Coronary interventions

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

EuroIntervention 2021;16:1307-1317. DOI: 10.4244/EIJ-D-20-00169

Francesco Burzotta
Francesco Burzotta1, MD, PhD; Jens Flensted Lassen2, MD, PhD; Thierry Lefèvre3, MD; Adrian P. Banning4, MD, PhD; Yiannis S. Chatzizisis5, MD, PhD; Thomas William Johnson6, MD; Miroslaw Ferenc7, MD, PhD; Sudhir Rathore8, MD; Remo Albiero9, MD; Manuel Pan10, MD, PhD; Olivier Darremont11, MD; David Hildick-Smith12, MD; Alaide Chieffo13, MD; Marco Zimarino14, MD, PhD; Yves Louvard3, MD; Goran Stankovic15, MD, PhD
1. Insitute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy; 2. Department of Cardiology B, Odense Universitets hospital & University of Southern Denmark, Odense C, Denmark; 3. Ramsay Générale de Santé - Institut cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier, Massy, France; 4. Cardiovascular Medicine Division, Radcliffe Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom; 5. Cardiovascular Division, University of Nebraska Medical Center, Omaha, NE, USA; 6. Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol NHSFT & University of Bristol, Bristol, United Kingdom; 7. Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany; 8. Frimley Health NHS Foundation Trust, Camberley, Surrey, United Kingdom; 9. Interventional Cardiology Unit, Ospedale Civile, Sondrio, Italy; 10. Department of Cardiology, Reina Sofia Hospital, University of Cordoba (IMIBIC), Cordoba, Spain; 11. Clinique St Augustin, Bordeaux, France; 12. Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom; 13. Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; 14. Cath Lab SS. Annunziata Hospital and Institute of Cardiology, University of Chieti, Chieti, Italy; 15. Department of Cardiology, Clinical Center of Serbia, and Medical Faculty, University of Belgrade, Belgrade, Serbia

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.

Visual summary. 15th consensus document from the European Bifurcation Club.

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