Expert consensus

DOI: 10.4244/EIJ-D-23-00124

The 17th expert consensus document of the European Bifurcation Club – techniques to preserve access to the side branch during stepwise provisional stenting

Manuel Pan1, MD, PhD; Jens Flensted Lassen2, MD, PhD; Francesco Burzotta3, MD, PhD; Soledad Ojeda1, MD, PhD; Remo Albiero4, MD; Thierry Lefèvre5, MD; David Hildick-Smith6, MD; Thomas W. Johnson7, MD; Alaide Chieffo8, MD; Adrian P Banning9, MD, PhD; Miroslaw Ferenc10, MD, PhD; Olivier Darremont11, MD; Yiannis S. Chatzizisis12, MD, PhD; Yves Louvard5, MD; Goran Stankovic13, MD, PhD

Abstract

Provisional stenting has become the default technique for the treatment of most coronary bifurcation lesions. However, the side branch (SB) can become compromised after main vessel (MV) stenting and restoring SB patency can be difficult in challenging anatomies. Angiographic and intracoronary imaging criteria can predict the risk of side branch closure and may encourage use of side branch protection strategies. These protective approaches provide strategies to avoid SB closure or overcome compromise following MV stenting, minimising periprocedural injury. In this article, we analyse the strategies of SB preservation discussed and developed during the most recent European Bifurcation Club (EBC) meetings.

Introduction

Provisional stenting has become the default technique for the treatment of most coronary bifurcation lesions. This strategy has also been called the simple approach; however, sometimes the procedure is not so simple – the side branch (SB) can occlude after main vessel (MV) stenting in up to 6-18% of cases12345. Restoring SB patency can be difficult, and the fear of having to deal with this situation may persuade operators to adopt an...

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