-Smith¹³, MD; Miroslaw Ferenc¹⁴, MD, PhD; Thomas W. Johnson¹⁵, MD, PhD; Alaide Chieffo¹⁶^,¹⁷, MD, PhD; Olivier Darremont¹⁸, MD; Adrian Banning¹⁹, MD, PhD; Patrick W. Serruys²⁰, MD, PhD; Goran Stankovic²¹, MD, PhD

1. Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; 2. Università Cattolica del Sacro Cuore, Rome, Italy; 3. Ramsay Générale de Santé – Institut cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy, France; 4. Department of Cardiology B, Odense Universitets Hospital & University of Southern Denmark, Odense, Denmark; 5. Department of Interventional Cardiology, Cardiovascular Hospital, Hospices Civils de Lyon, Lyon, France and INSERM U1060, CarMeN Laboratory, Université de Lyon, Lyon, France; 6. Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; 7. Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland and Clinical Department of Interventional Cardiology, Saint John Paul II Hospital, Kraków, Poland; 8. Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland; 9. Heart Centre, Saga-Ken Medical Centre Koseikan, Saga, Japan; 10. Interventional Cardiology Unit, Ospedale Civile Sondrio, Sondrio, Italy; 11. Department of Cardiology, Reina Sofía Hospital, University of Córdoba (IMIBIC), Córdoba, Spain; 12. Division of Cardiovascular Medicine, Center for Digital Cardiovascular Innovations, University of Miami, Miller School of Medicine, Miami, FL, USA; 13. Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom; 14. Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany; 15. Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol & Weston NHSFT, Bristol, United Kingdom and University of Bristol, Bristol, United Kingdom; 16. Vita-Salute San Raffaele University, Milan, Italy; 17. Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; 18. Clinique Saint-Augustin – Elsan, Bordeaux, France; 19. Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom; 20. Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland and CORRIB Research Centre for Advanced Imaging and Core Laboratory, Galway, Ireland; 21. Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia and Faculty of Medicine, University of Belgrade, Belgrade, Serbia

Abstract

The 2023 European Bifurcation Club (EBC) meeting took place in Warsaw in October, and the latest evidence for the use of intravascular ultrasound (IVUS) and optical coherence tomography (OCT) to optimise percutaneous coronary interventions (PCI) on coronary bifurcation lesions (CBLs) was a major focus. The topic generated deep discussions and general appraisal on the potential benefits of IVUS and OCT in PCI procedures. Nevertheless, despite an increasing recognition of IVUS and OCT capabilities and their recognised central role for guidance in complex CBL and left main PCI, it is expected that angiography will continue to be the primary guidance modality for CBL PCI, principally due to educational and economic barriers. Mindful of the restricted access/adoption of intracoronary imaging for CBL PCI, the EBC board decided to review and describe a series of tips and tricks which can help to optimise angiography-guided PCI for CBLs. The identified key points for achieving an optimal angiography-guided PCI include a thorough analysis of pre-PCI images (computed tomography angiography, multiple angiographic views, quantitative coronary angiography vessel estimation), a systematic application of the technical steps...

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